16 Medical Imaging and Radiotherapy Journal (MIRTJ) 39 (Suppl. 1)
Medical Imaging and Radiotherapy Journal (MIRTJ) 39 (Suppl. 1)
KLINIČNI POMEN SLIKANJA HRBTENICE V STOJEČEM POLOŽAJU
CLINICAL IMPORTANCE OF SPINE IMAGING IN STANDING POSITION
Marija Jeglič 
Univerzitetni klinični center Ljubljana, Klinični inštitut za radiologijo, Zaloška cesta 7, 1000 Ljubljana, Slovenija / 
University medical centre Ljubljana, Institute of Radiology, Zaloška cesta 7, 1000 Ljubljana, Slovenia
Korespondenca / Corresponding author: marija.jeglic@gmail.com
Prejeto/Recived: 12. 2. 2022
Sprejeto/Accepted: 17. 2. 2022
IZVLEČEK
Uvod: Slikanje hrbtenice je standardna slikovna metoda, ki 
dopolnjuje klinični pregled pacienta z bolečinami v hrbtu. 
Redno jo uporabljamo pri pacientih z deformirano hrbtenico, 
ki se običajno bolj zavedajo bolečinskih simptomov, medtem 
ko stojijo, in ne toliko, ko ležijo. Zato je slikanje v stoječem 
položaju ključno za pridobitev informacij o dejanskem stanju 
hrbtenice.
Namen: V prispevku so opisani klinični razlogi za napotitev 
pacienta z deformirano hrbtenico na rentgensko slikanje 
in možnosti izboljšanja rentgenske slikovne diagnostike v 
klinični praksi.
Metode: Pregled literature in opis primera. Primer pokaže 
razliko med rentgenogrami ledvene hrbtenice iste pacientke, 
slikane v ležečem in stoječem položaju.
Rezultati: Raziskave izpostavljajo statistično značilne 
razlike med meritvami v stoječem in ležečem položaju pri 
rentgenski preiskavi hrbta. Najbolj očitne razlike so pri oceni 
ledvene lordoze, Cobbovem kotu, rotacijami vretenc, nagibu 
medenice, zdrsu vretenc in zožitvi intervertebralnih foramnov.
Razprava: Prikazane deformacije hrbtenice se bodisi zaradi 
sile gravitacije bodisi zaradi naravne rotacije vretenc razlikujejo 
glede na to, ali pacient leži ali stoji. Glede na raziskave to 
sovpada z bolečinsko simptomatiko pacienta z deformacijo 
hrbtenice, zato bi bilo smiselno slikati hrbtenico takšnega 
pacienta v stoječem položaju, če zdravstveno stanje pacienta 
to omogoča. Slikovni sistem EOS predstavlja dobro izbiro, 
če si ga lahko privoščimo, saj omogoča hkratno zajemanje 
frontalnega in lateralnega rentgenograma.
Zaključek: Analiza literature potrjuje klinični vtis, da se 
na rentgenogramih hrbtenice v stoječem položaju večina 
deformacij prikaže v večjem obsegu kot pri ležečem položaju. 
Zato je pri kliničnem pregledu pacienta z bolečino ob prisotni 
deformaciji hrbtenice smiselna uporaba rentgenske preiskave 
hrbtenice stoje, ko je to mogoče in ob upoštevanju načel 
ALARA (angl. as low as reasonably achievable). Pri tem si lahko 
pomagamo s pripomočki za stabilizacijo pacientov. 
Ključne besede: slikanje stoje, deformacija hrbtenice, slikanje 
hrbtenice, lordoza, skolioza
ABSTRACT
Introduction: Spine x-ray imaging represents a standard 
x-ray imaging technique as part of a clinical examination of 
patients with spine deformities when experiencing back pain. 
These patients with spine deformities are usually more aware 
of symptoms when standing and not as much when lying 
down. Therefore, taking x-rays while standing is crucial to 
obtain important information about the actual condition of 
the spine.
Purpose: The paper describes clinical reasons for appointing 
a patient with a deformed spine on X-ray imaging and 
possibilities of improving X-ray imaging diagnostics in clinical 
practice. 
Methods: Literature review and case description. The case 
shows the diff erence between lumbar spine radiographs of 
the same patient, taken in the supine and standing position.
Results: The studies highlight statistically signifi cant 
diff erences between standing and lying down X-rays image 
measurements. The most obvious diff erences are in lumbar 
lordosis, Cobb angle, vertebral rotations, pelvic tilt, vertebral 
slippage, and foramen narrowing.
Discussion: The radiographs of spine deformities diff er when 
the patient is lying down or standing up because of gravity 
load or the natural rotation of the vertebrae. According to the 
research, this coincides with the pain symptoms of a patient 
with spinal deformity, so it would make sense to use X-ray 
imaging of the spine in such a patient in a standing position 
if the patient´s medical condition allows it. EOS technology 
is a good option if it can be aff orded, because it allows 
simultaneous acquisition of frontal and lateral images.
