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Oh: Do Not Think to See One Side and Know the Whole - We Have to Understand Cervical Spine Dynamics Not Only Static State
Dynamic magnetic resonance imaging (MRI) is a very useful tool for detecting the patients’ hidden pathology which is not detected by static MRI. MRI is a gold standard tool for diagnosis of the patient’s pathology. But sometimes we are not sure the pathology from static MRI for making a patient’s neurology worsening. In this situation, if you check this patient’s neurology worsening during flexion or extension, then I recommend dynamic MRI for detection of hidden pathology.
As you know, the human is very dynamic during daily living. So, we have to understand the human spine dynamics. Especially cervical spine is more mobile than any other part of spine. One study showed that dynamic changes in reflex exam are commonly seen in patients being evaluated for symptomatic cervical stenosis [1]. Like this we can find the pathology from dynamic MRI if we cannot see the pathology from routine static MRI.
We use can use EOS stereo-radiography system for finding the whole spinal sagittal balance. The EOS image is very helpful for showing a patient’s spinal sagittal balance during weight bearing position (standing). MRI are designed so that the patient is scanned in the horizontal position (typically supine). Upright MRI is a very recent technique that allows the patient to be scanned in several different weight-bearing positions [2]. Dynamic MRI makes some role for overcoming limitation that conventional MRI can scan in supine position.
I think this review article will help for spine surgeons to understand that cervical dynamic MRI is a promising new tool in diagnosing and treating cervical spondylotic myelopathy.


1. Tuchman A, Tan LA, Shillingford JN, et al. Dynamic changes in the reflex exam of patients with sub-axial cervical stenosis. J Clin Neurosci 2019;60:84-7.
crossref pmid
2. Botchu R, Bharath A, Davies AM, et al. Current concept in upright spinal MRI. Eur Spine J 2018;27:987-93.
crossref pmid pdf

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