Upright / dynamic (flexion-extension) imaging

What it is

Upright or dynamic imaging examines the craniocervical junction in different positions — such as upright (weight-bearing), and with the neck bent forward (flexion) and backward (extension) — to assess for instability. It is used selectively in Chiari-related conditions.

Understanding Upright / dynamic (flexion-extension) imaging

Standard MRI is usually done lying down with the neck in a neutral position, which may not reveal instability that appears only with movement or weight-bearing. Dynamic imaging (flexion-extension views) and upright imaging can show whether the alignment at the craniocervical junction changes abnormally with position — important for detecting craniocervical instability (CCI) or atlantoaxial instability (AAI), which can accompany Chiari, especially in people with connective-tissue conditions like EDS. Identifying instability matters because it can change treatment (for example, requiring fusion in addition to or instead of decompression). Dynamic imaging is used selectively, particularly when instability is suspected. Understanding upright and dynamic imaging clarifies how craniocervical stability is assessed beyond standard scans.

Why it matters

Understanding dynamic imaging helps families see how examining the craniocervical junction in different positions can reveal instability that standard scans miss — important because instability can change the treatment approach.