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Radiological and Clinical Significance of Cervical Dynamic Magnetic Resonance Imaging for Cervical Spondylotic Myelopathy: Jun Jae Shin, Sun Joon Yoo, Tae Woo Kim, Jae-Young So, Won Joo Jeong, Mu Ha Lee, Joongkyum Shin, Yoon Ha; Neurospine 2024;21(2):443-454. Published online June 30, 2024; DOI: https://doi.org/10.14245/ns.2448166.083

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Radiological and Clinical Significance of Cervical Dynamic Magnetic Resonance Imaging for Cervical Spondylotic Myelopathy

Neurospine. 2024;21(2):443-454. Published online June 30, 2024

DOI: https://doi.org/10.14245/ns.2448166.083

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Radiological and Clinical Significance of Cervical Dynamic Magnetic Resonance Imaging for Cervical Spondylotic Myelopathy

Neurospine. 2024;21(2):443-454. Published online June 30, 2024

DOI: https://doi.org/10.14245/ns.2448166.083

Objective
The study compared the morphometric changes of the cervical spinal cord using dynamic magnetic resonance imaging (MRI) in patients with cervical spondylotic myelopathy (CSM) and assessed the correlation with kinematic changes, cord cross-sectional area (CSA), and high signal intensity (SI) on T2-weighted imaging (T2WI).
Methods
Patients with CSM were evaluated through dynamic MRI for sagittal and axial CSA changes of the cervical cord, cerebrospinal fluid (CSF) reserve ratio, degree of cord impingement, cord compression rate, range of motion (ROM), and severity of SI on T2WI. The degree of cord impingement was evaluated using the Muhle grading system. Clinical outcomes were assessed using Japanese Orthopaedic Association scoring and Nurick grade.
Results
The study included 191 patients (113 males) with a mean age of 55.34 ± 12.09 years. The lowest sagittal CSF reserve ratio and cord occupation rate were observed during extension. Cord impingement and SI change were more prevalent in extension-positioned MRI. There was no difference between ROM on dynamic radiographs and dynamic MRI. Preoperative cervical ROM was greater in patients with intensely high SI change.
Conclusion
Dynamic MRI is useful for evaluating neck movement. Patients with high SI had greater ROM before surgery but worse outcomes after. Neck extension exacerbated cervical stenosis and cord compression compared to flexion, and cervical spinal motion contributed to the severity of CSM. Cervical spinal motion should be carefully evaluated, particularly in hyperextension, to prevent worsening of CSM.

