After a routine supine neutral-position (0°) examination, the dynamic examination is performed. Extension MRI views yield a higher detection rate of missed cervical disc bulges than flexion views. Posterior disc herniations become less severe in upright-flexion position. This change is a worthy preoperative note to surgeons who operate on the spine in positions of partial flexion. Cervical cord impingement is increased in extension MR images as compared to flexion MR images, indicating a minor role of flexion in contributing to cord impingement. Radiologists can easily decide whether to perform extension MR imaging before the final pulse sequence in a neutral-position examination. The use of axial loading during MR imaging offers the opportunity to image in the most symptomatic position with the Ligamentum flavum contributing to 50 and 85% of the load induced narrowing of the spinal canal.