Abstract
Introduction. Flexion-extension, or kinematic, MRI has been used to identify dynamic spondylotic spinal cord compression not seen with traditional static MRI. The use of kinematic MRI to diagnose postoperative complications, specifically dynamic compression, is not as well documented. The authors describe a case of dynamic spinal cord compression by the paraspinal muscles causing worsening myelopathy following cervical laminectomy. This was only diagnosed with flexion-extension MRI. Methods. The patient was a 90-year-old male presenting to the neurosurgery clinic with functional decline and cervical spondylotic myelopathy. Results. A multilevel laminectomy was performed. Following surgery the patient had progressive weakness and worsening myelopathy. No active cord compression was seen on multiple MRIs obtained in a neutral position, and flexion-extension X-rays did not show instability. A kinematic MRI demonstrated dynamic compression of the spinal cord only during neck extension, by the paraspinal muscles. To relieve the compression, the patient underwent an instrumented fusion, with cross-links used to buttress the paraspinal muscles away from the cord. This resulted in neurologic improvement. Conclusions. We describe a novel case of spinal cord compression by paraspinal muscles following cervical laminectomy. In individuals with persistent myelopathy or delayed neurologic decline following posterior decompression, flexion-extension MRI may prove useful in diagnosing this potential complication.
Highlights
Flexion-extension, or kinematic, MRI has been used to identify dynamic spondylotic spinal cord compression not seen with traditional static MRI
We report a case of a 90-year-old male with progressively worsened myelopathy following cervical laminectomy for Cervical spondylotic myelopathy (CSM)
The unusual phenomenon of dorsal compression by paraspinous musculature was likely enabled by a number of anatomic factors. These include reversal of the lordotic curvature, large disc-osteophyte complexes, a robust posterior cervical muscle mass, and a rigid mid-cervical spine in conjunction with mobile upper segments. The prevalence of this problem after cervical laminectomy is unknown, but it is possible that this pathophysiology accounts for some cases in which patients fail to improve after laminectomy
Summary
Cervical spondylotic myelopathy (CSM) develops through narrowing of the spinal canal and repetitive injury to the spinal cord as a result of osteophyte formation, disc herniation, and ligament hypertrophy. Previous studies using flexion-extension, or kinematic, MRI have demonstrated dynamic compression of the cervical cord and roots with movement of the neck from neutral position [1, 2]. The use of flexion-extension MRI to detect postoperative complications is not as well-described. We report a case of a 90-year-old male with progressively worsened myelopathy following cervical laminectomy for CSM. Postoperative MRI in neutral alignment demonstrated adequate spinal decompression, and flexion-extension X-rays showed no cervical instability. It was only with kinematic MRI that significant compression of the cervical cord by the paraspinal musculature was found during neck extension
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