Referring to cine[radiography], this method revealed information not observable on static x-ray because motion occurred at various stages within the range, not at the end stage. Taylor M., Skipping R, "Paradoxical Motion of the atlas inflexion: a fluoroscopic study of chiropractic patients." Euro Journal Chiropractic 1987; 35:116-34. Bell GD, "Skeletal Applications of Video fluoroscopy" Journal of Manipulative and Physiological Therapeutics Vol 13 Number 7 Sept 1990:396-405

Shippel & Robinson advocated the use of VF for evaluation of hyperextension and hyper flexion injuries because they believe such motion study can most accurately assess soft tissue damage and Ligamentous instability. The article also points out that one of the greatest advantages of using video fluoroscopy is its ability to show the joint in motion throughout the entire range of motion. Shippel AH, Robinson GK~ "Radiological and magnetic resonance imaging of cervical spine instability: a case report." Journal of Manipulative and Physiological Therapeutics 1987; 10:316-22

Stanley Paris reached the conclusion that cineradiography is superior; stating that the static radiographs are not helpful in identifying instability because they cannot capture true motion. They also stated that what happens within the normal range of motion is "considerably more valuable because subjects normally function within the first 50% of their movement, rarely at the end of their range." Paris SV, "Physical signs of instability." Spine 1985; 10.277-9

In Donald Resnik's book, long recognized as a premier reference on the subject of fluoroscopy, he states "fluoroscopy has replaced plain film for detection of meniscal tears and ligamentous abnormalities." He also says for joint motion study, fluoroscopy "provides information defining the presence of spinal instability ..."Finally, he discusses the benefit of VF especially when stress is applied to the wrist, knee, ankle, and shoulder. Resnik D. "Fluoroscopy". In: Resnik D, Niwayaina G eds. Diagnosis of bone and joint disorders. Vol. 1 2nd ed. Philadelphia.' WB Saunders. 1988.

Video Fluoroscopy, or its equivalent, cineroentgenography, has proven itself superior to conventional roentgenography for the analysis of spinal biomechanics and has been shown to be of value in clinical diagnosis. Robinson GK, Lantz G, "Video Fluoroscopy in Chiropractic Management of Cervical Syndromes." Journal of Chiropractic Research and Clinical Investigation; Vol 6, Number 4 January 1991.

Supports the superiority of cineradiography over plain film radiography in evaluating spinal mechanics. Buoncore E, Hartman JT, Nelson DL. "Cineradiograms of the cervical spine in the diagnosis of soft tissue injuries." JAMA 1966. 198:143-7.

A review of 721 relevant articles from the medical literature by the QT Force on spinal related disorders and published in Spine 1987 concluded that cineradiography has been demonstrated useful, by non-randomized control trial, in cases where radicular compression is presumed and spinal stenosis confirmed and in post surgical spine pain cases symptomatic six months or longer after surgery. Spitzer WO et al. "Scientific approach to the assessment and management of activity- related spinal disorders. A Monograph for Clinicians' Report of the Quebec Task Force on Spinal Disorders." Spine 1987,' 7S.S5-S9.

Bland describes in his 1987 text the superiority of cineradiography over all other imaging modalities in determining spine motion. Bland JH. "Disorders of the cervical spine diagnosis and medical management." Philadelphia, PA; W.B. Saunders 1987:144.

...Digital motion radiography is currently a valuable diagnostic method in evaluating painful hyper mobility and instability due to posttraumatic and degenerative pathology of capsular and axial ligaments. ÉEvaluation of certain axial and peripheral joints in motion affords a noninvasive opportunity to identify specific segments responsible for nociception. At the upper cervical levels, this technology is capable of identifying excessive motion at atlanto occipital, lateral and median atlanto axial joints, and indirectly pathology of their respective fiborous articular capsules and periarticular ligaments. Linetsky, MD, Felix, "Radiologic Evaulation Prior to Rit/Prolotheraphy", Pain Management, A Practical Guide for Clinicians

Tasharski, et al presented a case report demonstrating the superiority of cinefluorography over routine standard radiography in diagnosing abnormal atlanto-axial hyper mobility. Stating that routine stress radiographs failed to identify any reason for the patients' symptoms, but a fluoroscopic exam revealed abnormal atlanta-axial hypermobility. Tasharski CS, Heinze WJ, Pugh JL. "Dynamic atlanto-axial aberration: a case study and cinefluorographic approach to diagnosis". Journal of Manipulative and Physiological Therapeutics >1981; 2:65-68.

Stokes and Frymoyer have described the inherent difficulty of recording movement (within range of motion) characteristics from static flexion/extension films. They acknowledge that motion radiography is superior to static plain films in obtaining such information.

Stokes IAF, Frymoyer JW, "Segmental Motion and Instability". Spine 1987; 12: 688-691.

More recently, Humphreys, et al reported in the European Journal of Chiropractic that digitized video fluoroscopy is now suitable for research and clinical use in the evaluation of coronal plan lumbar spine intersegmental motion. Humphreys K, Breen A, Saxton D. "Incremental lumbar spine motion in the coronal plane: an observer variation study using digital video fluoroscopy." European Journal of Chiropractic 1990, 38: 56-62.

These and other reports, such as that by Woesner and Mitts, have shown that VF provides information which is obtainable by no other method available today, and that this information can be of vital assistance to the chiropractic or medical practitioner in assessing a patient's condition and in developing a plan of care.

A comparison study of 40 randomly selected patients who had roentgenographic investigation of the cervical spine by both cineradiography and conventional lateral roentgenograms in flexion, neutral position, and extension was made for the analysis of motion. In 14 of the 40 patients, abnormal motion was detected in the spine that was not seen on the plain roentgenograms.

Woesner ME, Mitts MG. "The evaluation of cervical spine motion below C-2: a comparison of cineroentgenography and conventional roentgenographic methods." American Journal of Roentgenology, Radium Therapy and Nuclear Medicine 1972; 115: 148-154.

The author begins by noting cineradiography is becoming widely available and reports of its use in orthopedic problems, particularly those of the cervical spine. Cineradiography has been used to detect instability not ascertainable by routine roentgenograms obtained in flexion and extension. Correspondingly, it was concluded that the use of cineradiography has elucidated abnormalities seen on plain roentgenograms of the cervical spine. Jones, Malcomb, D.,MD, "Cineradiographic Studies of Abnormalities of the High Cervical Spine", Archives of Surgery (AMA).

"Cineradiographic studies demonstrated 1 or more abnormalities in 43 of 50 patients involved in rear-end collisions." Jones, Malcomb, D., MD., "Cervical Spine Cineradiography After Traffic Accidents", Archives of Surgery (AMA).