Traumatic injuries to the cervical spine can injure many sensitive structures including the ligaments that hold the vertebrae together. These ligaments connect the bones and allow movement within a certain “normal” limit. When these structures are overstretched by traumatic forces, they are torn, resulting in the formation of scar tissue. The problem is a normal ligament has elastic properties, allowing it to return to “normal” length. The scarred ligament has no elastic properties. Essentially it turns into a “loose” rubber band.
This injury is generally difficult to identify unless the doctor really knows where and how to look. Properly objectifying this has huge implications for causality, a treatment plan or future treatment, and persistent functional loss. In a study on George’s Line by Muggleton and Allen (1998), the authors discussed different measurement protocols and compared them.
The authors state, “The concept of George’s line provides an ideal against which measured positions of vertebrae acquired in vivo [in the body] can be compared” (Muggleton & Allen, 1998, p. 31).
We perform a full assessment of the damage to the spinal joints and correlating ligaments utilizing evidence-based objective biomechanical analysis and protocols that have been established for Roentgenometric Digitization of the spine. We isolate and document both visually and in detailed written report, the damage to spinal joints and the following ligaments utilizing flexion extension x-rays and a digital motion x-ray.
- Anterior longitudinal
- Posterior longitudinal
The DXD software program that we use provides us the unique opportunity to capture images that will clearly indicate the dysfunctional or gapping joint to show aberrant motion isolated by movement of the patient. This may be especially helpful when determining the severity of a whiplash injury as we are able to define and quantify ligament laxity in the injured area.
Stress view pathologies are correlated with AMA guidelines.
Clinical Findings Used to Place Patient in DRE Category
- Alteration of motion segment integrity – Documenting increased translational or angular motion
- Radiculopathy, or herniated disc / Electrodiagnostic verification
- Cauda Equina syndrome
Stands up in Court
In the Circuit Court, Seventh Judicial Circuit in and for Flagler County, Florida – Hurd vs Perrotta and Perrotta, the court found that the reports from the DXD software were reliable and relevant as well as admissible. The Court further stated that the algorithm used in DXD is the same as that used by the treating neurosurgeon in this case. The finding of the neurosurgeon was similar to that of the DXD software. The Court viewed this as attestation to the accuracy and reliability of the DXD software program. It was also found that the software is sufficiently reliable as it uses the same algorithm employed in other computerized programs that utilize a Picture Archive Communication System or PACS. *Complete court document can be read here.
Below is a sample report that Dr. Colby Staubs created with the DXD software that has been compiled upon evidence-based objective biomechanical analysis and protocols that have been established for Roentgenometric Digitization of the spine. This report follows the AMA Guides to The Evaluation of Permanent Impairment, 5th Edition, Errata.
For more information or a further explanation, please contact St Petersburg Chiropractic Injury & Rehab at (727) 519-3757.