Clinical feasibility of 2D dynamic sagittal HASTE flexion-extension imaging of the cervical spine for the assessment of spondylolisthesis and cervical cord impingement.

Purpose: To assess the utility of a 2D dynamic HASTE sequence in assessment of cervical spine flexion-extension, specifically (1) comparing dynamic spondylolisthesis to radiographs and (2) assessing dynamic contact upon or deformity of the cord.

Methods: Patients with a dynamic flexion-extension sagittal 2D HASTE sequence in addition to routine cervical spine sequences were identified. Static and dynamic listhesis was first determined on flexion-extension radiographs reviewed in consensus. Blinded assessment of the dynamic HASTE sequence was independently performed by 2 radiologists for (1) listhesis and translation during flexion-extension and (2) dynamic spinal cord impingement (cord contact or deformity between neutral, flexion and extension).

Results: 32 scans in 32 patients (9 males, 23 females) met inclusion criteria acquired on 1.5 T (n = 15) and 3 T (n = 17) scanners. The mean acquisition time was 51.8 s (range 20-95 seconds). Dynamic translation was seen in 14 patients on flexion-extension radiographs compared to 12 (reader 1) and 13 (reader 2) patients on HASTE, with 90.6 % agreement (K = 0.83; p = 0.789). In all cases dynamic listhesis was ≤3 mm translation with one patient showing dynamic listhesis in the range 4-6 mm. Four cases (13 %) demonstrated deformity of the cord between flexion-extension, not present in the neutral position. For cord impingement there was strong inter-reader agreement (K = 0.93) and the paired sample Wilcoxon signed rank test found no significant difference between the impingement scores of the two readers (p = 0.787).

Conclusions: A sagittal dynamic flexion-extension HASTE sequence provides a rapid addition to standard MRI cervical spine protocols, which may useful for assessment of dynamic spondylolisthesis and cord deformity.