From the Guidelines
An order for a digital motion X-ray of the cervical spine should specify anteroposterior, lateral, and open-mouth odontoid views, with visualization of the cervicothoracic junction, as these are the minimum required views for assessing cervical spine injury, as per the American College of Radiology guidelines 1. When ordering a digital motion X-ray of the cervical spine, it is essential to include the patient's clinical history and suspected diagnosis, such as whiplash injury, ligamentous instability, or suspected atlantoaxial instability. The order should also note any specific areas of concern within the cervical spine that require particular attention.
- The order should indicate whether the study is to be performed weight-bearing (standing/sitting) or non-weight-bearing, as this affects the visualization of potential instability.
- If comparison with previous imaging is needed, this should be mentioned along with the date of prior studies.
- Digital motion X-ray is valuable because it captures the spine in motion, revealing abnormalities that might not be apparent on static images, although the addition of flexion-extension views has not been shown to be of clinical utility, as stated in the American College of Radiology guidelines 1. However, it is crucial to note that CT is considered the gold standard for identification of cervical spine fractures, outperforming radiographs in identification of cervical spine fractures in high-, moderate-, and low-risk stratifications 1.
- The use of CT with IV contrast does not aid in detection of cervical spine injury 1.
- MRI may be warranted in some patients, particularly those with neurologic symptoms or suspected soft-tissue injuries, as it is superior to CT in identifying many soft-tissue injuries, such as epidural hematoma, cord contusion, and ligament sprains 1.
From the Research
Digital Motion X-ray of the Cervical Spine
To order a digital motion X-ray of the cervical spine, the following points should be considered:
- The order should include the range of motion to be examined, such as flexion and extension 2, 3
- The order may specify the use of lateral-view X-rays for each of five neck positions: full flexion, full extension, and three intermediate positions 4
- The order should include the parameters to be measured, such as kinematic (angles and centers of rotation) and geometric (pattern of curvature) parameters 4
- The order may require the use of specific instruments, such as a goniometer, inclinometer, or cervical range of motion (CROM) instrument, to assess cervical flexion-extension, lateral flexion, and rotation 5
- The order should specify the need for dynamic motion analysis, which can be performed using cineradiography or videofluoroscopy 6, 3
Key Considerations
- The order should be tailored to the specific needs of the patient and the clinical question being addressed
- The use of digital motion X-ray should be justified based on the patient's symptoms and medical history
- The order should be clear and concise, with specific instructions for the radiology department
- The results of the digital motion X-ray should be interpreted in the context of the patient's overall medical condition and treatment plan 2, 6