Understanding Flexion-Extension X-Rays and Spinal Instability
What is a Flexion-Extension X-Ray?
Patients and doctors often find the concept of spinal instability challenging, especially when most conversations around back and neck pain revolve around herniated discs and compressed nerves. Traditional imaging methods like MRIs often overlook spinal instability, yet identifying this condition is crucial for effective treatment. This is where a flexion-extension X-ray becomes essential.
Defining Spinal Instability
The spine consists of three primary sections: the cervical (neck), thoracic (upper back), and lumbar (lower back) regions. One of the complexities of human bipedalism is maintaining spinal stability. Imagine a stack of 24 building blocks; keeping them upright without toppling over requires a balance of support and flexibility.
Two main systems ensure spinal stability:
Ligaments - These strong, flexible bands act like duct tape, limiting excessive movement between vertebrae.
Stabilizing Muscles - Specifically, the multifidus muscles, which adjust vertebrae alignment during movement.
Injuries to these ligaments or muscles can lead to spinal instability, characterized by excessive movement between vertebrae. This instability can cause pain through joint wear and tear or nerve irritation, often leading to conditions like sciatica. Notably, such issues may not be evident in static imaging like MRIs.
Identifying Instability with X-Rays
Standard X-rays and MRIs, being static, fail to detect instability, which only manifests during movement. Thus, a flexion-extension X-ray is used. This involves taking X-ray images while the patient moves, highlighting instability.
Lumbar (Lower Back) X-ray: The patient bends forward and backward.
Cervical (Neck) X-ray: The patient looks down and then up.
Challenges with Flexion-Extension X-Rays
Ideally, these X-rays should be performed with sufficient movement to reveal any instability. However, this is not always the case due to:
Radiology Technicians’ Caution: Technicians may avoid pushing patients to their limits to prevent pain, often resulting in insufficient movement.
Technical Difficulties: Achieving the required motion can be challenging, leading to inaccurate results.
If the movements during the test are inadequate, it can result in a false negative, missing the actual instability.
Ensuring Accurate Flexion-Extension X-Rays
To ensure the test is effective:
For Lumbar X-rays: Bend forward as far as possible, aiming to touch your toes, then bend backward as far as you can.
For Cervical X-rays: Look down and then up to the maximum extent possible.
Insist on achieving these full ranges of motion, even if it means gently ignoring conservative instructions from the technician.
Conclusion
A flexion-extension X-ray is a critical tool for diagnosing spinal instability, a common yet often overlooked cause of back and neck pain. Understanding how to perform this test correctly ensures accurate diagnosis and effective treatment. Visit our friends at flextimaging.com to get a flexion extension x-ray today.
References
Offiah CE, Day E. The craniocervical junction: embryology, anatomy, biomechanics and imaging in blunt trauma. Insights Imaging. 2017;8(1):29–47. doi:10.1007/s13244-016-0530-5
Silvis ML, Mosher TJ, Smetana BS, et al. High prevalence of pelvic and hip magnetic resonance imaging findings in asymptomatic collegiate and professional hockey players. Am J Sports Med. 2011;39(4):715-721. doi:10.1177/0363546510388931