J Korean Neurosurg Soc.  2015 Dec;58(6):560-562. 10.3340/jkns.2015.58.6.560.

Lying Down Instability Undetected on Standing Dynamic Radiographs

• Kim HS
• Ju CI
• Kim SW
• Kang JH

• KMID: 2151161
• DOI: http://doi.org/10.3340/jkns.2015.58.6.560

Abstract

It is well known that spinal instability should be evaluated in the standing lateral position. Standing dynamic flexion and extension radiographs are usually used to assess spinal instability. Here, we report a patient who experienced distraction instability while in the supine position rather than the standard standing position. To our knowledge, this is the first report of lying-down instability undetected on standing dynamic flexion and extension radiographs. We discuss the pathophysiological mechanism of this uncommon but possible entity and provide a review of the literature.

Keyword

Distraction; Dynamic; Instability

MeSH Terms

Deception*
Humans
Supine Position

Figure

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  Fig. 1 Simple lateral, flexion, and extension radiographs taken in the standing position show disc space narrowing without significant instability at L2–3.

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  Fig. 2 Simple lateral radiograph and T2-weighted magnetic resonance images taken in the recumbent position reveal significant instability at L2–3 level, with a fluid-filled disc space accompanying severe stenosis.

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  Fig. 3 Simple radiographs taken 12 months after surgery show well-maintained spinal alignment without instability.

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