BlueCross BlueShield of Tennessee Medical Policy Manual

Dynamic Spinal Visualization and Vertebral Motion Analysis

DESCRIPTION

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. Vertebral motion analysis (i.e., KineGraph VMA™) uses similar imaging, with the addition of controlled movement and computerized tracking. The purpose of VMA is to determine whether the abnormal movement of the spine contributes to neck or back pain. These technologies have been proposed for the evaluation of spinal disorders including neck and 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.

POLICY

IMPORTANT REMINDERS

ADDITIONAL INFORMATION

Current literature evaluating the clinical utility of dynamic spinal visualization techniques, including digital motion x-ray and cineradiography/video fluoroscopy, vertebral motion analysis 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.  

SOURCES

American College of Radiology. (2018). ACR - ASNR - SCBT - MR Practice parameter for the performance of magnetic resonance imaging (MRI) of the adult spine. Retrieved June 11, 2019 from http://www.acr.org/guidelines.

BlueCross BlueShield Association. Evidence Positioning System. (9:2018). Dynamic spinal visualization (6.01.46). Retrieved June 10, 2019 from https://www.evidencepositioningsystem.com/. (9 articles and/or guidelines reviewed)

Cheng, B., Castellvi, A.E., Davis, R.J., Lee, D.C., Lorio, M.P., Prostko, R.E., et al. (2016). Variability in flexion extension radiographs of the lumbar spine: A comparison of uncontrolled and controlled bending. International Journal of Spine Surgery, 10 (20), doi: 10.14444/3020. (Level 2 evidence)

Davis, R., Lee, D.C., Wade, C., & Cheng, B. (2015). Measurement performance of a computer assisted vertebral motion analysis system. International Journal of Spine Surgery, 9 (36), doi: 10.14444/2036. (Level 4 evidence)

Gerigk. L., Bostel, T., Hegewald, A., Thome, C., Groden, C., Neumaier-Probst, E., et al. (2012). 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.

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 http://www.accessdata.fda.gov.

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 http://www.accessdata.fda.gov.  

Yeager, MS., Cook, D.J., & Cheng, BC. (2014). Reliability of computer-assisted lumbar intervertebral measurements using a novel vertebral motion analysis system. The Spine Journal: official journal of the North American Spine Society, 14 (2), 274-281. Abstract retrieved June 11, 2019 from PubMed database.

ORIGINAL EFFECTIVE DATE:  8/11/2007

MOST RECENT REVIEW DATE:  10/31/2019    

ID_BA

Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.