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Unstable cervical spine flexion x ray4/17/2024 But, significant instability usually require surgical management. Minor instabilities can be treated with exercise and therapy. To this point, often times, during an operation, when people are relaxed due to the anesthesia, we often identify a instability pattern by direct observation of the disk level, or by obtaining imaging during the operation.Ĭervical Instability is a potential serious issue, and can lead to significant problems. We cannot get enough information to assess instability. In that scenario, people will not allow the neck to flex or extend. Sometimes, people have severe neck stiffness and pain, with spasms. Conclusions: Our results show that in patients who underwent acute radiographic evaluation of blunt cervical. There is a problem, however with flexion-extension x-rays. extension views of cervical spine for instability. Continued neck pain should be evaluated for instability. People with Rheumatoid arthritis have risks of developing instability secondary to the auto immune effects. Patients who have had a recent trauma, with concerns of disruption of the liagments and supporting structures in the neck.ģ. And, as discussed above, criterion for rotatory instability has not been established.Ģ. But, now that we know there is a certain radiation risk to CT scans, I do not know if the risks for the scan will justify the test for rotational instability. In theory, we can have baseline CT scans of the neck, then as the person to rotate the neck to see if there is excessive facet subluxation on rotation identified by the CT scan. Unfortunately, we do not have good established criterion on how to define a rotational instability, and we do not have a good test, that does not subject you to significant radiation dosing. In patients with chronic neck pain, who describe increasing pains with specific motions, flexion-extension x-rays can help define the instability.Īs a side issue, I am sure there a some patients that become instable with rotation as well. Then, let’s assume these people have already had the usual initial treatments such as physical therapy, chiropractic care, and medications.ġ. So, the question becomes, when should we suspect a cervical instability? First, lets assume these people have already been worked up to make sure there is no fracture, tumor, infection or significant disk herniation. Instability is established by a angulation of greater than 11.5 degrees on comparison flexion-extension. When the neck bends forward or is in flexion, the end plates are essentially parallel. When the disk space angles are measured, it opens to 14.6 degrees. In the above images, we can see that when the neck extends, the disk space opens. On comparison flexion-extension x-rays, instability can manifest by excessive “fishmouthing” of the disk space. In these same X-rays, we identify another known criterion for cervical instability. The accepted criterion for cervical instability includes a motion of greater than 3.5 mm’s. But, with extension, there is a 4.3 mm movement of the C6 body posterior (towards the back) to the C7 body. On Flexion, the posterior corners of the vertebral bodies line up. In this x-ray series, it demonstrates movement of the vertebral body of C6 on C7.
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