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Limitation of Functional MRI of the Cervical Spine in Supine Position

The capability of magnetic resonance imaging (MRI) to differentiate and simultaneously depict osseous, discoligamentary, muscular, neural structures and CSF cavities has attained a specific degree of importance, particularly in functional diagnostic of the spinal column (SC), and even more especially in the cervical spine (CS). The examination process is, however, influenced by the apparatus-technical conditions such that the diagnostic value is considerably limited. Except for a few trials with open, low field equipment with limited resolution, which performed functional examination of the CS in upright position, this is usually performed in a closed system on the supine patient. Examination in the supine position are highly problematic for the assessment of functional defects in the cervical spine. The supporting mat leads to a passive compliance of the cervical structures, the possible artificially simplified movement in this position causes loss of the effect of all functional mechanisms. Therefore examination in the upright position appears to be mandatory. A neutral, self-controlled up-right position, in which the gravitational force is actively balanced should be the starting point for motional examinations. At the same time high spatial and temporal resolution are necessary to study the detailed motional displacement of the relevant structures. An optimized MR-system for such examinations will therefore require a magnetic field strenght of at least 1 T. Technically such a concept can be realized by a superconductive magnet with a vertical bore. Apart from the technical system specifications, appropriate devices for patient positionig and standardized motional excursions have to be realized in order to permit functional diagnostic of the CS appropriate to the real physiological situation.