The use of MR-myelography combining flexion and extension imaging in the diagnosis of cervical myelopathy: a case report.

This report describes the use of a non-invasive MR-Myelogram combining flexion and extension views to demonstrate causative factors in cervical myelopathy. Utilizing a new approach to MRI, mimicking an older technique of flexion/extension cervical myelography, we were able to identify the pathology of a patient suffering from progressive cervical myelopathy. We report a patient suffering from progressive multilevel cervical myelopathy due to posterior compression of the spinal cord by an inbuckling ligamentum flavum. Neutral position radiologic assessment failed to reveal any significant spinal cord compression. In this patient, the dynamic MRI and MR-Myelography was critical for demonstrating the posterior compression of the spinal cord by the ligamentum flavum. Flexion and extension MRI images of the cervical spine complemented by non-invasive MR-myelography were obtained. Surgical decompression was indicated based on these additional studies. The use of invasive myelography and in particular, flexion/extension myelography is in decline. MR-myelography combining flexion and extension views can be a useful noninvasive means of studying patients with possible ligamentous hypertrophy and dynamic cord compression.