Conclusions: An analysis of the literature confi rms the clinical 
impression that most deformities appear on the radiographs 
of the spine in the standing position largely than in the supine 
position. Therefore, in the clinical examination of a patient in 
pain in the presence of spinal deformity, it is clinically justifi ed 
to use X-ray examination of the spine standing up, when 
possible and taking into account the principles of ALARA (as 
low as reasonably achievable). Patient stabilization aids can 
help.
Keywords: standing x-rays imaging, spine deformation, 
lordosis, scoliosis
Medical Imaging and Radiotherapy Journal (MIRTJ) 39 (Suppl. 1) 17
Medical Imaging and Radiotherapy Journal (MIRTJ) 39 (Suppl. 1)
LITERATURA / REFERENCES
Abul-Kasim K, Overgaard A, Maly P, et al. Low-dose helical 
computed tomography (CT) in the perioperative workup 
of adolescent idiopathic scoliosis. Eur Radiol. 2009;19(3): 
610–18. [PubMed] [Google Scholar]
 Adam C, Izatt M, Askin G. Design and evaluation of an MRI 
compatible axial compression device for 3D assessment of 
spinal deformity and fl exibility in AIS. Stud Health Technol 
Inform. 2010;158:38–43. 
Cobb J. Outline for the study of scoliosis. Instr Course Lect. 
1948; 5: 261–75.
Dhakal GR, et al. Comparison between Standing and Supine 
Lateral Radiographs in Low Grade Spondylolisthesis. 
Department of Spine Surgery, Park Clinic, Kolkata, India. 
14-JMMIHS. Volume 2, Issue 4. 2015
Even JL, Chen AF, Lee JY. Imaging characteristics of »dynamic« 
versus »static« spondylolisthesis: analysis using magnetic 
resonance imaging and fl exion/extension fi lms. Spine J. 
2014; 14: 1965-1969.  [PubMed]  [DOI]
Fischgrund J et al. Rothman-Simeone The Spine; 7th Edition. 
Chapter 12: Spine imaging (Jeff rey S. Ross, MD, Gordon R. 
Bell, MD)
Frieder M, Christian J et al. Changes in the Lumbar Spine 
of Athletes From Supine to the True-Standing Position 
in Magnetic Resonance Imaging. Spine 35 (9): 1002-7. 
20/04/2010.
Hasewaga H, Okamoto M et al. Diff erence in whole spinal 
alignment between supine and standing positions 
in patients with adult spinal deformity using a new 
comparison method with slot-scanning three-dimensional 
x-ray imager and computed tomography through 
digital reconstructed radiography. BMC Muskuloskeletal 
Disorders volume 19, Article number: 437 (2018).
Illes T, Tunyogi-Csapo M, Somoskeoy S. Breakthrough in three-
dimensional scoliosis diagnosis: signifi cance of horizontal 
plane view and vertebra vectors. Eur Spine J. 2011; 20(1): 
135–43. [PMC free article] [PubMed] [Google Scholar]
Kalra MK, Quick P, Singh S, et al. Whole spine CT for evaluation 
of scoliosis in children: Feasibility of sub-milliSievert 
scanning protocol. Acta Radiol. 2013; 54: 226–30. [PubMed] 
[Google Scholar]
Kanno H, Ozawa H, Koizumi Y, Morozumi N, Aizawa T, Ishii 
Y, Itoi E. Changes in lumbar spondylolisthesis on axial-
loaded MRI: do they reproduce the positional changes in 
the degree of olisthesis observed on X-ray images in the 
standing position? Spine J. 2015; 15: 1255-1262.  [PubMed] 
[DOI]
Labelle H, Aubin CE, Jackson R, et al. Seeing the spine in 
3D: How will it change what we do? Journal of pediatric 
orthopedics. 2011;31(1 Suppl):S37–45. [PubMed] [Google 
Scholar]
Lam GC, Hill DL, Le LH, et al. Vertebral rotation measurement: 
A summary and comparison of common radiographic 
and CT methods. Scoliosis. 2008;3:16. [PMC free article] 
[PubMed] [Google Scholar]
Leone A, Guglielmi G, Cassar-Pullicino VN, Bonomo L. Lumbar 
intervertebral instability: a review. Radiology. 2007; 245: 
62-77.  [PubMed]  [DOI].
Mario Cabraja, Ellafi  Mohamed, Daniel Koeppen, Stefan 
Kroppenstedt. The analysis of segmental mobility with 
diff erent lumbar radiographs in symptomatic patients 
with a spondylolisthesis. Eur Spine J. 2012; 21: 256-261.
Maus T. Imaging the Back Pain Patient. Physical Medicine and 
Rehabilitation Clinics of North America. Volume 21, Issue 4, 
November 2010, Pages 725-766.
Stokes IA. Three-dimensional terminology of spinal deformity. 
A report presented to the Scoliosis Research Society by 
the Scoliosis Research Society Working Group on 3-D 
terminology of spinal deformity. Spine. 1994; 19(2): 236–
48. [PubMed] [Google Scholar]
Vavruch L, Tropp H, et al. A Comparison of Cobb Angle: 
Standing Versus Supine Images of Late-Onset Idiopathic 
Scoliosis. Pol J Radiol, 2016; 81: 270-276