Dynamic Compression of the Spinal Cord by Paraspinal Muscles following Cervical Laminectomy: Diagnosis Using Flexion-Extension MRI

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.