Permanent Impairment Rating Through X-ray Digitization

National Injury Diagnostics
800 Wisconsin St. Bldg. D2, Mailbox 50
Suite 102
Eau Claire WI 54703
Tele: 715-833-8533  Fax: 715-839-7902
info@nationalinjurydiagnostics.com

Represented Present or Past in:
International Chiropractic Association
Washington Chiropractic Association
Wisconsin Chiropractic Association
International Association for the Study of Pain
Loss of Motion Segment Integrity

Loss of Motion Segment Integrity, TRANSLATION:  Refers to the measured A-P movement of one vertebral body compared to its adjacent vertebral body in flexion vs. extension (lateral view).

Loss of Motions Segment Integrity, ANGULAR VARIATION:  Refers to the difference in endplate angles measured in flexion vs. extension (lateral view).

The A.M.A. Guides to the Evaluation of Permanent Impairment, 5th Edition 2001, states that the following are the determining measurements, which when met or exceeded qualify for a DRE Category IV, which is assigned a Whole Person Impairment of 25% to 28%.



Translation is defined as antero-posterior motion of one vertebra over another that is:
>3.5 mm in cervical spine
>2.5 mm in thoracic spine
>4.5 mm in lumbar spine
Angular motion difference of two adjacent segments
>11 deg Cervical spine
>15 deg at L1-L2, L2-L3 & L3-L4
>20 deg at L4-L5
>25 deg at L5-S1


These same Guides tell us that:

“Motion of individual spine segments cannot be determined by physical examination but is evaluated with flexion extension roentgenograms” pg. 379 AMA Guides

“When routine x-rays are normal and severe trauma is absent, motion segment alteration is rare; thus, flexion and extension x-rays are indicated only when the physician suspects motion segment alteration from history or findings on routine x-rays.” Pg. 379 AMA Guides

Digital Radiographic Mensuration (X-ray Digitization) is computerized enhanced generation of biomechanical line drawings of plane film radiographs. Identifying biomechanical deficits such as instability of the lumbar or cervical spine such as Loss of Motion Segment Integrity is complex and difficult. It is virtually impossible for the doctor to determine these findings by just looking at the films.  The Computer aided analyses determine “exactly and accurately” what is there, making the diagnosis very accurate, thus enabling the doctor to arrive at the most conclusive diagnosis possible? This also allows the doctor to determine the most prudent course of treatment for optimal outcomes.

Many doctors are unfamiliar with computer aided digitizing analysis of spinal X-rays. However, the practice of using computers to "help" analyze radiographic films is not new it is based on the research conducted by Dr. Chung Ha Suh, at the University of Colorado under a National Institute of Health grant.
Diagnostic radiographic techniques have been shown to be reliable and they provide unparalleled diagnostic benefits. This technique has undergone peer review by an independent research agency (ECRI), which is the collaborating center of the World Health Organization; the procedure was accepted for inclusion in the US government’s National Guidelines Clearing House of the Agency for Health Care Policy and Research (AHCPR). The inclusion of Radiographic digitizing is rated as “Established”.

Smith vs. Yohe, Supreme Court of Pennsylvania 10-9-63:
“If a physician as an aid to his diagnosis (i.e.; his judgment) does not avail himself of the scientific means and facilities open to him for the collection of the BEST factual data upon which to arrive at his diagnosis, the result is not an error of judgment but negligence in failing to secure an adequate factual basis upon which to support his diagnosis or judgment.”