Understanding Spinal Injuries: Why Spinal Instabilities Get Missed on X-rays

Introduction

When patients visit the emergency room after a potential spinal injury, they often undergo X-rays, and a quick radiology report is provided. If you've ever experienced this or know someone who has, you might have received feedback like, "No instability detected." But what does that really mean, and why is it important to dive deeper?

The Fast-Paced Radiology Read

The X-ray reading you receive in an emergency room is often rapid—sometimes taking less than a minute. Radiologists are skilled in reviewing X-rays quickly, focusing primarily on identifying catastrophic conditions like fractures, infections, or degenerative changes in the spine. These quick reads are not designed to catch everything, particularly a condition like spinal instability.

The Limitations of X-rays in Detecting Instability

One of the most common misconceptions is that spinal instability can be easily seen on X-ray films. This is a fallacy, spinal instability is detected as excessive spine motion that causes a neurological effect.  It is not picked up by the human eye, as it is a measured phenomenon, that requires just that, measurements. While radiologists might notice issues like excessive motion or misalignment between vertebrae (conditions known as anterolisthesis and retrolisthesis), these findings are not always definitive signs of instability. Instability, again, is a measured phenomenon, not something that can be spotted by the eye on an X-ray image alone.

Measuring Instability: Why It’s Not an Eyeball Test

Instability in the spine is similar to measuring heart function through an echocardiogram. Cardiologists don't just look at an ultrasound image and determine how well a heart is working—they measure specific functions like the volume of blood being pumped. Likewise, instability in the spine requires measurements to determine the extent of excessive motion between vertebrae. Without these measurements, it’s impossible to diagnose instability accurately.

Types of Spinal Injuries

To better understand spinal injuries, it's important to know that there are three ways that the spine can be damaged (deranged), and each way has a very specific imaging biomarker associated with it.

1. Fractures: Injuries to the bone, which are picked up on x-ray or CT,
2. Disc damage: Which is seen on MRI scans when a disc herniates or displaces.
3. Ligament injuries: Damage to non-disc ligaments, which are responsible for stabilizing the spine. This damage causes excessive motion and instability which is picked up with specialized stress x-rays and accurate measurements.  Today these procedures have advanced using specialized machine learning AI procedures.

Ligament injuries are a primary cause of spinal instability. Excessive motion between vertebrae—measured using specialized imaging techniques—is a key indicator of ligament damage. The more motion there is, the more likely it is that the ligaments have been injured. In fact, excessive motion can even affect the facet joints, which are a significant source of spinal pain.

Why a Comprehensive Test Is Essential

Given the complexity of spinal injuries, especially ligament damage, a simple X-ray read in the emergency room isn't sufficient for diagnosing instability. More advanced tests are required, such as dynamic motion imaging, which can measure the degree of movement in the spine and provide a clear picture of ligament function.

For healthcare providers working in personal injury cases, it's essential to use unbiased, third-party testing methods with high-quality, FDA-cleared equipment. This ensures that the evaluation of spinal instability is accurate, reliable, and professionally credible.

Conclusion

When it comes to diagnosing spinal instability, quick X-ray reads aren’t enough. If you or your patients are dealing with neck or back pain following an accident, make sure to seek out comprehensive testing that can measure the degree of instability. With accurate measurements, healthcare professionals can better understand the extent of spinal injuries and develop more effective treatment plans.

If you're a healthcare provider in the personal injury space and haven't yet explored using advanced imaging for spinal instability, consider setting up an account with specialists like Spinal Kinetics to provide your patients with the highest level of care.