Clinical Cases

Functional MRI scan of the cervical spine upright in a natural weight-bearing position


The Upright MRI system allows MRI diagnosis of the cervical spine in the upright, natural weight-bearing position.

Full functional assessments are also feasible with Upright MRI scans. In addition to the neutral, upright position, the cervical spine can also be imaged in the flexion, extension, lateral tilt and rotation positions.

This system can be used to image disorders that cannot be detected with conventional MRI scans performed in the supine position.

The patient presented in this case has no history of cervical spine problems. Over the last six months, this patient has been experiencing regular bouts of vestibular vertigo of approximately 10 minutes’ duration.

There have also been occasional complaints about headaches during this period.

A functional examination of the cervical spine was therefore carried out with speci c focus on the craniocervical junction in the Upright MRI scan.

Cervical Spine

Instability in the region of the craniocervical junction was highlighted during the functional examination with evidence of circumscribed, pincer-shaped narrowing of the cervical myelon on flexion (Fig. A).

Particular attention should be paid to congenital aplasia of the dens axis which, in the usual region of the apex of the dens axis, comprises only a small core bone (Os odontoideum). In the flexion position (Fig. A), there is obviously a circumscribed forward shift of the atlas towards the Foramen magnum causing considerable narrowing of the spinal canal on the upper dens level.

In the extension position (Fig. C), the shift of the atlas towards the Epistropheus is visible with marked myelon decompression.

Circumscribed myelopathy is apparent in the region of the upper dens, at the Ligamentum transversum level.

Secondary  ndings include intervertebral disc degeneration at levels C3 to C6 with flat disc protrusions of no clinical relevance.

Diagnosis was con rmed through a functional Upright MRI scan.

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