The Two Most Important Imaging Bio-markers for Spinal Ligament Injury
In this article, I want to give you a quick overview of the two most important imaging bio-markers for spinal ligament injury. These two bio-markers are what doctors should use to determine the severity and the location of a ligament injury.
Unfortunately, this is not the standard practice, or the standard work up used for spinal injury patients. Most patients that have spinal ligament injuries are working with doctors that actually have no idea about the severity and location of their ligament injuries.
That is really a huge problem going on today because its these injuries that are the most common cause of chronic pain and disability today. We really need to have more doctors in the market that can work up these injuries in a standardized fashion.
What Is a Imaging Bio-marker?
The first challenge we have when understanding how imaging bio-markers can be used to diagnose injured patients is to begin with a definition.
So first off, a imaging bio marker is a feature in an image that indicates a biological state in the body.
For example, a common imaging bio-marker is a fracture. There isn’t anyone who can tell someone they have a fractured bone without an x-ray or a CT scan. It’s a separation of bone or a misalignment of bone that is visible on either an x-ray or a CT scan, which is the definitive imaging bio-marker. These images also show the location and the severity of the fracture.
When we have ligament damage to the spine there are two imaging bio-markers, and there are two completely different modalities that pick them up.
The most prominent imaging bio-marker to determine both the severity and location of a ligament injury is excessive motion in the joint.
Stress radiology, flexion extension radiology where you are stressing a joint coupled with highly accurate measurements of the intersegmental motion allows for discovery of this imaging bio-marker.
The way you uncover this is with Spinal Kinetics, CRMA, or an excessive motion study. You’ll want to use a board-certified medical radiology company like Spinal Kinetics to accurately carry out this study.
Spinal Kinetics is a niche company that serves the entire United States. They do these studies for medical doctors, chiropractors, or anyone else in the spinal ligament injury market. This is a resource we are going to talk about more later in this article.
Let Me Offer A Quick Refresher on The Spine Itself
The spin is made up of over 100 joints and there are over 220 specialized ligaments that hold it together, only 23 of these ligaments are discs, so there are a lot of non-disc ligaments with the potential to cause issues.
As a matter of fact, in between two vertebra there is a disc, we all accept that. There are nine other ligaments that hold that spinal motion unit or joint together.
So, when we have excessive motion, we need a study that tells us what is going on with all ten affected ligaments, not just the disc.
This is the imaging bio-marker that tells us how severe the excessive motion is and allows us to grade the severity of the sprain or spinal instability.
We Need an MRI to Pick Up Disc Herniation
Remember, I said there’s 220 specialized ligaments in the spine. If one of the 23 ligaments that form the discs herniates, we need an MRI to pick that up. This is not going to show up on stress radiology, but stress radiology today with excessive motion testing can give us a better idea if the disc is involved or not.
An MRI cannot pick up excessive motion, but it does a fantastic job picking up these disc herniations. These are two completely different imaging bio-markers.
Now, any doctor that’s working with a disc injury patient should first ask the question:
“Is there excessive motion in the other 9 ligaments associated with this disc herniation?”
They then need to assess whether there is significant or severe excessive motion associated with this disc, they need to know is it occurring at the same level? Is it above the disc? Is it below the disc?
If this turns out to be the case a doctor needs to know. That way he or she can devise a treatment plan that accounts for this.
These types of injuries rehab differently. This is something that plagues the injury market. We have patients with this type of injury and the doctors have no idea. Obviously, with this being the case, they cannot offer an effective treatment and the patient shows limited if any improvement.
An Outside Third-Party Is Needed to Find These Imaging Bio-Markers
Something I’m going to suggest doesn’t always sit well with doctors. That doesn’t make it untrue. These imaging bio-markers are so significant that they should always be done by a qualified independent third-party medical radiologist in order to have the findings accepted. Period. That way everyone is assured that provider bias is not in play.
Treating providers should stay in their lane with treatment and leave imaging to the radiologists. That way everyone is doing what they do best. This also removes the issue of bias. We need these images to be beyond reproach. Why?
The imaging findings themselves are what drives all reimbursement.
What I found out a long time ago as a treating provider, is that it was best to have these done by an unbiased independent third-party. As a treating doctor, if I was going to send out for an MRI study to check for disc herniation, I wanted it done independently.
I wanted zero liability of having the images come back and try to read them myself. I don’t deal with them enough. Best to leave this to the experts and stay in my space.
What my space was, was the treatment of the conditions that the radiologist identified.
If I wanted an excessive motion study done…again this needed to be done in an unbiased manner.
This way us treating providers can just use the results to drive care. It’s done unbiased, so there’s no manipulation of the results.
Treating Providers Are Looked Upon as Having a Bias
Often, treating providers are seen as having a vested interest in a finding coming out a certain way. This can cause reimbursement issues and integrity issues. This is something that us doctors in the space have no need for.
Let me give you an example to show you what I mean and how this looks to an insurance company.
Say, we have a surgeon and he does spinal fusion surgeries. There is no way that it’s going to be looked upon favorably if he is ordering, executing, and interpreting his own excessive motion studies to obtain pre-authorization of these procedures.
We can recognize that the insurance carrier is going to have an issue with this way of doing things. It just wouldn’t be allowed to happen. And in the spinal injury market, it shouldn’t happen either.
These finding are so important; they drive all reimbursement. They need to be done in an independent and unbiased manner.
So, let’s recap what we’ve went over today.
There are two imaging bio-markers that we need to become experts in:
- MRI Studies
- Stress X-ray Excessive Motion Studies
One of them, the MRI shows us herniated discs and the other one shows us the severity of injury and location of injury of the other spinal ligaments.
Whenever we order one of these studies they need to be done and interpreted by an independent third-party.
This removes all issues of bias and allows for easier documentation. This gives us our best chance for reimbursement from the insurer.
By accepting these two Imaging bio-markers we can move towards a standard way of diagnosing these injuries. Cavities in the dental industry are all worked up the same. Spinal ligament injuries should be no different. This is something that is sorely lacking and one of the things that the SmartInjuryDoctors®Program brings to the market today.
For more information on Spinal Ligament Injuries please check us out at www.smartinjurydoctor.com or check out our SmartInjuryDoctors® Podcasts on Apple Podcasts, Spotify, Google Play or Stitcher.
For information on spinal ligament testing by board certified medical radiologists go to www.thespinalkinetics.com
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