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Shaw Chiropractic
A Medical-Legal Newsletter for Personal Injury Attorneys
by Dr. Steven W. Shaw

Fluoroscopy: Objective Evidence of Injury

Several years ago I had written a newsletter on the topic of Fluoroscopy and its spine applications. Fluoroscopy has once again become a popular imaging modality. Therefore, I have decided to revisit the topic and reprint the prior newsletter with some updates.

I was recently asked by an attorney why there was no way to objectively document a client’s neck pain. He could not understand why the MRI was negative if a problem existed. I explained that most spinal complaints are of a mechanical nature. Therefore, complaints cannot be demonstrated on conventional studies which are designed to image static anatomical abnormalities. Unlike a disc herniation or fracture, a mechanical lesion can only be demonstrated using a test which measures functional alterations.

To appreciate the functional versus structural concept you may want to consider a patient with a kidney infection. Imaging studies of the kidneys would most likely be normal. However, functional tests like blood chemistry and urine analysis would demonstrate the functional components of the infection. In a similar fashion, a person who was neck pain with pain referred down the arm may have EMG abnormalities in the absence of a disc herniation or tumor. Many of the body’s illnesses are functional rather than anatomical and therefore assessed in a different manner than anatomical lesions. Unfortunately, we have become so crazed with the anatomical imaging studies like MRI, CT, Ultrasound, X-ray, etc that we don’t always look for the right test. Rather, we do what has become habit.

Several years ago, a well respected Hartford lawyer called me after returning from a national trial lawyers meeting in Las Vegas. He was excited about this “new” technology he had just studied. He could not get over the incredible benefits of the procedure and encouraged me to look into it further. The technology he was referring to is called video fluoroscopy (VF).

Fortunately, I was very familiar with the VF procedures and in fact had owned a VF machine for several years. I had been reluctant to use the test since no one in the New England area had been using the gy for this specific approach. In our office we only used the VF technology when it was absolutely necessary and perhaps we erred in our much too conservative patient selection criteria.

Fluoroscopy is also known as video fluoroscopy, cineradiography and fluorovideo motion analysis and most recently as dynamic motion x-ray (DMX). Every hospital in the country has a fluoroscopic suite which they use for upper and lower GI studies as well as during invasive injection techniques such as facet blocks. Orthopedic surgeons will use the technology during surgical procedures to determine if joint replacements are installed and functioning properly. In a similar manner, the fluoroscope can be used to assess spinal function to determine abnormal coupling patterns of adjacent vertebra.

VF imaging is a form of low dose x-ray which is recorded like a movie x-ray. In the early days the recording medium used was movie film and thus it was termed cineradiography. With the advances in video capture and storage the term video fluoroscopy has become popular. Regardless of what you call it, the procedure which is very low in radiation exposure can demonstrate the movement of the spine during multiple planes of motion.

The test is valuable for several reasons. First, it can assess the ligamentous integrity of the spine by showing areas of laxity and instability. Second, unlike stress x-ray films which are limited to end range analysis, motion patterns can be evaluated. This will assist in the determination of transitional abberancies in joint coupling from muscular imbalances, joint disorders and pathology. Finally, VF is a visual technology which can easily be demonstrated to concerned parties such as patients, insurance adjusters and jurors. This is exactly the type of information a jury can digest for a better appreciation of a clients injuries. The video information is easy to see and is real time so that it keeps their attention.

In the past year, several mobile fluoroscopic services have started in Connecticut. Unfortunately, the fees charged by for the services often exceed those charged for MRI services. In order to make the procedure more accessible and reasonable, last month we acquired a mobile fluoroscopic unit to be used for our offices. The machine will be brought to each of our offices on an as needed basis to accommodate our patients. We have hired a technician with experience in the procedure and contracted with a radiologist to do interpretation of the studies. It is our hope that by adding this to our available services we can better serve the patients health care needs as well as document the injuries in a more objective and demonstrable manner