BlueCross BlueShield of Tennessee Medical Policy Manual

Dynamic Spinal Visualization


Dynamic spinal visualization is a general term addressing different imaging technologies, including digital motion x-ray and videofluoroscopy (i.e., cineradiography/videoradiography).Unlike standard x-rays, which take a single picture at one point in time, videofluoroscopy provides motion pictures of the body. These technologies allow the simultaneous visualization of movement of internal body structures, such as the spine (vertebrae), with corresponding external body movement. These technologies have been proposed for the evaluation of spinal disorders including low back pain.

Digital motion x-ray (i.e., DMX) involves the use of either film x-ray or computer-based x-ray snapshots taken in sequence as the individual moves. Film x-rays are digitized into a computer for manipulation while computer-based x-rays are automatically created in a digital format. The digitized snapshots are then put in order using a computer program and played on a video monitor, creating a moving image of the inside of the body.

Dynamic magnetic resonance imaging (MRI) is also being evaluated for imaging of the cervical spine. This technique uses an MRI-compatible step-less motorized positioning device and a real-time true fast imaging with steady-state precession sequence to provide passive kinematic imaging of the cervical spine.

Note: This policy does not address radiographic digitization of an x-ray. Radiographic digitization is the computer enhancement of a “still” x-ray and does not involve movement or motion.




Current literature evaluating the clinical utility of dynamic spinal visualization techniques, including digital motion x-ray and cineradiography/videofluoroscopy, or dynamic magnetic resonance imaging for the evaluation and assessment of the neck and back is limited to a few studies involving small numbers of participants. The clinical utility of these technique have not been demonstrated and these technologies remain investigational. 


Ahmadi, A., Maroufi, N., Behtash, H., Zekavat, H., & Parnianpour, M. (2009). Kinematic analysis of dynamic lumbar motion in patients with lumbar segmental instability using digital videofluoroscopy. European Spine Journal, 18 (11), 1677-1685. (Level 4 evidence)

American College of Radiology. (2014) ACR - ASNR - SCBT - MR Practice parameter for the performance of magnetic resonance imaging (MRI) of the adult spine. Retrieved June 12, 2017 from

BlueCross BlueShield Association. Medical Policy Reference Manual. (3:2017). Dynamic spinal visualization (6.01.46). Retrieved June 12, 2017 from BlueWeb. (6 articles and/or guidelines reviewed)

Gerigk. L., Bostel, T., Hegewald, A., Thome, C., Groden, C., Neumaier-Probst, E., et al. (2012, March) Dynamic magnetic resonance imaging of the cervical spine with high-resolution 3-dimensional T2-imaging. Clinical Neuroradiology; 22(1):93-99. Abstract retrieved August 1, 2016 from PubMed database.

Lazennec, J., Brusson, A., Folinais, D., Zhang, A., Pour, A., Rousseau, M. (2015, August) Measuring extension of the lumbar-pelvic-femoral complex with the EOS® system. European Journal of Orthopaedic Surgery & Traumatology;25(6):1061-8. Abstract retrieved June 12, 2017 from PubMed database.

Mellor F. E., Muggleton, J. M., Bagust, J., Mason, W., Thomas, P. W., & Breen, A. C. (2009). Midlumbar lateral flexion stability measured in healthy volunteers by in vivo fluoroscopy. Spine, 34 (22), E811-E817. (Level 4 evidence - Independent study)

U. S. Food and Drug Administration. (2008, August). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K080847 (RFVision 9.9™). Retrieved July 24, 2002 from

U. S. Food and Drug Administration. (2009, May). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K082781 (Kinegraph VMA™). Retrieved July 24, 2002 from 




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