X-rays in flexion and extension can show angular instability of the cervical spine, as well as hypermobility or spondylolisthesis.
Additional dens imaging through the open mouth can be useful (Sandberg x-rays).
Moreover, images in lateral bending through the open mouth can be taken.
A very useful method is the passive flexion and extension x-ray with the help of the doctor. The doctors expose themselves to the radiation, and push the patient’s head in maximum flexion and extension. This technique has the advantage that the patient goes far beyond the pain and moves further than without the doctor’s force. Disadvantage, of course, is that the symptoms can get a lot worse afterwards.
X-rays do always carry the risk of radiation exposure, which is why it is very important that the radiologist knows exactly how to carry out the whole test.