This is one good reason why we recommend standing X-rays instead of lying down. First it should be pointed out that unless there is a red flag during the examination, we don’t immediately recommend X-rays of the spine prior to treatment. Normally conservative treatment can ensue for a few weeks to see if our interventions are going to be helpful. If expected improvement is not achieved then imaging may be necessary. In those cases, to obtain a better understanding of posture and weight baring, we recommend standing films.
Report in Clinical Spine Surgery
Conclusions: Routine standing lateral radiographs should be standard practice to identify DS, as nearly 1/3 of cases will be missed on supine MRI. This may have implications on whether or not an arthrodesis is performed on those patients requiring lumbar decompression. Flexion-extension radiographs demonstrated no added value compared with standing lateral x-rays for the purposes of diagnosing DS.
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