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What is Loss of Motion Segment Integrity? 25% Impairment!

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Sample Report #1

Patient's Name: John Q. Public
Referred By: Dr. Do Right
Date of Films: 01/01/01
Report: 01/02/01

RADIOGRAPHIC BIOMECHANICAL REPORT

This report is based upon biomechanical analysis and protocols that have been established for roentgenological computerized digitization printouts of the spine. This evaluation does not include or constitute a pathological report. Radiographs used were of acceptable quality and in compliance with normal protocols for x-ray digitization.

Lateral Cervical Spine: Baselines were abnormal.

• Occiput Angle = 34.7° (normal = 16.1°).
  
• Measures for cervical stenosis appear to be within normal limits.
• George's line is abnormal C3-4 and C4-5 in the neutral lateral view.
• Jackson's Angle = 4.1° (normal = 39.9°).
• Atlas/Skull Angle = 19.3° (normal = 5.6°)
• Vertebral baselines were abnormally divergent.
• Atlas Angle = 15.5° (normal = 21.7°).
• Atlas/Axis Angle = 23.9° (normal = 0.2°).
• Motion Segment Integrity, Angular variation is abnormal at C6 = 11.7°. (normal<7.0°).
• Motion Segment Integrity, Translation is abnormal at C2= 4.7mm, C3= 3.8mm and C4= 2.9mm. (normal<2mm).
  

Lateral Cervical Spine: IMPRESSION:

1. The decreased Jackson's Angle substantiates a marked hypolordosis of the cervical spine.
2. George's line suggests ligamentous compromise at the C3-4 and C4-5 levels.
   
3. Compensation for the abnormal Jackson's Angle appears to have taken place in the upper cervical spine as evidenced by the significant variances from normal in the Occiput Angle, Atlas/Skull Angle and the Atlas/Axis angle.
4. Abnormal motion segment integrity values are indicated for both angular variation and translation as listed above. These findings are highly suggestive of ligament and connective tissue damage. *
   
5. Ratable motion segment integrity loss is measured at C6 for an angular variation value in excess of 11° and at C2 and C3 for translation values greater than or equal to 3.5mm. By definition these findings confirm damage resulting in spinal segmental instability. **
   

*Measurements over 1mm Translation and / or over 7° Angular Variation are considered to be clinically significant and in excess of normal flexibility of the cervical spine.. (SPINE 2001, February; 26(3): (256-261), Lin, Tsai, Chu and Chang.

**Abnormal measurements over 11° Angular Variation and / or greater than or equal to 3.5mm Translation (Loss of Motion Segment Integrity) by definition constitutes ligament damage which results in instability and calculates a whole person impairment of 25% to 28%. (Guides to the Evaluation of Permanent Impairment, Fifth Edition, 2001.)

Recommendation: Correlate the structural findings with functional examination findings, i.e. spinal range of motion, computerized muscle testing, NCV testing, etc. to determine levels of vertebral subluxation and treatment plan.

Harold G. McCoy, D.C., D.A.C.S., D.A.B.F.E.

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Sample Report #2

Patient's Name: John Q. Public
Referred By: Dr. Do Right
Date of Films: 01/01/01
Report: 01/02/01

RADIOGRAPHIC BIOMECHANICAL REPORT

This report is based upon biomechanical analysis and protocols that have been established for roentgenological computerized digitization printouts of the spine. This evaluation does not include or constitute a pathological report. Radiographs used were of acceptable quality and in compliance with normal protocols for x-ray digitization.

Lateral Lumbar Spine: FINDINGS

• Lumbar Gravity line falls to the anterior of the anterior tip of the sacrum and is termed "out of sectors."
• The center of L3 falls to the anterior of the sacrum by 4 mm.
• George's Line is abnormal at L2-3 in the neutral projection.
• Lower lumbar vertebral base lines converge abnormally.
• Ferguson's angle was measured at 45.6° (normal = 35.2°)
• Loss of Motion Segment Integrity, Angular Variation measurements are insufficient for consideration as a "ratable event".(ratable measures for L1-2, L2-3 and L3-4 are > 15.0°; for L4-L5 >20.0°, for L5-S1 > 25°).*
• Loss of Motion Segment Integrity, Translation measurement (hypermobile subluxation) is abnormal at L3 =6.0 mm. (ratable measures for the Lumbar spine are > 4.5mm). *
  

Lateral Lumbar Spine: IMPRESSION:

1. The lumbar gravity line position suggests an increased load distribution onto the anterior spinal elements.
2. A moderately steep Ferguson's Angle also favors axial loading to the anterior which in turn will traction the posterior lumbar connective tissues.
3. George's line is abnormal L2-3 suggesting ligamentous damage.
4. Motion segment integrity loss is noted at L3 with Translation measures greater than 4.5mm. By definition these findings confirm damage to the extent that spinal segmental instability results.
   

* Measurements of Motion Segment Integrity in the lumbar spine in excess of those listed above represent a ratable whole person impairment of 20% to 23%. (Guides to the Evaluation of Permanent Impairment, Fifth Edition, 2001.)

Recommendation: Correlate the structural findings with your functional examination, i.e. spinal range of motion, computerized muscle testing, NCV, etc. to determine levels of vertebral subluxation and treatment plan.

Harold G. McCoy, D.C., D.A.C.S., D.A.B.F.E.

Click Here to download this document in Adobe Acrobat Reader format.