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.