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. 2024 Jun 30;21(2):443–454. doi: 10.14245/ns.2448166.083

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Copyright © 2024 by the Korean Spinal Neurosurgery Society

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Fig. 4. — Increase of SI grade and cervical stenosis during extension. A 53-year-old male was diagnosed with cervical spondylotic myelopathy due to a herniated cervical disc at C4–5–6. (A) Flexion-positioned magnetic resonance imaging (MRI) showed intramedullary faint SI (G1) at C4–5 and no effacement of subarachnoid space. (B) Neutral-positioned MRI showed complete obliteration of the anterior subarachnoid space (Muhle grade 2). (C) Extension-positioned MRI showed severe cord impingement at C4–5–6 (Muhle grade 3) and intense intramedullary SI (G2). (D) Flexion-positioned axial view showed cord compression, but the subarachnoid space was not obliterated. (E) On the neutral axial T2-weighted imaging (T2WI), effacement on the right anterior subarachnoid space was noted. (F) On extension-positioned axial T2WI, intense intramedullary SI (G2) was observed.