Medical policy: Dynamic Spinal Visualization and Vertebral Motion Analysis

Policy number: MP 5.051

Effective date: 2/1/2026

Policy

The use of dynamic spinal visualization is considered investigational. There is insufficient evidence to support a general conclusion concerning the health outcomes or benefits associated with this procedure.

Vertebral motion analysis is considered investigational. There is insufficient evidence to support a general conclusion concerning the health outcomes or benefits associated with this procedure.

Product variations

This policy is only applicable to certain programs and products administered by Capital Blue Cross and subject to benefit variations. Please see additional information below.

FEP PPO - Refer to FEP Medical Policy Manual.

Description/Background

Flexion/extension radiography

Dynamic spinal visualization and vertebral motion analysis are proposed for individuals who are being evaluated for back or neck pain and are being considered for standard flexion/extension radiographs. Flexion/extension radiographs may be performed with a passive external force or by the patient’s own movement. Typically, radiographs are taken at the end ranges of flexion and extension and the intervertebral movements (rotation and translation) are measured to assess spinal instability. Flexion/extension radiographs may be used to assess radiographic instability in order to diagnose and determine the most effective treatment (e.g., physical therapy, decompression, or spinal fusion) or to assess the efficacy of spinal fusion.

Dynamic spinal visualization

Digital motion X-ray

Most spinal visualization technologies use x-rays to create images either on film, video monitor, or computer screen. Digital motion x-ray involves the use of film x-ray or computer-based x-ray “snapshots” taken in sequence as a patient moves. Film x-rays are digitized into a computer for manipulation, while computer-based x-rays are automatically created in a digital format. Using a computer program, the digitized snapshots are then sequenced 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 computer software 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

Videofluoroscopy and cineradiography are different names for the same procedure, which uses fluoroscopy to create real-time video images of internal structures of the body. Unlike standard x-rays, which 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 with the assistance of computer software.

Dynamic magnetic resonance imaging

Dynamic magnetic resonance imaging is also being developed to image the cervical spine. This technique uses an MRI-compatible stepless motorized positioning device and a real-time true fast imaging with steady-state precession sequence to provide passive kinematic imaging of the cervical spine. The quality of the images is lower than a typical MRI sequence but is proposed to be adequate to observe changes in alignment of vertebral bodies, the width of the spinal canal, and the spinal cord. Higher resolution imaging can be performed at the end positions of flexion and extension.

Vertebral motion analysis

Vertebral motion analysis systems like the KineGraph VMA (vertebral motion analyzer) provide assisted bending with fluoroscopic imaging and computerized analysis. The device uses facial recognition software to track vertebral bodies across the images. Proposed benefits of vertebral motion analysis are a reduction in patient-driven variability in bending and assessment of vertebral movement across the entire series of imaging rather than at the end range of flexion and extension.

Regulatory status

In 2012, the KineGraph VMA™ (vertebral motion analyzer; Ortho Kinematics) was cleared for marketing by the U.S. Food and Drug Administration through the 510(k) process (K133875). The system includes a Motion Normalizer™ for patient positioning, standard fluoroscopic imaging, and automated image recognition software. Processing of scans by Ortho Kinematics is charged separately. Table 1 lists a sampling of the spinal visualization and motion analysis devices currently cleared by the FDA. Product code: LLZ.

Table 1. Spinal visualization and motion analysis devices cleared by the U.S. Food and Drug Administration

Rationale

Summary of evidence

For individuals who have neck or back pain who receive dynamic spinal visualization, the evidence includes comparative trials. The relevant outcomes are test accuracy, symptoms, and functional outcomes. Techniques include digital motion x-rays, cineradiography/videofluoroscopy, or dynamic magnetic resonance imaging of the spine and neck. Most available studies compare spine kinetics in patients who have neck or back pain with symptomatic kinetics in healthy controls. In a feasibility study of novel dynamic magnetic resonance imaging for the detection of spondylolisthesis, three dynamic MRI protocols demonstrated sensitivities of 68.8% to 78.6% when compared to standard flexion-extension radiographs. No evidence was identified on the effect of this technology on symptoms or functional outcomes. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.