Citations

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Dynamic K-Line Status and Surgical Outcomes in Multilevel Cervical OPLL: A Multicenter Comparative Study
Jun Jae Shin, Sun Joon Yoo, Se Jun Park, Dong Kyu Kim, Hyun Jun Jang, Bong Ju Moon, Kyung Hyun Kim, Jeong Yoon Park, Sung Uk Kuh, Dong Kyu Chin, Keun Su Kim, Chang Kyu Lee, Keung Nyun Kim, Tae Woo Kim, Yoon Ha
Journal of Clinical Medicine.2026; 15(2): 520. CrossRef
Dynamic Cervical Myelopathy Misleading on Neutral Imaging: The Role of Flexion–Extension MRI
Leonardo Anselmi, Donato Creatura, Mario De Robertis, Ali Baram, Emanuele Stucchi, Gabriele Capo, Jad El Choueiri, Federico Pessina, Maurizio Fornari, Carlo Brembilla
Journal of Clinical Medicine.2026; 15(4): 1333. CrossRef
Intramedullary Strain During Neck Extension is Associated with Microstructural Spinal Cord Injury in Degenerative Cervical Myelopathy
Mahmudur Rahman, Karthik Banurekha Devaraj, Balaji Harinathan, Omkar Chauhan, Matthew Budde, Narayan Yoganandan, Aditya Vedantam
Annals of Biomedical Engineering.2026; 54(7): 2015. CrossRef
Predictive factors for outcomes of anterior-only surgery in multilevel pincer-type cervical spondylotic myelopathy: The role of the posterior compression score
Lin Xie, Wenbo Wu, Kun Wang, Yu Song, Xianlin Zeng, Cao Yang, Xiaobo Feng
Journal of Orthopaedics.2026; 75: 305. CrossRef
Clinical and Radiological Characterization of Cervical Spinal Stenosis Using Muhle Grading on Flexion-Extension Dynamic MRI: Correlation With mJOA in an Institutional Cohort
José Ramón Rodríguez-Fonseca, Daniel Alberto Reyes-Navarro, Armando Saúl Ruiz-Treviño, Alejandro Miranda González, José Oscar Chávez-Bejar, Alexis Agustín Altamirano Carrizoza, Christian Gabriel de Jesús Ordaz-Pérez, María Maldonado-Vega
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Tao Gao, Yi Tong, Tao Li, Jiandong Tang, Zhiyu Cheng, Xu Lin, Haigang Hu, Shenyu Wan, Chao Wu
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The Role of Dynamic Cervical Magnetic Resonance Imaging in Determining the Level of Posterior Decompression in Cervical Spondylotic Myelopathy
Luay Şerifoğlu, Abdulmutalip Karaaslanlı
World Neurosurgery.2025; 195: 123698. CrossRef
T2-weighted MRI high signal in cervical spondylotic myelopathy is associated with dynamic change
Xiangzhen Kong, Zhenchuan Liu, Kangle Song, Keyu Pan, Yuanqiang Zhang, Jianlu Wei, Lei Cheng
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X-ray Diagnostics of Degenerative Spinal Canal Stenosis at the Cervical Level (Literature Review)
V. S. Petrova, P. V. Seliverstov, V. A. Sorokovikov, S. N. Larionov
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Weight-bearing MRI of the cervical spine: A scoping review of clinical utility and emerging applications
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Evaluation of Cases Diagnosed with Cervical Myelopathy or Syringomyelia Referred with a Preliminary Diagnosis of Amyotrophic Lateral Sclerosis
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European Spine Journal.2025;[Epub] CrossRef
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Flexion K-Line Status Predicts Surgical Strategy in Multilevel Cervical Ossification of the Posterior Longitudinal Ligament: A Multicenter Comparison of Laminoplasty and Laminectomy With Fusion
Jun Jae Shin, Sun Joon Yoo, Se Jun Park, Dong Kyu Kim, Hyun Jun Jang, Bong Ju Moon, Kyung Hyun Kim, Jeong Yoon Park, Sung Uk Kuh, Dong Kyu Chin, Keun Su Kim, Yong Eun Cho, Chang Kyu Lee, Dong Ah Shin, Seong Yi, Keung Nyun Kim, Joongkyum Shin, Yoon Ha
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From the Editor-in-Chief: Featured Articles in the June 2024 Issue
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Commentary on “Radiological and Clinical Significance of Cervical Dynamic Magnetic Resonance Imaging for Cervical Spondylotic Myelopathy”
Aydin Sinan Apaydin, Khoi Than
Neurospine.2024; 21(2): 455. CrossRef

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Assessment of Cervical Myelopathy Risk in Ossification of the Posterior Longitudinal Ligament Patients With Spinal Cord Compression Based on Segmental Dynamic Versus Static Factors: Zhongyuan He, Nguyen Tran Canh Tung, Hiroto Makino, Taketoshi Yasuda, Shoji Seki, Kayo Suzuki, Kenta Watanabe, Hayato Futakawa, Katsuhiko Kamei, Yoshiharu Kawaguchi; Neurospine 2023;20(2):651-661. Published online June 30, 2023; DOI: https://doi.org/10.14245/ns.2346124.062

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Assessment of Cervical Myelopathy Risk in Ossification of the Posterior Longitudinal Ligament Patients With Spinal Cord Compression Based on Segmental Dynamic Versus Static Factors

Neurospine. 2023;20(2):651-661. Published online June 30, 2023

DOI: https://doi.org/10.14245/ns.2346124.062

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Assessment of Cervical Myelopathy Risk in Ossification of the Posterior Longitudinal Ligament Patients With Spinal Cord Compression Based on Segmental Dynamic Versus Static Factors

