Why do we take flexion-extension x-rays?

Back and neck pain patients and doctors are often confused by the idea of instability in the spine. From the patient’s standpoint, since they’ve mostly heard about herniated discs and compressed nerves, this idea is a bit foreign. Doctors are primarily looking for things that show up on MRIs, so they frequently miss the concept of spine instability altogether. Finding out if your back or neck is unstable is often critical for finding relief.

What Is Spinal Instability?

Your spine is made up of the neck (cervical), upper back (thoracic), and low back (lumbar) areas. Your spine is made up of 24 vertebrae that are stacked like kid’s blocks. When was the last time you stacked more than 20 blocks on top of each other without the whole rickety tower collapsing?

To keep the spine from collapsing, you have two main systems. One is strong ligaments that limit motion in certain areas. The other is made up of stability muscles which help stabilize one vertebra on the other as you move. If the ligaments get injured or the muscles go offline, the vertebrae can move too much, leading to too much motion between them, or an unstable spine. Unstable vertebrae can cause pain by placing excessive wear and tear on the spine joints (facets) or disc and can irritate or pinch the spinal nerves leading to radiating pain into the arms or legs. In fact, sometimes the spine looks fine on MRI when the real culprit is instability.

Since regular x-rays and MRIs are static images without any movement, these tests can’t identify instability. Many patients who have normal x-rays or MRIs are later diagnosed with instability as the cause of their back or neck pain. After a thorough history and examination, the Doctors at Exactacare will determine your injury requires flexion-extension x-rays. These images are conveniently performed in our offices with our state-of-the-art digital x-ray machines.