• Hazem M A Alkosha, Mohamed A El Adalany, Hesham Elsobky, Asharaf S Zidan, Amin Sabry, and Basem I Awad.
• Department of Neurosurgery, Mansoura University, Dakahlia, Egypt. Electronic address: hazem_kosha@yahoo.com.
• World Neurosurg. 2022 Aug 1; 164: e1078-e1086.

ObjectiveTo evaluate the reliability and usefulness of cervical flexion/extension magnetic resonance imaging (MRI) as a tool for decision-making regarding treatment of symptomatic cervical spondylosis.MethodsWe prospectively collected demographic, clinical, and flexion/neutral/extension MRI data for consecutive 24 patients who had presented with symptomatic cervical degenerative disease. From the survey responses, we analyzed the agreement between clinical interpretation and judgment when neutral MRI (nMRI) versus flexion/extension MRI (fMRI/eMRI) had been provided. Additionally, the mean cervical canal diameter (MCCD), as measured by 2 independent radiologists, was tested for intra- and interobserver reliability. The differences in MCCD between nMRI, fMRI, and eMRI and the correlation with the qualitative assessment by spine surgeons were also evaluated.ResultsUsing nMRI only, 16.7%-33.3% of the surgical candidates were missed. Neurosurgeons were significantly more likely to use a posterior approach and instrumentation when fMRI/eMRI studies were available compared with nMRI studies alone. More levels had undergone surgery when the providers had been presented with the fMRI/eMRI studies. The raters expressed a preference for the use of fMRI/eMRI in their future practice. The MCCD was significantly different when measured on the nMRI studies compared with the fMRI/eMRI studies and correlated with the qualitative assessments.ConclusionsFlexion/extension MRI studies were useful for assessing patients with cervical degenerative spine disorders regarding the surgical indication, direction of the approach, and use of multilevel instrumentation, especially for patients with early cervical myelopathy.Copyright © 2022 Elsevier Inc. All rights reserved.

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