• Lifeng Lao, Michael D Daubs, Trevor P Scott, Kevin H Phan, and Jeffrey C Wang.
• Department of Orthopaedic Surgery, Renji Hospital Shanghai Jiaotong University School of Medicine, Shanghai, China.
• Eur Spine J. 2014 Aug 1; 23 (8): 1725-9.

PurposeTo determine if adding flexion and extension MRI studies to the traditional neutral views would be beneficial in the diagnosis of cervical disc bulges.MethodsFive hundred patients underwent MRI in neutral, flexion and extension positions. The images were analyzed using computer software to objectively quantify the amount of disc bulge.ResultsCompared to the neutral position, cervical disc bulges were significantly increased in the extension position (P < 0.05), but on flexion position, there was no significant difference (P > 0.05). For patients without or <3 mm of disc bulge in neutral, 2.97% demonstrated an increase in bulge to ≥3 mm bulge in flexion, and 16.41% demonstrated an increase to ≥3 mm bulge in extension. For patients in the neutral view that had a baseline disc bulge of 3-5 mm, 3.73% had increased bulges to ≥5 mm in flexion and 11.57% had increased bulges to ≥5 mm in extension.ConclusionA significant increase in the degree of cervical disc bulge was found by examining extension views when compared with neutral views alone. Kinematic MRI views provide valuable added information, especially in situations where symptomatic radiculopathy is present without any abnormalities demonstrated on traditional neutral MRI.

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