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Q: What is a Cervical X-ray Assessment?
A: DDS’ Cervical X-ray Assessment (CXA) is designed to objectively diagnose and identify the location, extent and nature of both neck and back injuries through evidence-based documentation and testing.
The CXA is noninvasive radiologic imaging that shows continuous X-ray images that come together in a motion picture. CXA serves as a diagnostic evaluation tool that allows our clinicians to view weight-bearing motion in real time. Your clients often feel pain when they are in motion – not while in a static position; thus, their injuries should be evaluated when they themselves are in motion.
The Cervical X-ray Assessment consists of a 10-15 page Cervical Motion Report (CMR), and a 12-14 page DXD Report. The CMR is an illustrative report that documents 12 differnet ROM. The CMR additionally includes a motion X-ray video that includes over 2,000 pictures and 7 ranges of motion, while the DXD report includes an analysis of the X-rays and an AMA Guidelines alignment. Together, the CMR and the DXD make up the most accurate, evidence based cervical diagnostic test to date.
Q: Who Needs CXA?
A: When a patient comes to his or her doctor with a complaint of pain, changes in motion range or sensory issues, the doctor’s job is to locate the cause of the complaint. CXA allows doctors to most accurately examine and diagnose your client’s neck and spinal injuries.
When the cause of those injuries is accident related, CXA becomes an important and useful tool for attorneys. CXA allows doctors to correlate subjective findings—the patient’s complaint of pain or discomfort—with objective documentation—finding the evidence that explains your client’s spinal condition. This correlation is what attorneys use in court to ensure that their clients receive the maximum compensation for the injuries.
Q: Why Cervical X-ray Assessment? The Science Behind the Technology.
A: Neck and spinal pain affects a person’s active daily life. This pain is the result of motion; therefore static films do not fully or accurately diagnose spinal injuries. A Cervical X-ray Assessment is necessary to determine impairment ratings.
The upper 30 percent of the cervical spine contains only ligaments, no discs. Motion X-rays provide key insight into a motion segment of the spine. A motion segment is “two adjacent vertebrae, the intervertebral disk, the apophyseal or facet joints, and the ligamentous structures between the vertebrae” (AMA Guidelines 4th & 5th Edition, 378). A spinal injury can manifest itself in the alteration of motion segment integrity (AOMSI), which can be loss of motion segment integrity (increased translational or angular motion) or decreased motion.
AOMSI is often the subject of misdiagnosis for two reasons: alteration occurs at the millimeter measurement, and static diagnostic technologies fail to detect these minute shifts in or within the vertebrae. DXD allows motion analysis to quantify alteration of motion segment integrity in ways standard X-rays, MRIs, and CT scans cannot. DXD measures spinal abnormalities—when translation (anterior-posterior slippage) in the cervical spine exceeds 3.5 mm and angulation (posterior wedging) exceeds 11 degrees.
Q: How do you correlate your findings with the AMA Guidelines?
A: DXD dynamically assesses musculoskeletal structures by capturing articular motion through stress views of the spine. These views provide evaluative, quantitative insight into spinal abnormalities, and, most importantly, ligament laxity in specific spinal regions. Stress views allow DDS' physicians to determine whether the vertebrae are hyper- or hypomobile and quantify ranges as normal (0-1 mm), abnormal (1.0-3.5 mm) or ratable (greater than 3.5 mm) (AMA Guielines, 379). This measurement of ligament laxity “objectively quantifies a patient’s spinal injury regardless of symptoms, disc lesions, range of motion, reflexes, age or gender” (Cielo, 2).