This is why we obtain flexion, extension and standing X-rays, ..
These studies were assessed by 3 orthopedic surgeons, 1 neurosurgeon, and 3 radiologists. All of the clinicians routinely interpret flexion/extension x-rays of the spine in their clinical practices. The observers from the various subspecialties were chosen to represent the clinicians that read flexion/extension films on a daily basis in clinical practice. Observers were first asked to review all 75 films at one session. Cases were presented in random order and were not organized by condition. The x-rays were presented to the clinicians on a computer workstation with a high-resolution, high contrast monitor. The workstation software allowed the clinicians to zoom in or out, change image brightness and contrast and measure distances and angles as they would typically do in their clinical practice. Clinicians were only asked to determine whether or not there was instability or a failed fusion present at any intervertebral motion segment from C2 to C7. There were no specific criteria given to the clinicians to define instability. Each clinician made these decisions as they would normally do in their clinical practice. Each level was recorded as either stable or unstable, or fused or not fused. No details of patient history or symptoms were provided to avoid any potential bias that may introduce.
Sciatica Treatment - Lumbar Spine X-Ray Flexion And Extension
Universally accepted definitions of the normal motion at each level, whether normal motion guidelines can be applied in the presence of severe degeneration, spondylolisthesis, or localized kyphotic deformities, and the threshold level of motion that defines a pseudoarthrosis would likely substantially reduce disagreement. There are many peer-reviewed studies that would facilitate development of consensus based guidelines for the clinical assessment of flexion/extension x-rays. These studies include several on motion in the asymptomatic cervical spine(; –), on changes in motion that can occur with trauma, post-trauma, or degeneration(; ; –), and on methods for measuring motion(; ; –). There are also several references on testing or validating methods for assessing lumbar(–) and cervical(–) fusions using flexion/extension x-rays. Unfortunately, all of this information on intervertebral motion has yet to be assimilated into generally accepted objective guidelines that can be used in clinical practice. The lack of an accepted “gold standard” for instability or fusion also prevents a level 1 scientific study of a diagnostic test. Finally, this study was focused on definitions of the quantity of motion. A consensus on the quality of motion, as assessed by parameters such as the center-of-rotation, may prove at least as valuable as a consensus on the quantity of motion.
Ligamentous instability can be demonstrated on flexion-extension views if there is displacement of one vertebra in relation to the adjacent vertebrae (spondylolisthesis).
Flexion and extension radiography of the lumbar spine: …
Non-operative treatment is usually recommended for patients as the first line of treatment. Physical therapy to work on posture, balance and spinal mechanics is often combined with strengthening of the back, flank and abdominal muscles to provide dynamic support to the lower lumbar spine. The careful use of over the counter anti-inflammatory medications along with periodic pain management for flare-ups, possible including spinal injections, can often make spondylolisthesis symptoms more manageable. Some weight loss, reconditioning, and life style modifications and ergonomic efficiencies may also be useful.
Color X Rays Cervical Spine Anatomy Flexion Extension
The lytic (subtype a) results from the separation or dissolution of the pars. The incidence of this type of Spondylolisthesis increases from less than 1 percent in children 5 years of age to 4.5 percent in children 7 years of age. The remaining 0.8 to 1 percent increase occurs between the ages of 11 to 16 years, presumably because of stress fractures caused by athletic activity. Extension movements of the spine, with lateral flexion, can increase the shearing stress at the pars interarticularis and result in Spondylolysis.
Interactive Color X Ray Lumbar Spine Spondylolisthesis
Flexion-extension x-rays are commonly used clinically to assess stability of the cervical spine, for several medical conditions. Diagnosis and treatment decisions are made, in part, based on the clinician’s assessment of these x-rays. When used to assess fusions, the goal is to detect any significant motion between vertebrae. When used to assess levels adjacent to a fusion, degeneration or post-trauma patients, the goal is to detect abnormally high or unusual motion. One important measure of a diagnostic test is the agreement between observers when using the test. Despite wide-spread use of cervical spine flexion and extension films in clinical practice, there is little evidence that clinicians will agree when assessing fusions, or spinal stability adjacent to, or in the absence of fusion.
Flexion/extension lateral X-rays of the lumbar spine:
Validated, computer-assisted technology is available to quantify intervertebral motion from cervical flexion-extension x-rays, but there is only limited evidence that this technology can significantly improve the agreement between clinicians. The goals of this study were two fold. The first was to quantify agreement between clinicians when they assess fusion status or the stability of the cervical spine from flexion-extension x-rays, using the methods that they routinely use in clinical practice. The second goal was to examine whether use of computer assisted technology has any effect on interobserver agreement when assessing flexion/extension x-rays of the cervical spine.