 | To confirm or deny suspected ligamentous instability
and/or intersegmental dysfunction.
| To detect instability and abnormalities not
ascertainable by routine diagnostics (plain film x-ray, CT, MRI)
| For patients with pain and/or radiculopathy occurring
or increasing during motion.
| For cases with trauma involvement known to result in
ligamentous instability.
| To evaluate and document hyper or hypo mobility, and/or
neuroforaminal occlusion.
| For evaluation of spinal fusion or suspected failed
surgeries
| To rule out malingering
| For patients with residual symptoms after a reasonable
course of treatment (1-4 weeks acute, 4-8 weeks chronic).
| |
For information contact:Randy Rinkleib, D.C. Toll Free: 877-642-9680 or 530-642-9680
Buonocare, Edward, MD et.at.k, Cineradiograms of Cervical Spine in Diagnosis of Soft-Tissue Injuries, Journal American Medical Association. The author concludes that cineradiography adds another diagnostic method of evaluating suspected soft-tissue injuries of the cervical spine by demonstrating its motion during exercise. Furthermore, the cineradiographic study will have its greatest value if it can detect abnormal motion in patients who show normal spines on standard roentgenograms and before degenerative changes have occurred.
Jones, Malcomb, D.,MD., Cineradiographic Studies of Abnormalities of the High Cervical Spine, Archives of Surgery. The author begins by noting cineradiography is becoming widely available and reports of its use in orthopedic problems, particularly those of the cervical spine. Cineradiography has been used to detect instability not ascertainable by routine roentgenograms obtained in flexion and extension. Correspondingly, it was concluded that the use of cineradiography has elucidated abnormalities seen on plain roentgenograms of the cervical spine.
Jones, Malcomb, D., MD., Cervical Spine Cineradiography After Traffic Accidents, Archives of Surgery. "Cineradiographic studies demonstrated 1 or more abnormalities in 43 of 50 patients involved in rear-end collisions."
Woesner, Merlin, E., MD., and Mitts, The Evaluation of Cervical Spine Motion Below C2: A comparison of Cineroentgenographic and Conventional Roentgenographic Methods. A comparison study of 40 randomly selected patients who had roentgenographic investigation of the cervical spine by both cineradiography and conventional lateral roentgenograms in flexion, neutral position, and extension was made for the analysis of motion. In 14 of the 40 patients, abnormal motion was detected in the spine that was not seen on the plain roentgenograms.
Videofluoroscopy is a process whereby motion studies are recorded on videotape and played back on a VCR machine. Videofluoroscopy has been called by some (1) “The most valuable technique in analyzing motion of the Cervical Spine”. An area which is central to our practice.
Many authorities have written on the subject of video fluoroscopy, lending it medical as well as legal standing and credibility. These are Robert Bailey, Professor of Orthopedic Surgery at Ann Arbor, Michigan (2), John Bland, Professor of Medicine, University (4) and Donald Resnick, Professor of Radiology, University of California, San Diego, (5) to name but a few.
The areas most frequently studied are the Cervical Spine and the temporomandibular joints. Other joints, such as the shoulder, wrist and knee joints are evaluated less often.
The routine in the cervical spine is for the patient to perform a Range of Motion while being fluoroscoped, with the motion being recorded on a videotape. The various views begin with nodding, flexion, and extension, in the lateral and oblique projections, followed by lateral bending and rotation in the frontal projection, and lastly, lateral bending in the open mouth projection.
We look for any abnormal motion such as hyper or hypomobility, anterolisthesis or retrolisthesis, hypermobility or widening of the facet joints, and lateral translation of C1 on C2.
The stability of the cervical spine depends on bony structures to only a minor degree; stability depends to a major degree on the ligamentous structure. (6) Thus any abnormal bony motion is indicative of ligamentous damage and instability.
Any translation of one vertebral body on another in the Cervical Spine is abnormal, and as little as 3.5mm is considered grounds for a 25% whole person impairment. (7)
It is of single importance in the care of the patient to establish the presence of ligamentous damage, as these ligaments do not heal, and this movement of the articular surfaces results in pain via fibers of the autonomic nervous system, and long-term degenerative changes. In addition, the damaged ligaments create a fragile structure which is more susceptible to future trauma.
It should be noted that the ACCR and the Committee on Scientific Affairs has determined that the utilization of Videofluoroscopy is a useful imaging modality for the demonstration of spinal intersegmental joint dysfunction. (8)
Also in this regard, the 1993 Mercy Center Consensus Conference rated Videofluoroscopy as Promising, with evidentiary ratings of Class II and III and a consensus rating of #1 (the highest level). These Videofluoroscopy procedures are effective for evaluation for the quality of spinal motion. It is unique in this respect since, unlike stress views, it not only provides a view of total excursion, but also how the segments arrived there. (9)
In view of the above, it is my opinion that videofluoroscopy is a major addition to our diagnostic armamentarium and plays a significant role in the care and treatment of our patients.
Bibliography