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.
Dynamic spinal visualization (i.e., digital motion x-ray, videofluoroscopy/cineradiography, dynamic magnetic resonance imaging) in the evaluation of the spine is considered investigational.
Vertebral motion analysis (i.e., KineGraph VMA™) is considered investigational.
Any specific products referenced in this policy are just examples and are intended for illustrative purposes only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available. These examples are contained in the parenthetical e.g. statement.
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits, or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
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.
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
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