Spines how they differ in MRI views in Flexion & extension compared to being Static

[cavalier]

These are some further illustrations of how our spines can change upon flexion & extension with stenosis in compression etc.

Here is some examples on this site for a Cervical MRI - http://www.sikermedical.com/services...vical_flexion/
I wish mine had been done this way showing both static
& flexion & extension views how it changes. Especially notice the last 2 views on this site if i could have posted it - as it demonstrates clearly how flexion & extension changes the dynamics of the same person who in the above images was simply laying flat -


MRI of the Cervical Spine with Flexion and Extension

Basics: What is an MRI of the Cervical Spine with Flexion, Extension, and Cine?
In addition to obtaining the standard images of the cervical spine see MRI of the Cervical Spine, sagittal Vibe and T2 images are obtained in full passive flexion and extension. *With the patient in the MRI machine, they are asked to gently flex their neck and then extend their neck. In each position MRI images are obtained.* Also, real time imaging with dynamic haste sequences are obtained while the patient is moving their neck and head from flexion to neutral to extension, and again back to neutral.* *Conducting the exam in multiple positions allows the spine to be assessed for stability translation of the vertebrae with respect to each other during movement, and also permits evaluating how the curvature changes over time during movement.* This information can help explain abnormal movements possibly indication how compensation, due to a prior injury, contributes to a misalignment. *This dynamic sequence is also very helpful in ascertaining the relative mobility and angulation at each disc space during flexion and extension.*

Also this is a good read - www.ncbi.nlm.nih.gov/pubmed/19281025

2009 Feb;22 126-7.Links
Study the degree of cervical spinal canal stenosis by MRI in flexion and extension of the cervical vertebrae

Zhong YM, Shi M, Li ZF, Xu JW, Zha JL, Yang G, Wei JD.
Surgical Department of Spinal, the 1st Hospital Affiliated to Guangxi TCM College, Nanning 530023, Guangxi, China.

OBJECTIVE: To study the degree and changes of cervical spinal canal stenosis by MRI scans in flexion and extension of the cervical vertebrae. METHODS: *Thirty cases of cervical stenosis* included 13 male and 17 female with an average age of 39 years ranging from 28 to 66 years. The sagittal *diameter of cervical spinal canal were below 10 mm which is absolute stenosis in 12 cases,within 10 to 12 mm which is correspondence stenosis in 18 cases*. MRI scans in neutrality, flexion, extension performanced and the degree of cervical spinal canal stenosis and the changes of spinal cord compression were evaluated after MRI scans obtained. RESULTS: *Nineteen patients of extension occurrenced stenosis more serious, 8 patients of flexion occurrenced* My NOTE - That's 27 folks out of 30 that looked worse upon flexion or extension than in the neutral MRI position of laying flat. P < 0.05. CONCLUSION: For the cervical stenosis imaging diagnostic, *flexion and extension of cervical MRI scan can be used to supplement conventional MRI examination neutral position, and the extension of MRI is more sensitivity than neutral position and flexion bit*.

PMID: 19281025 PubMed - indexed for MEDLINE

Related articles
Dynamic changes of the spinal canal in patients with cervical spondylosis at flexion and extension using magnetic resonance imaging. Invest Radiol. 1998 Aug; 33 8 444-9.
Invest Radiol. 1998
The use of MR-myelography combining flexion and extension imaging in the diagnosis of cervical myelopathy: a case report. W V Med J. 2009 Jan-Feb; 105 10-4.
W V Med J. 2009
Cervical degenerative disease at flexion-extension MR imaging: prediction criteria. Radiology. 2003 Apr; 227 1 136-42. Epub 2003 Feb 11.
Radiology. 2003
Dynamic magnetic resonance imaging evaluation of craniovertebral junction abnormalities. J Comput Assist Tomogr. 2007 May-Jun; 31 3 354-9.
J Comput Assist Tomogr. 2007
ReviewProceedings of the State-of-the-Art Symposium on Diagnostic and Interventional Radiology of the Spine, Antwerp, September 7, 2002 Part two. Upright, weight-bearing, dynamic-kinetic MRI of the spine pMRI/kMRI. JBR-BTR. 2003 Sep-Oct 86 5 286-93.
JBR-BTR. 2003

Personally what I am wanting in a Doc is one who UNDERSTANDS the mechanics of the spine & how things DO change upon movement in either direction. This is critical for a stenosis patient. I just made the mistake of eating a pretzel & I choked on it - quite common for me as my pipes are so narrowed in my throat due to the compression - yet so many don't even see that - yet I am only 7 MM's in one spot & 8 & 9 compared to 15 to 20 mm's for a normal person - of course everything logically is more tight. So until I have a doc who gets it I wont have anyone touch me.