Neurospine. 2023;20(2):651-661. Published online June 30, 2023

DOI: https://doi.org/10.14245/ns.2346124.062

Objective
Using segmental dynamic and static factors, we aimed to elucidate the pathogenesis and relationship between ossification of the posterior longitudinal ligament (OPLL) and the severity of cervical myelopathy.
Methods
Retrospective analysis of 163 OPLL patients' 815 segments. Imaging was used to evaluate each segmental space available for the spinal cord (SAC), OPLL diameter, type, bone space, K-line, the C2–7 Cobb angle, each segmental range of motion (ROM), and total ROM. Magnetic resonance imaging was used to evaluate spinal cord signal intensity. Patients were divided into the myelopathy group (M group) and the without myelopathy group (WM group).
Results
Minimal SAC (p = 0.043), (C2–7) Cobb angle (p = 0.004), total ROM (p = 0.013), and local ROM (p = 0.022) were evaluated as an independent predictor of myelopathy in OPLL. Different from the previous report, the M group had a straighter whole cervical spine (p < 0.001) and poorer cervical mobility (p < 0.001) compared to the WM group. Total ROM was not always a risk factor for myelopathy, as its impact depended on SAC, when SAC > 5 mm, the incidence rate of myelopathy decreased with the increase of total ROM. Lower cervical spine (C5–6, C6–7) showing increased “Bridge-Formation,” along with spinal canal stenosis and segmental instability (C2–3, C3–4) in the upper cervical spine, could cause myelopathy in M group (p < 0.05).
Conclusion
Cervical myelopathy is linked to the OPLL’s narrowest segment and its segmental motion. The hypermobility of the C2–3 and C3–4, contributes significantly to the development of myelopathy in OPLL.

