Spinal Ligament Injuries - The Missing LinkBack pain is the leading cause of disability world wide, with many people missing a diagnosis of a pathoanotomic lesion, or cause.
How many people go to their physician with back pain, and leave with a diagnosis of "back pain"? People are commonly diagnosed with "lumbago" and "cervicalgia", which is nothing more than a description of their symptoms. Unfortunately, without a better diagnosis of the cause of a patient's back pain, such as disc herniation, facet syndrome, circumferential or radial tear, spinal stenosis, or alteration of motion segment integrity (spinal ligament instability) patient outcomes are poor and the cost of treatment is higher. When a person does not have an accurate diagnosis, how can they be prescribed treatment? Obviously, they can't be prescribed the most appropriate treatment for their particular condition, and here lies the heart of our problem and world wide back pain and opiate addiction/abuse epidemic. The most common diagnosis for back pain in medicine, is the sprain/strain diagnosis. A sprain/strain is a diagnosis of a torn ligament (sprain) and a torn muscle (strain). Sprains and strains can be graded based on how much of the muscle or ligament is torn. According to the current ICD-10 (international classification of diseases) codes, which physicians use to describe the patient's condition, the physician cannot grade your sprain/strain! This is a significant problem, considering that a grade one sprain has no change in ligament length (thus no instability), but a grade three sprain is torn from 2/3 to a complete tear, and causes laxity in the joint resulting in increased pain, arthritic degeneration and possible nerve and spinal cord compression. Grade 2 and 3 spinal ligament sprains are serious medical conditions and can cause spinal ligament instability, or "Alteration of Motion Segment Integrity", that carries up to a 25% whole person impairment according to the AMA Guides to Impairment. The definition of spinal instability is well established in the medical peer reviewed literature, and has been defined by White and Panjabi, who are considered world leading spinal biomechanists. You would think there would be a standard way to "work up" and diagnosis these injuries, which are the most common cause for back pain in the world wouldn't you? Until Computerized Radiographic Mensuration Analysis (CRMA), there has not been an efficient way to grade and diagnosis the degree of a spinal ligament sprain. CRMA, or Computerized Radiographic Mensuration Analysis is not complicated or difficult to understand, rather it is exactly the opposite, a simple and uncomplicated process of measuring excessive movement of the bones of the spine on an x-ray. A CRMA analysis of an x-ray, is nothing more than using computer software to speed up the process of what we used to do by hand to check for ligament damage to the spine, which is mark anatomical points on the x-ray image and measure slippage in millimeters, or excessive rotation of one of the vertebra on one-another in degrees. Now we simply mark anatomical points, and the computer does all the measuring for us. We can now uphold a higher standard of care by checking an entire spinal region with high accuracy for ligament sprain and potential instability that could result in chronic pain, life long loss of enjoyment, create stress and difficulty with work, school and household duties, and even result in spinal fusion surgery to stabilize the spine. CRMA is an incredibly important test that allows us to diagnose torn spinal ligaments, which are considered one of the worst soft tissue injuries you can have. If you are interested in having CRMA performed for yourself, one of your clients, or if you want to begin using it in your practice contact my office or Spinal Kinetics. Spinal Kinetics is leading the way in spinal ligament testing in the United States. Healthcare providers have a duty to uphold a high standard of care, and with these injuries causing such a high degree of impairment and potential disability in the long-term, I believe that every patient should have CRMA testing as the "Standard of Care". With accurate spinal ligament sprain testing, we can better diagnose, prognose and treat the most common cause of back pain in the world, the spinal ligament sprain. |
Translation Instability
Angular/Rotational Instability
Harvard’s Augustas White, MD, and Yale’s Manohar Panjabi, PhD, established the standard for the assessment of clinical instability. Their initial article was published in the journal Clinical Orthopaedics and Related Research in June, 1975, and titled (7):
Biomechanical analysis of clinical stability in the cervical spine |
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The following information is courtesy of Chaney Law Firm, PA:
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Trial Judge Court Order on CRMA
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Learn about Spinal Sprains and CRMA
Videos Courtesy of Spinal Kinetics
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