Dynamic Cervical Cord Compression Post-laminectomy Visualized by Flexion-extension Magnetic Resonance Imaging: Case Report

Flexion-extension magnetic resonance imaging (MRI) in the cervical spine is not universally used in cervical spine surgery. However, flexion-extension MRIs can identify previously undetected spinal stenosis, improve surgical decision-making, and maybe a better tool to evaluate postoperative outcomes. One uncommon complication after laminectomy, to treat cervical spinal stenosis, is muscle weakness due to subsequent dynamic cord compression by posterior paraspinal musculature. We present a case of a 41-year-old male who underwent posterior cervical decompression and developed subsequent neurological deficits and muscle weakness. MRI with neutral cervical positioning did not show spinal stenosis necessitating surgical intervention. However, given the patient’s increasing tetraparesis, flexion-extension MRI was performed and it revealed significant spinal stenosis in both flexion and extension positions due to spondylosis and compression from paraspinal muscles. This case demonstrates the utility of flexion-extension MRI in identifying pathologies such as cord compression by paraspinal muscles. Exclusive use of a neutral-position MRI scan may not be sufficient to provide proper diagnoses for cervical spine pathologies. Flexion-extension MRI should be considered when the degree of neurological symptoms outweighs minimal or absent pathology seen on neutral-position sagittal MRI.