Lines of Mensuration – Spine Measuring Ligament Laxity/Translation Instability (Use Arrow Keys to move Forward and Backward Through this Presentation) First you must have lateral flexion and extension plain x-ray films of the spine Make the lines of Mensuration on the Extension Film (as shown in next slides) Make the lines of Mensuration on the Flexion film (as shown in next slides) Add TOGETHER the measurement (in millimeters) at each level Steven C Eggleston, D.C., Esq. Attorney at Law 620 Newport Center Dr., Suite 1100 Newport Beach, CA 92660 (949) 719-2499 www.HBTinstitute.com

Cervical Spine How to Draw Lines of Mensuration Note: I know this is a lumbar spine. This is the only example in the AMA guides for how to draw lines of mensuration. Source: AMA Guides to the Evaluation of Permanent Impairments, 5th Edition

Thoracic Spine How to Draw Lines of Mensuration Note: I know this is a lumbar spine. This is the only example in the AMA guides for how to draw lines of mensuration. Source: AMA Guides to the Evaluation of Permanent Impairments, 5th Edition

Lumbar Spine How to Draw Lines of Mensuration Source: AMA Guides to the Evaluation of Permanent Impairments, 5th Edition

This is the Bible for Rating Injuries PI Basic 2009: Impairment Ratings

Extension Film Once these lines are drawn, the measurement is made in millimeters between the two parallel lines that are perpendicular to the vertebral body. Note: Due to the limitations in absolute accuracy for drawing lines in a PowerPoint presentation, some red lines in the sample do not go directly through the blue dots. When you actually do these measurements on real x-ray films, make very small dots on the exact posterior-superior and posterior-inferior point of the vertebral body, then draw very thin lines through the dots where they were placed. Since these measurements are in millimeters, absolute accuracy with the sharpest possible pencil must be your goal. Extension Film Example of how lines are drawn on a real film. First, make dots, then draw the lines as shown. C3-C4 C4-C5 C5-C6

728.4 C3-4 C4-5 C5-6 Flexion Film Example: 1.75mm at C3-4 on Flexion + 2.0mm at C3-4 = 3.75mm Total Translation at C3-4 Measure the translation instability at each vertebral level in both flexion and extension, add them together, and that is the total translation (ligament instability) at that vertebral level.

Have A DACBR Read Your Films Experienced spine radiologists like Dr. Glynna Rangel read and mark films like this dozens of times a DAY Have someone with vast experience read your films. Get a detailed, written radiology report NOTE: Most medical radiologists are paid so little by the Health Insurance companies that they must read a full Davis series and dictate the report in one to two minutes. These reads are often unreliable and inaccurate. Have an experience spine radiologist do a 2nd opinion when the patient has symptoms that last more than 90 days and the medical radiologist read the films as “essentially normal.” It is highly likely that the ligament instability was not addressed or even looked at.

www.HBTinstitute.com Steven C Eggleston, D.C., Esq. Attorney at Law This lesson in radiology markings was brought to you by: Steven C Eggleston, D.C., Esq. Attorney at Law 620 Newport Center Dr., Suite 1100 Newport Beach, CA 92660 (949) 719-2499 www.HBTinstitute.com