What an X-ray Can Show After a Car Accident, and What It Cannot
A spinal X-ray after a car accident shows bone and alignment. It does not show discs, ligaments, nerves, or the spinal cord directly, and in a high-risk trauma patient it misses many injuries that CT finds. X-rays still answer specific questions well, especially about alignment and motion. Which question is being asked decides whether an X-ray is the right test, and that is how I use them with patients in Charlotte.
X-ray Is Not the First Test for Suspected Fracture
The American College of Radiology's Appropriateness Criteria for suspected spine trauma state that CT is preferred to radiographs for the initial assessment of spine trauma (Beckmann, J Am Coll Radiol 2019). The reason is sensitivity. In a meta-analysis of seven studies, pooled sensitivity for cervical spine injury was 52% for plain radiographs and 98% for CT (Holmes and Akkinepalli, J Trauma 2005). A patient who meets the criteria for imaging after a crash should have CT, not an X-ray, when fracture is the concern.
What an X-ray Does Show
An X-ray shows the shape and position of each vertebra, the spacing between them, and the curve of the spine. A standing X-ray shows that alignment under the body's weight, which a lying-down study cannot. At a Charlotte spine center, 28% of spondylolisthesis levels seen on standing radiographs were not visible on supine MRI (Segebarth, J Spinal Disord Tech 2015). Those were degenerative cases, but the principle carries over: position changes what the image shows.
What Motion X-rays Add
Lateral X-rays taken in flexion and extension measure how far each vertebra slides and tilts on the next. The AMA Guides to the Evaluation of Permanent Impairment accept alteration of motion segment integrity, the radiographic sign of ligament laxity, only on these plain-film motion views. No other imaging test is used for that rating. Motion films are taken only after fracture has been excluded.
Curve Changes After a Collision
One retrospective case series found 41 patients from three spine clinics who had a lateral cervical X-ray before a motor vehicle collision and another after it (Haas, Diagnostics 2024). After the crash, C2-C7 lordosis was reduced by about 8 degrees on average, with the greatest loss at C3-C5. Pain scores rose from 2.7 to 5.0 out of 10. Four patients, about 10%, developed segmental translations just under the 3.5 mm instability threshold.
That study has real limits. It is a retrospective case series with no control group, the patients came from clinics that already X-ray routinely, and the authors include researchers affiliated with Chiropractic Biophysics NonProfit and with PostureCo, the developer of the measurement software. It is the only study I know of with before-and-after films in the same patients. It supports the idea that alignment can change after a crash. It does not establish how often that happens or what it means for symptoms.
What an X-ray Cannot Show
An X-ray cannot show a disc herniation, a torn ligament on a still film, swelling in the bone, or injury to the spinal cord or nerves. The ACR criteria rate MRI as usually appropriate when there is concern for ligament injury (Beckmann, J Am Coll Radiol 2019). A normal X-ray report after a crash means the bones and alignment on that film looked normal. It is not a statement that the spine is uninjured.
For an example of how post-collision imaging findings and outcomes are documented in the peer-reviewed literature, read Dr. Justin Dick's published case report on refractory lumbar pain following a motor vehicle accident in a geriatric patient.
Frequently Asked Questions
Can an X-ray show a spinal injury after a car accident?
An X-ray shows bone and alignment. It misses many injuries in high-risk trauma patients, with 52% pooled sensitivity in the cervical spine compared with 98% for CT (Holmes and Akkinepalli, J Trauma 2005).
Should I get an X-ray or CT after a car accident?
When fracture is the concern and imaging is indicated, CT is preferred. The American College of Radiology states that CT is preferred to radiographs for the initial assessment of spine trauma (Beckmann, J Am Coll Radiol 2019).
Can an X-ray show a herniated disc or torn ligament?
No. X-rays do not show discs or ligaments directly. MRI is usually appropriate when there is concern for ligament injury, and flexion and extension X-rays can measure excessive motion caused by ligament laxity.
