The Rationale and Safety of Routine Imaging in Rehabilitative Spine Care: Delayed Radiographs for Patients Presenting With Spine Disorders is Debatable

Postural alignment is a critical determinant of health status. Its degradation is associated with deformity-caused and compensation-related back pain, neurologic involvement, osteoarthritic development, as well as disability and reduced quality of life. Radiography remains the most efficient method of evaluating standard sagittal and coronal spine and pelvic metrics that are used to plan surgical and nonsurgical treatment strategies. Many current spine guidelines dissuade the use of initial screening X-rays and some chiropractic guidelines condemn repeat imaging to assess progress from treatment regimens; these are anti-scientific viewpoints that ignore alternate viewpoints and evidence. Current understanding of the relationship between different spinopelvic parameters are essential to plan biomechanically appropriate interventions that are patient-specific. There are radiographically measured parameter thresholds critically related to several spinal disorders and positive patient outcomes. Current guidelines must include a caveat for contemporary biomechanical evaluation and its consequent specific treatments and should recommend routine radiographic imaging for spine patients undergoing corrective rehabilitative interventions. The failure to radiographically diagnose spinal deformity is argued to be negligence in many cases. The prime obstacle to routine X-ray imaging lies with the presumed threat of cancer, however, this is dogma; we summarize the main evidence from recent publications why this is so.