Imaging modalities such as X-Ray, computerized tomography (CT), magnetic resonance imaging (MRI), and bone scan have all become essential to the evaluation of bone and soft tissue in patients with back pain. All techniques provide valuable static images of the spine, yet lack the capability of providing detailed information about spinal motion. Dynamic end-range x-rays, the standard in assessment of range of motion and vertebral translation, are taken at the patient’s maximum voluntary bending angle in flexion and extension (FE) and/or lateral bending (LB). The current standard of practice is to measure, with ruler and protractor, the relative change between adjacent vertebrae at each bending extreme. The resulting rotational or translational values are then expressed as the intervertebral angle (IVA) or as a percentage of vertebral body depth, respectively. This method, however, is subject to a high level of patient, imaging site, and observer related variability, in the form of uncontrolled bending angles, disparities in equipment and practices, and manual image analysis. An additional limitation of static imagery is the inability to assess motion in the spine as it traverses between end ranges. This information may expose motion abnormalities that occur mid-range that might otherwise be missed by clinicians. Lastly, motion of the spine may present differently in weighted and un-weighted positions. Effects of muscle activation and gravitational forces are not accounted for by current standards.

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