Introduction
When evaluating patients for spinal ligament injuries, obtaining accurate flexion and extension X-rays is essential. These images allow you to identify ligamentous instability—an often overlooked yet critical aspect of spinal injuries. Fortunately, positioning patients for these studies is straightforward, provided they can move into flexion and extension without severe pain or physical limitations. Below, we’ll walk through the key points you need to know.
When to Take Flexion and Extension X-Rays
- Immediate Imaging: If the patient can flex and extend (cervical or lumbar), it’s best to capture these images right away. Early testing provides valuable information on how severely ligaments may be damaged.
- Delayed Imaging: If a patient is in too much pain or cannot physically move into flexion or extension, wait until their symptoms subside enough to achieve acceptable positioning. This situation is relatively rare in most clinical practices.
Key Insight: You don’t need to wait for all pain and inflammation to resolve before ordering these X-rays—only if the patient truly cannot perform the movements.
Positioning for Cervical Spine Imaging
- Flexion
- Ask the patient to touch their chin to their chest (or as close as comfortably possible).
- Ensure the motion is happening in the cervical spine and not just tilting of the head.
- The goal is a clear C-shaped curvature in the neck on the lateral view.
- Extension
- Instruct the patient to look up at the ceiling, extending their neck as far as comfortably possible.
- Avoid excessive torso movement—focus on pure cervical extension.
- A-P Open Mouth and Lateral Bending
- These additional views help assess the upper cervical region and any instability around C1-C2.
- If you have questions about how to obtain clear images, Spinal Kinetics provides positioning guides and training resources.
Pro Tip: A digital X-ray system often yields clearer images for measuring ligament damage than advanced motion X-rays (DMX), making the subsequent radiographic mensuration easier.
Positioning for Lumbar Spine Imaging
- Flexion
- Ask the patient to bend forward to about 40-45 degrees—a moderate flexion that shows a C-curve in the lumbar region.
- Emphasize that the patient must keep the buttocks from sticking out to avoid compensatory hip flexion.
- Extension
- Instruct the patient to bend backward with their buttocks tucked in.
- Aim for a clear, extended lumbar curve without excessive rotation or lateral bending.
Key Insight: Proper positioning is critical. Over-rotation or poor patient alignment will muddy the results and reduce the accuracy of any ligament assessment.
Why Quality Images Matter
If you have any concerns about patient positioning or technique:
- Contact Spinal Kinetics: We have a positioning guide and can provide tailored advice for your specific equipment setup or clinical scenario.
- Refine Your Skills: Whether you’re taking the X-rays in-house or working with an imaging center, ensure that everyone involved understands how to capture consistent, high-quality images.
Final Thoughts
Becoming proficient in spinal ligament evaluations starts with mastering patient positioning for flexion and extension X-rays. By ensuring clear, well-aligned images, you’ll set the stage for accurate diagnoses, effective treatment plans, and ultimately better patient outcomes. If you have questions or need further guidance, Spinal Kinetics is here to help with both training and resources.
Remember: Good imaging is the foundation for uncovering ligamentous instability—don’t underestimate its importance in delivering top-tier care to your patients.