Can a car accident change the curve of the neck on X-ray?
One case series of 41 patients with X-rays before and after a crash found an average loss of about 8 degrees of cervical lordosis (Haas, Diagnostics 2024). The study had no control group, and the finding needs confirmation.
What do flexion and extension X-rays show?
They measure how far each vertebra slides and tilts on the next. The AMA Guides accept alteration of motion segment integrity only on these films. Dr. Justin Dick in Charlotte, NC takes them after fracture has been excluded.
Where can I get spinal X-rays after a car accident in Charlotte, NC?
Dr. Justin Dick, DC, CNMT, ARRT(N)(CT), performs and reviews spinal X-rays for car accident patients at Clear Life Scoliosis and Chiropractic Center, 8814 Rachel Freeman Way, Suite 103, Charlotte, NC 28278, phone 980-368-0766. Personal injury patients are treated on a lien basis, with no out-of-pocket payment at the time of care.
Sources and Evidence Tiers
- Beckmann NM, West OC, Nunez D, et al. ACR Appropriateness Criteria: Suspected Spine Trauma. J Am Coll Radiol. 2019;16(5S):S264-S285. PMID 31054754. LinkEvidence tier: Evidence-based guideline with expert panel rating (RAND/UCLA and GRADE)
- Holmes JF, Akkinepalli R. Computed tomography versus plain radiography to screen for cervical spine injury: a meta-analysis. J Trauma. 2005;58(5):902-905. PMID 15920400. LinkEvidence tier: Meta-analysis of observational studies (no RCTs)
- American Medical Association. Guides to the Evaluation of Permanent Impairment, Fourth, Fifth, and Sixth Editions.Evidence tier: Expert consensus (impairment rating guideline)
- Segebarth B, Kurd MF, Haug PH, Davis R. Routine upright imaging for evaluating degenerative lumbar stenosis: incidence of degenerative spondylolisthesis missed on supine MRI. J Spinal Disord Tech. 2015;28(10):394-397. PMID 25353204. LinkEvidence tier: Retrospective cohort
- Haas JW, Oakley PA, Ferrantelli JR, Katz EA, Moustafa IM, Harrison DE. Abnormal static sagittal cervical curvatures following motor vehicle collisions: a retrospective case series of 41 patients before and after a crash exposure. Diagnostics (Basel). 2024;14(9):957. PMID 38732372. LinkEvidence tier: Retrospective case series; authors include CBP NonProfit and PostureCo affiliations
About the author. Dr. Justin M. Dick, DC, is the owner and treating clinician at Clear Life Scoliosis and Chiropractic Center in Charlotte, NC. He holds dual imaging credentials as a Certified Nuclear Medicine Technologist (CNMT) and as an ARRT-registered technologist in nuclear medicine and CT, ARRT(N)(CT). He is a Senior Fellow of the CLEAR Institute, holds the ISICO World Masters credential, is a SOSORT provisional member, and is a certified DOT medical examiner on the FMCSA National Registry. He has multiple peer-reviewed publications indexed in PubMed and serves as adjunct faculty at Life, Sherman, and Palmer chiropractic colleges.
Service Area
Clear Life Scoliosis and Chiropractic Center sees personal injury and spinal imaging patients from Charlotte NC, Huntersville NC, Ballantyne NC, Matthews NC, Concord NC, Mooresville NC, Rock Hill SC, and Fort Mill SC.
Related Pages
- Personal injury and car accident spinal care in Charlotte
- Dr. Justin Dick's research
- Case report: refractory lumbar pain after a motor vehicle accident
- Research and evidence at Clear Life
- Questions and answers
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Clear Life Scoliosis and Chiropractic Center
8814 Rachel Freeman Way, Suite 103
Charlotte, NC 28278
Phone: 980-368-0766
Email: office@clearlifescoliosis.com
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