Chiropractic

Why do we need full spine Xrays?

Loss of cervical curve leads to cervicogenic symptoms, total spine malalignment, and increased potential for injury as shown in the following studies:

Cervical kyphosis (segmental or total) leads to total spinal misalignment, rounding of the shoulders, headache, neck pain, scapular pain, and possibly even lower back pain.
(Traumatic thoracic outlet syndrome. Kai Y, et al. Orthop Traumatol 1998;47:1169-1171.)

Straight/reversed cervical curves at risk, potential for injury to facet capsular lig. under impact loads like rear end collision (stamper et al journal of biomechanics 2005)

Patients with cervical curves < 20 are two times as likely to have cervicogenic symptoms, odds that patient has cervicogenic symptoms with ARA Elliptical modeling and sagittal lumbar lordosis method to discriminate normal and LBP (journal of spinal disorders 1998)

Loss of lordosis predictive of neck pain. C2-c7 lordosis: Normal-34.5, acute-28.6, chronic-22.8 (Harrison dd, spine, 2004 modeling of sagittal spine as a method to discriminate hypolordosis) 72 asymptomatic, 52 acute, 70 chronic patients.

Normal ARA- 40, acute- hyperlordotic, chronic- 29.6-35, (Harrison, j of spinal disorders, 1998, Elliptical modeling of the sagittal lumbar lordosis and segmental rotation angles as a method to discriminate between normal and low back pain subjects.) 50 normal, 50, acute, 50 chronic, 25 abnormalities patients.

Reducing the anterior translation of the cervicothoracic spine and thoracic hyperkyphosis, may be beneficial in reducing the risk or occurrence of osteoporotic fractures. osteoporotic thoracic kyphosis deformities in elderly subjects are promoted by postural forces, and are subsequently exacerbated by anterior translation of the head and upper torso. The analytical model reproduces the features of spinal deformities caused by osteoporotic wedge fractures, namely, increased thoracic kyphosis. Vertebral deformities are exacerbated by anterior translation of the upper spinal column, which increase compressive loads in the thoracolumbar region of the spine. (Keller, spine, 2003, prediction of spinal deformity)

Ant. Translation increases the stresses acting on the vertebral body and may lead to early arthritic changes. (Harrison de, JMPT, 2002)

Reversal of the normal cervical spine curvature, as seen in cervical kyphosis, can lead to, mechanical pain, neurological dysfunction, and functional disabilities (grosso, j of neurosurg spine, 2013 relationship between focal kyphosis correction and neurological outcomes)

Sagittal plane spinal posture associated with future dependence in ADL. (Kamitani, gerontol a biol sci med sci, 2013). 804 patients 65-94 y/o. Admission to nursing home or home assistance. All were independent at baseline. 4 year follow up 126 became dependent. 1 unit increase in post transl = 1.79 increase in disability.

Visualization/posture analysis alone is not sufficient to determine spinal curves as shown in these studies:
1. Concurrent validity of flexicurve instrument measurements: sagittal skin contour of the cervical spine compared with lateral cervical radiographic measurements. (Harrison DE1, Haas JW, Cailliet R, Harrison DD, Holland B, Janik TJ. JMPT 2005 Oct;28(8):597-603.) The flexicurve sagittal skin contour measurement has poor concurrent validity compared with established radiographic measurements of the cervical lordosis. The flexicurve tracings always predicted lordosis, overestimated the lordosis compared with x-ray values, and cannot discriminate between radiographic lordosis, straightened, S curves, and kyphotic alignments of the cervical curve.
A comparison of actual and apparent lumbar lordosis in black and white adult females. (Mosner ea, Bryan Jim, still ma, shippee r, spine 1989;14:310-314)
Effects of gender, age, and bmi on spinal curvature in standing. (Vachalathiti r, presented at the 26th annual ISSLS conference, 219 b, Hawaii June 21-25, 1999)

Cervical subluxation correction improves LBP as shown in :
1. The effect of adding forward head posture corrective exercises in the management of lumbosacral radiculopathy: a randomized controlled study. (Moustafa IM, Diab AA, J Manipulative Physiol Ther. 2015 Mar-Apr;38(3):167-78. doi: 10.1016/j.jmpt.2014.11.009. Epub 2015 Feb 20.)

2. The addition of forward head posture correction to a functional restoration program seemed to positively affect disability, 3-dimensional spinal posture parameters, back and leg pain, and S1 nerve root function of patients with chronic discogenic lumbosacral radiculopathy.

3. Radiology and radiographic radiation not as risky as previously thought under linear no threshold models. In fact it has hormesis effect in body.
Time to reject the Lear-no threshold hypothesis and accept thresholds and hormesis: a petition to the us nuclear regulatory commission. (Marcus cs, Clin nucl med, July 2015)
Evidence for beneficial low level radiation effects and radiation hormesis. (The British Institute of Radiology, January 28, 2014)
Tremendous human, social, and economic losses caused by obstinate application of the failed linear-no threshold model. (Sutou s, yakugaku zasshi, 2015)

PCCRP guidelines – accepted by the National guideline clearing house making them a federally accepted guideline for x ray utilization.
http://www.pccrp.org/

According to the standards in section 2.B. Indications for Spine Radiography in Children and Adults which say: “The main focus of this document is the following list of patient conditions that warrant a radiographic evaluation for the assessment of spinal subluxation. This evaluation for the assessment is independent of any “Red Flags” assessment. For the assessment of spinal subluxations, the Chiropractor becomes aware of conditions which affect the safety and appropriateness of chiropractic care by conducting a consultation that should include a personal history, family history, present complaints, and any recent or past traumas. Additionally, an orthopedic, neurological, range of motion (ROM), and a postural examination may be helpful. Indications for spine radiographic examinations include, but are not limited to:

1. Abnormal posture,
2. Spinal Subluxation (as defined in this document),
3. Spinal deformity (eg, scoliosis, hyper-kyphosis, hypo-kyphosis, etc…),
4. Trauma, especially trauma to the spine,
5. Birth Trauma (eg, forceps, vacuum extraction, caesarean section etc…),
6. Restricted or abnormal motion,
7. Abnormal gait,
8. Axial pain,
9. Radiating pain (eg, upper extremity, intercostal, lower extremity),
10. Headache,
11. Suspected short leg,
12. Suspected spinal instability,
13. Follow-up for previous deformity, previous abnormal posture, previous spinal
subluxation/displacement, previous spinal instability,
14. Suspected osteoporosis,
15. Facial pain,
16. Systemic health problems (eg, skin diseases, asthma, auto-immune diseases,
organ dysfunction),
17. Neurological conditions,
18. Delayed developmental conditions,
19. Eye and vision problems other than corrective lenses,
20. Hearing disorders (eg, vertigo, tinnitus, etc…),
21. Spasm, inflammation, or tenderness,
22. Suspected abnormal pelvic morphology,
23. Post surgical evaluation,
24. Suspected spinal degeneration/arthritis,
25. Suspected congenital anomaly,
26. Pain upon spinal movement,
27. Any “Red Flag Conditions” covered in previous guidelines