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Changes in the Cervical Range of Motion and Clinical Outcomes After Laminectomy With Fusion for Ossification of the Posterior Longitudinal Ligament: Impact of K-Line and OPLL Subtypes
Zhihao Ma, Yi Huang, Peihong Hou, Hao Li, Mengyuan Zhang, Jiayan Wu, Jinxu Chen, Huawei Liu, Wenhao Hu, Guoquan Zheng
Neurosurgery.2026; 98(6): 1413. CrossRef
Single-cell transcriptome profiling reveals the heterogeneity of ossification of the posterior longitudinal ligament (OPLL) and its immune microenvironment
Zhongyuan He, Jiaxiang Zhou, Fuan Wang, Peng Guo, Jianfeng Li, Zhengya Zhu, Tao Tang, Nguyen Tran Canh Tung, Yoshiharu Kawaguchi, Shaoyu Liu, ManMan Gao, Xizhe Liu, Zhiyu Zhou
Cell Biology and Toxicology.2026;[Epub] CrossRef
Reduction of Spinal Cord Cross-Sectional Area Is Associated With Myelopathy in Severe Cervical Ossification of the Posterior Longitudinal Ligaments
Hyun-Jun Jang, Dong-Kyu Kim, Bong-Ju Moon, Kyung-Hyun Kim, Jeong-Yoon Park, Sung-Uk Kuh, Keun-Su Kim, Yong-Eun Cho, Dong-Kyu Chin
Neurosurgery.2026;[Epub] CrossRef
Importance of gap evaluation in the ossification of posterior longitudinal ligament lesions using 3-dimensional computed tomography
Hazem Alaa, Nguyen Tran Canh Tung, Tomoya Ueno, Hiroto Makino, Hayato Futakawa, Shoji Seki, Yoshiharu Kawaguchi
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Reduced Vertebral Hounsfield Unit Values in the Bridging Group of Ossification-Related Segments in Patients with Ossification of the Posterior Longitudinal Ligament of the Cervical Spine
Zheming Yu, Junqiao Lv, Zhiqiang Wang, Xuefeng Tian, Xiaohua Hou, Lin Sun
World Neurosurgery.2025; 195: 123638. CrossRef
A modified measurement method for functional spinal unit ROM of cervical spine
Jianxi Wang, Hao Zhou, Bo Hu, Fazhi Zang, Wen Yuan, Huajiang Chen, Lei Liang
Scientific Reports.2025;[Epub] CrossRef
The Role of K-Line and Canal-Occupying Ratio in Surgical Outcomes for Multilevel Cervical Ossification of the Posterior Longitudinal Ligament: A Retrospective Multicenter Study
Jun Jae Shin, Sun Joon Yoo, Dong Kyu Kim, Hyun Jun Jang, Bong Ju Moon, Kyung Hyun Kim, Jeong Yoon Park, Sung Uk Kuh, Dong Kyu Chin, Keun Su Kim, Yong Eun Cho, Won Joo Jeong, Tae Woo Kim, Chang Kyu Lee, Dong Ah Shin, Seong Yi, Keung Nyun Kim, Joongkyum Shi
Neurospine.2025; 22(2): 337. CrossRef
Factors Associated With Repeat Surgery in Cervical Ossification of the Posterior Longitudinal Ligaments
Hyun Jun Jang, Bong Ju Moon, Kyung Hyun Kim, Jeong Yoon Park, Dong Kyu Chin, Keun Su Kim, Yong Eun Cho
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Association between Congestive Heart Failure and Ossification of the Posterior Longitudinal Ligament in Korea: A Nationwide Longitudinal Cohort Study
Dong Soon Jang, Hakyung Kim, Seung Hun Sheen, Inbo Han, Soo Hyun Lee, Woo Seok Choi, Je Beom Hong, Min Jai Cho, Seil Sohn
The Nerve.2024; 10(1): 19. CrossRef
Radiological and Clinical Significance of Cervical Dynamic Magnetic Resonance Imaging for Cervical Spondylotic Myelopathy
Jun Jae Shin, Sun Joon Yoo, Tae Woo Kim, Jae-Young So, Won Joo Jeong, Mu Ha Lee, Joongkyum Shin, Yoon Ha
Neurospine.2024; 21(2): 443. CrossRef
The Improvement of Intraoperative Motor Evoked Potential after Decompression in Cervical Compressive Myelopathy: Its Significance and Related Factors
Jong Yun Kwon, Dong Hwan Kim, Kyoung Hyup Nam, Byung Kwan Choi, In Ho Han
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Bone Density of Vertebral Bodies and Ossified Masses in Cervical Ossification of the Posterior Longitudinal Ligament: An Imaging Study Based on MRI, CT, and DEXA
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Calcified Tissue International.2024;[Epub] CrossRef
Management of Cerebrospinal Fluid Leakage by Pump-Regulated Volumetric Continuous Lumbar Drainage Following Anterior Cervical Decompression and Fusion for Ossification of the Posterior Longitudinal Ligament
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Neurospine.2023; 20(4): 1421. CrossRef

12,463 View
227 Download
11 Web of Science
13 Crossref

Review Article

Recommendations of WFNS Spine Committee

Cervical Spondylotic Myelopathy: Natural Course and the Value of Diagnostic Techniques –WFNS Spine Committee Recommendations: Mehmet Zileli, Sachin A. Borkar, Sumit Sinha, Rui Reinas, Óscar L. Alves, Se-Hoon Kim, Sumeet Pawar, Bala Murali, Jutty Parthiban; Neurospine 2019;16(3):386-402. Published online September 30, 2019; DOI: https://doi.org/10.14245/ns.1938240.120

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Cervical Spondylotic Myelopathy: Natural Course and the Value of Diagnostic Techniques –WFNS Spine Committee Recommendations

Neurospine. 2019;16(3):386-402. Published online September 30, 2019

DOI: https://doi.org/10.14245/ns.1938240.120

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Cervical Spondylotic Myelopathy: Natural Course and the Value of Diagnostic Techniques –WFNS Spine Committee Recommendations

