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). These technologies allow the simultaneous visualization of movement of internal body structures, such as the spine (vertebrae), with corresponding external body movement. All of these methods use x-rays to create images either on film, on a video monitor, or on a computer screen. 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. This moving image can then be evaluated by a physician alone or by using a computer that evaluates several aspects of the body’s structure such as intervertebral flexion and extension to determine the presence or absence of abnormalities.

Videofluoroscopy and cineradiography are different names for the same procedure that uses a technique called fluoroscopy to create real-time video images of internal structures of the body. Unlike standard x-rays that take a single picture at one point in time, fluoroscopy provides motion pictures of the body. The results of these techniques can be displayed on a video monitor as the procedure is being conducted as well as recorded to allow computer analysis or evaluation at a later time. Like digital motion x-ray, the results can be evaluated by a physician alone or using the assistance of computer analysis software.

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.




The current literature evaluating the clinical utility of dynamic spinal visualization techniques, including digital motion x-ray and cineradiography/videofluoroscopy for the evaluation and assessment of the spine is limited to a few studies involving small numbers of participants. Thus, the clinical utility of this technique has not been demonstrated. While numerous reports have studied the correlation of this technique to disc degeneration, no studies have evaluated the incremental value of this information compared to the standard x-rays and physical evaluation. In addition, no studies have shown how the use of this information has an impact on or improves health outcomes. At this time, the published data is insufficient to support the use of dynamic spinal visualization. Further evidence from large controlled trials is needed to demonstrate that the results of any one of these procedures has a significant positive impact on clinical care and is superior to current alternatives (e.g., standard x-rays). At this time, no clinical trials are scheduled.


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.

BlueCross BlueShield Association. Medical Policy Reference Manual. (9:2014). Dynamic spinal visualization (6.01.46). Retrieved September 11, 2015 from BlueWeb. (10 articles and/or guidelines reviewed)

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)

Teyhen, D. S., Flynn, T. W., Childs, J. D., & Abraham, L. D. (2007). Arthrokinematics in a subgroup of patients likely to benefit from a lumbar stabilization exercise program. Physical Therapy, 87 (3), 313-325.

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




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