Physiologic imaging of the spine

Spine imaging poses unique challenges to radiologist and clinician. The dynamic nature of the spine and its mobility across multiple segments is difficult to depict with any single imaging modality. Supine imaging fails to demonstrate the physiologic effects seen with axial load, physiologic posture or positional change. Physiologic imaging begins with standing radiographs. Advanced techniques include axial loading devices on conventional CT or MRI, dynamic (upright) MRI and stereoradiography (EOS). These techniques may unmask dynamic pathology that otherwise would be hidden on conventional supine imaging. Caution must be exercised where such techniques (upright MRI) reduce sensitivity to sinister disease.