Neurospine. 2019;16(3):386-402. Published online September 30, 2019

DOI: https://doi.org/10.14245/ns.1938240.120

Objective
This study presents the results of a systematic literature review conducted to determine most up-to-date information on the natural outcome of cervical spondylotic myelopathy (CSM) and the most reliable diagnostic techniques.
Methods
A literature search was performed for articles published during the last 10 years.
Results
The natural course of patients with cervical stenosis and signs of myelopathy is quite variable. In patients with no symptoms, but significant stenosis, the risk of developing myelopathy with cervical stenosis is approximately 3% per year. Myelopathic signs are useful for the clinical diagnosis of CSM. However, they are not highly sensitive and may be absent in approximately one-fifth of patients with myelopathy. The electrophysiological tests to be used in CSM patients are motor evoked potential (MEP), spinal cord evoked potential, somatosensory evoked potential, and electromyography (EMG). The differential diagnosis of CSM from other neurological conditions can be accomplished by those tests. MEP and EMG monitoring are useful to reduce C5 root palsy during CSM surgery. Notable spinal cord T2 hyperintensity on cervical magnetic resonance imaging (MRI) is correlated with a worse outcome, whereas lighter signal changes may predict better outcomes. T1 hypointensity should be considered a sign of more advanced disease.
Conclusion
The natural course of CSM is quite variable. Signal changes on MRI and some electrophysiological tests are valuable adjuncts to diagnosis.

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Clinical Article

Quantitative Pfirrmann Disc Degeneration Grading System to Overcome the Limitation of Pfirrmann Disc Degeneration Grade: Dae Cheol Rim; Korean J Spine 2016;13(1):1-8. Published online March 31, 2016; DOI: https://doi.org/10.14245/kjs.2016.13.1.1

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Quantitative Pfirrmann Disc Degeneration Grading System to Overcome the Limitation of Pfirrmann Disc Degeneration Grade

Korean J Spine. 2016;13(1):1-8. Published online March 31, 2016

DOI: https://doi.org/10.14245/kjs.2016.13.1.1

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Quantitative Pfirrmann Disc Degeneration Grading System to Overcome the Limitation of Pfirrmann Disc Degeneration Grade

Korean J Spine. 2016;13(1):1-8. Published online March 31, 2016

DOI: https://doi.org/10.14245/kjs.2016.13.1.1

Objective

Pfirrmann disc degeneration grade is one of morphologic disc degeneration grading system and it was reliable on routine T2-weighted magnetic resonance (MR) images. The purpose of this study was to evaluate the agreement of Pfirrmann disc degeneration grade, and check the alternative technique of disc degeneration grading system.

Methods

Fifteen volunteers (4 medical doctors related to spinal disease, 2 medical doctors not related to spinal disease, 6 nurses in spinal hospital, and 3 para-medicines) were included in this study. Three different digitalized MR images were provided all volunteers, and they checked Pfirrmann disc degeneration grade of each disc levels after careful listening to explanation. Indeed, all volunteers checked the signal intensity of disc degeneration at the points of nucleus pulposus (NP), disc membrane, ligaments, fat, and air to modify the quantitative Pfirrmann disc degeneration grade.

Results

Total 225 grade results of Pfirrmann disc degeneration grade and 405 signal intensity results of quantitative Pfirrmann disc degeneration grade were analyzed. Average interobserver agreement was "moderate (mean±standard deviation, 0.575±0.251)" from poor to excellent. Completely agreed levels of Pfirrmann disc degeneration grade were only 4 levels (26.67%), and the disagreement levels were observed in 11 levels; two different grades in 8 levels (53.33%) and three different grades in 3 levels (20%). Quantitative Pfirrmann disc degeneration showed relatively cluster distribution with the interobserver deviations of 0.41-1.56 at the ratio of NP and disc membrane, and it showed relatively good cluster and distribution indicating that the proposed grading system has good discrimination ability.

Conclusion

Pfirrmann disc degeneration grade showed the limitation of different interobserver results, but this limitation could be overcome by using quantitative techniques of MR signal intensity. Further evaluation is needed to access its advantage and reliabilities.

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