Imaging Spinal Segmental Mobility

Written by: James Demetrious, DC, DABCO

Diplomate, American Board of Chiropractic Orthopedists

“Motion is Life”

Health and homeostasis are dependent upon motion. Vital exchanges across cellular membranes, essential lymphatic drainage, CSF flow and spinal segmental mobility, etc., are vital to life functions.

The delivery of chiropractic spinal adjustments is a highly skilled procedure that requires insight into segmental hypo-mobility, hyper-mobility, and instability.

Recent Assessment

In a paper by Mathers et al., the authors provide insight into occult hypermobility of the craniocervical junction through a case report and review. They report,

“…clinicians who treat patients with neck pain and dysfunction need to carefully consider the possibility of CCJ hypermobility and instability before considering a treatment plan that includes end range mobilization or stretching techniques involving the CCJ.” [1]

From Mathers et al:

In their recent paper, Henderson et al. discuss the diagnosis of atlantoaxial instability. In this brief paper, the authors describe the etiology and diagnostic findings of ligamentous insufficiency. The authors report,

“In the hypermobility disorders, there may be abnormal facet overlap on full neck rotation<20%; lateral translation of the facet joints: translation in aggregate >7 mm on coronal imaging as seen on open mouth odontoid views. Open mouth odontoid views are very effective in identifying AAI.” [2]

New Technology

The new Konica Minolta Dynamic Digital Radiography permits visualization of physiological movement with radiation lower than an average fluoroscopy exam, and images can be taken weight-bearing or recumbent.

Questions and Thoughts

The utilization of imaging assessment of spinal segmental mobility requires continued evidence-based assessment. While incredibly interesting, further study is necessary to better define normative values, association with symptomatic presentations, appropriateness criteria, and establish standards of care.

Disclaimer

The views and opinions expressed in this presentation are solely those of the author. The information is not offered as a standard of care, as research and care evolve. We offer this only to educate and inform. Patients should seek the care of their doctors regarding their conditions.

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PostGradDC offers advanced post-graduate chiropractic continuing education. Our founder, Dr. James Demetrious, is an internationally distinguished board-certified chiropractic orthopedist, educator, author, and editor. For current, evidence-based, and clinically intuitive CE Coursework, attain your advanced training at PostGradDC.com.