This 3rd piece is a little about the STANDING MRI for what I had done for low back - it can get you in various extension & flexion views to compare to static - I wish I could transfer the pic's are nite & day differences - it makes for the images of the same person on MRI.

LANDMARK STUDY BY UCLA SCHOOL OF MEDICINE OF OVER 1,000 PATIENTS 1,302
QUANTIFIES THE "MISS RATE" OF STATIC MRI* COMPARED TO "DYNAMIC" UPRIGHT MRI
Static MRI is defined by UCLA as being scanned in one position, sitting straight up. It does not include being scanned in multiple positions, such as flexion as in bending forward, extension as in bending backward, lateral bending, or rotation.
The Findings Could Substantially Improve Surgical Outcomes
L4-5 is the area of the lumbar spine, or lower back, where most back problems occur “Miss Rate” 35.1%. L3-4 is the second most frequent location of back problems “Miss Rate 38.7%.
Table 1
% Spondylolistheses " Missed" by Static MRI
40° Flexion Overall "Miss Rate"
40° Flexion
Minimum Slip L2-3 L3-4 L4-5 L5-S1 L1-2 to L5-S1
3mm 30.8% 38.7% 35.1% 4% 18.1%
4mm 33.3% 53.8% 17.9% 3.5% 12.3%

10° Extension 10° Extension
L2-3 L3-4 L4-5 L5-S1 L1-2 to L5-S1
3mm 25% 20.8% 14% 3.2% 8.9%
4mm 33.3% 25% 4.2% 2.4% 5.0%

Table 2
Position Eliciting Disc Bulge % Cervical Disc Bulges Greater Than or Equal to 2mm "Missed" in the Neutral Sit Position But Seen on Flexion or Extension
Flexion 18.18%
Extension 23.75%
See Complete Study with Review of Findings at Bottom of this Page
Two Case Studies That Illustrate Problems "Missed" with Static MRI but Detected With Dynamic Upright MRI.
My note - That's 41 % folks when I add up these 2 different dynamics that were missed by Reg. Static MRI.
Recumbent
Static Upright
Dynamic Recumbent
Static Standing Flexion
Dynamic

WHY A CONVENTIONAL MRI IS NOT “GOOD ENOUGH”
Given the “miss rate” of static MRI reported by UCLA, a conventional static MRI is obviously not good enough. Only the UPRIGHT Multi–Position MRI can see your patient’s problem in the position he or she experiences it. - www.fonar.com/standup.htm

The pic's that go with these medical sites CLEARLY demonstrate nite & day differences upon extension & flexion for compression. That is why activity certain ones can make us much worse & it is not in our head. Jill

[jchebert1979]

It's funny you posted about flexion extension. I demanded one from my doctor just last week before my surgery. I posted the pics and they were merged in my thread in the big file called New To Board. Take a look, it proves exactly what your post is saying.

[cavalier]

Did surgery help your Chiari Malformation at all ? My dogs some of them have this issue. ( Cavaliers)
Who was your surgeon ? Just curious if the Doc is in the USA or not. Glad they took a look this way. It does make a difference. I wish my Cervical MRI had been done this way i feel it would have painted a more accurate picture.
Best - Jill

[jchebert1979]

Dr. John Oro in Aurora, CO did my surgery. He is one of the best in the world. Although after the surgery he told me that it was much worse than the MRI showed, I don't believe my worst symptoms were coming from the Chiari. I have only been able to gauge this after my cervical ADR surgery as it alleviated the head pain we thought was coming from the Chiari. I do not however regret the chiari surgery as I was almost guaranteed to have problems later on.

[daveinaustin]

Interesting reading! I have always felt that a vertical MRI would be significantly more useful in determining many back issues.

It's an interesting coincidence to read this article at this time. I just finished responding about an article, in which I was mentioning there would be different loads based on static vs. dynamic postioning of the body! :-)

-Dave

[daveinaustin]

Since my traditional MRI from 2 weeks ago did not show any results, I'm looking into a vertical MRI.

Have others had much success with it? Of course, the picture they show on one of the websites looks great! But, I'm trying to determine if I should just simply get the Precision SCS nerve stimulator, or continue on trying to determine the root cause.

http://www.psumri.com/physicians

-Dave

[jchebert1979]

Ask for a weight bearing MRI. I think nothing esle should be offered for spine patients. They cost no more than regular MRI's. The only problem is that unless you are in a large city, you might have to travel for one.

[Harrison]

Hey Dave, Jill et al…

In case you didn’t search, here are relevant topics on this matter that we discussed in the past 3-4 years….

Case Study Shows Better Outcome....FONAR

Weight Bearing/ Positional MRI

Sitting/Standing MRI

Standing MRI Where To Find Fonar.com

[daveinaustin]

Thanks! I'll start researching this tomorrow night.

-Dave