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An MRI scan is often performed to diagnose disc damage and signs of compression of nerve roots. This diagnostic method has two major disadvantages. On the one hand, you only ever see one layer of the spine and never the entire construct in one picture; on the other hand, the patient is lying down. Sometimes the spine looks quite different when a patient is lying down versus standing up, which can be explained by differences in load distribution and corresponding biomechanics when the patient is standing up. Therefore, if you want to treat a patient using manual therapy techniques, a standing X-ray of the entire spine is far more helpful and gives a far more realistic picture than an MRI scan.

Source: Dr. Matthias Meier

In this case, a 17-year-old woman is complaining of chronic headaches. An MRI scan did not reveal any pathological changes other than a somewhat steep cervical spine and discrete disc bulges, thus no specific measures were recommended other than physiotherapy. Standing X-ray diagnostics, however, revealed a distinct kink between the fourth and fifth cervical vertebrae (arrow), indicating an injury to the so-called posterior longitudinal ligament and interrupting the harmonic curve of the posterior longitudinal edge. This disruption of the structure can cause the spinal cord, which is contained within the spinal column, to experience a change in tension. The patient’s reaction will always be to tense the neck muscles in an attempt to prevent this misalignment from becoming more severe to the extent possible. The kink is not visible via MRI, but is clearly visible on X-ray. The recommended treatment is clear based on the diagnosis that has now been established. The drawn curve illustrates the position the cervical spine should be in.