For individuals who have back or neck pain who receive vertebral motion analysis, the evidence includes comparisons to standard flexion/extension radiographs. The relevant outcomes are test accuracy, symptoms, and functional outcomes. These studies reported that vertebral motion analysis reduces variability in measurement of rotational and translational spine movement compared with standard flexion/extension radiographs. Whether the reduction in variability improves diagnostic accuracy or health outcomes is uncertain. The single study that reported on diagnostic accuracy lacked a true criterion standard, limiting interpretation of findings. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.

Definitions

N/A

Disclaimer

Capital Blue Cross’ medical policies are used to determine coverage for specific medical technologies, procedures, equipment, and services. These medical policies do not constitute medical advice and are subject to change as required by law or applicable clinical evidence from independent treatment guidelines. Treating providers are solely responsible for medical advice and treatment of members. These policies are not a guarantee of coverage or payment. Payment of claims is subject to a determination regarding the member’s benefit program and eligibility on the date of service, and a determination that the services are medically necessary and appropriate. Final processing of a claim is based upon the terms of contract that applies to the member’s benefit program, including benefit limitations and exclusions. If a provider or a member has a question concerning this medical policy, please contact Capital Blue Cross’ Provider Services or Member Services.

Coding information

Note: This list of codes may not be all-inclusive, and codes are subject to change at any time. The identification of a code in this section does not denote coverage as coverage is determined by the terms of member benefit information. In addition, not all covered services are eligible for separate reimbursement.

Investigational; therefore, not covered:

References

1. Xu N, Wang S, Yuan H, et al. Does dynamic spine magnetic resonance imaging improve the diagnostic accuracy of cervical spondylotic myelopathy? A review of the current evidence. World Neurosurg. Apr 2017; 100: 474-479. PMID 28130164
2. Teyhen DS, Flynn TW, Childs JD, et al. Arthrokinematics in a subgroup of patients likely to benefit from a lumbar stabilization exercise program. Phys Ther. Mar 2007; 87(3): 313-25. PMID 17311888
3. Ahmadi A, Maroufi N, Behtash H, et al. Kinematic analysis of dynamic lumbar motion in patients with lumbar segmental instability using digital videofluoroscopy. Eur Spine J. Nov 2009; 18(11): 1677-85. PMID 19727854
4. Walter WR, Alizai H, Bruno M, et al. Real-time dynamic 3-T MRI assessment of spine kinematics: a feasibility study utilizing three different fast pulse sequences. Acta Radiol. Jan 2021; 62(1): 58-66. PMID 32233646
5. Hino H, Abumi K, Kanayama M, et al. Dynamic motion analysis of normal and unstable cervical spines using cineradiography: an in vivo study. Spine (Phila Pa 1976). Jan 15 1999; 24(2): 163-8. PMID 9926388
6. Takanayaki S, Takahashi K, Yamagata M, et al. Using cineradiography for continuous dynamic-motion analysis of the lumbar spine. Spine (Phila Pa 1976). Sep 01 2001; 26(17): 1858-65. PMID 11568694
7. Wong KW, Leong JC, Chan MK, et al. The flexion-extension profile of lumbar spine in 100 healthy volunteers. Spine (Phila Pa 1976). Aug 01 2004; 29(15): 1636-41. PMID 15284509
8. Huneidi M, Jankowski PP, Bouvyer B, et al. Contribution of MRI and imaging exams in the diagnosis of lumbar pseudoarthrosis. Orthop Traumatol Surg Res. Jan 19 2024; 103817. PMID 38246489
9. Shin JJ, Yoo SJ, Kim TW, et al. Radiological and clinical significance of cervical dynamic magnetic resonance imaging for cervical spondylotic myelopathy. Neurospine. Jun 2024; 21(2): 443-454. PMID 38955522
10. Cheng B, Castellvi AE, Davis RJ, et al. Variability in flexion extension radiographs of the lumbar spine: a comparison of uncontrolled and controlled bending. Int J Spine Surg. 2016; 10: 20. PMID 27441178
11. Yeager MS, Cook DJ, Cheng BC. Reliability of computer-assisted lumbar intervertebral measurements using a novel vertebral motion analysis system. Spine J. Feb 01 2014; 14(2): 274-81. PMID 24239805
12. Davis RJ, Lee DC, Wade C, et al. Measurement performance of a computer assisted vertebral motion analysis system. Int J Spine Surg. 2015; 9: 36. PMID 26273554