Is a unique imaging system, which enables the treating doctor to visualize the internal and external movements of the body or biomechanics simultaneously. Videotaping shows normal & abnormal joint motion, fractures, ligament damage and anterolisthese. Aids in the evaluation of Musculoskeletal disorders and a number of Orthopedic and Neuro-surgical procedures.

   Dynamic Motion X-ray (DMX) is the best diagnostic imaging tool to objectively demonstrate ligament instability, soft tissue injuries and intersegmental joint dysfunction. Earliest mention of motion x-rays with reference to abnormal motion in the cervical spine was by William Fielding, M.D., and an orthopedic surgeon, stating "the moving pictures must be seen for these movements to be fully appreciated it is impossible to describe adequately with static illustrations".

   DMX examination today, consists of the technologist having the patient move through a series of defined positional movements, while the fluoroscopic image is recorded on a VHS tape at 30 frames per second. The exam can be played back in real-time, slow motion or freeze frame, but it is the dynamic or motion aspect of the examination which shows the extent of the patient's injuries. This technology uses a low dose generator that keeps the patient exposure to a minimum. Standard hospital x-ray equipment uses an MA setting range from 100, 200 to 300 MA. DMX's is set at 2 or 3 MA. A typical examination runs approximately three minutes, which equals to exposure received by three static x-rays. To be able to see what we can see in three minutes, one would have to be exposed to some 3200 x-rays! Once the examination is completed, a videotape, if requested, is left with the ordering physician. A Radiologist trained specifically in the interpretation of these exams.

   Injuries to the neck, shoulder and thoracic/dorsal areas are often significant injuries brought about by either frontal or rear impact motor vehicle accidents. The resulting injuries are often soft tissue only. Typically instability of the cervical spine is thought to be due to the elastic and plastic deformation of the ligamentous structures and disc. Hypermobility and aberrant motion are most often the result of instability. Video fluoroscopic joint motion study is the ideal means of providing the examiner with information pertaining to stability within the spine. Alteration of normal coupling characteristic and loss of symmetry within the pattern of motion observed are but two key findings revealed by DMX. Cineroentgenography demonstrated abnormal motion not detected on conventional roentgenograms. Dynamic motion of the cervical spine cannot be observed on static x-rays. With the application of cineroentgenographic and, preferably, videofluoroscopic joint motion studies, pattern of motion, soft tissue damage, ligamentous instability, permanency of injury and prognosis are more capably assessed Indications for a study includes cases where post-traumatic instability is suspected either from physical examination findings or static radiographic interpretation, and also restricted range of motion, recurrent myelopathic and radicular symptomatology and cases where the patient is suspected to be malingering.

   DMX studies may be most helpful in discovering new information when routine plain films are normal, demonstrating suspected abnormalities from routine films, determining at what point in motion the hypermobility or aberrant motion occurs and revealing which characteristics in the pattern of motion are disturbed by instabilities regardless of their subtlety. It has also been a diagnostic test to demonstrate hypermobility of the atlanto-axial articulation complex, which is a big area overlooked post motor vehicle accidents where whiplash has occurred. Demonstration of abnormal motion of the cervical spine and hence, ligamentous injury, has enormous significance in the management of patients with neck pain. Ligamentous injuries never fully heal and therefore these injuries are considered permanent. By demonstrating objectively that ligaments are disrupted, DMX can both document an injury that has occurred and helps the physician determine a course of therapy or has reached maximum medical improvement.

   Temporomandibular Joint Syndrome (TMJ) is also a big component post motor vehicle accidents. Initially this is overlooked and sometimes doesn't develop until weeks after the accident. DMX uses a highly sensitive microphone attached to the outside of the skin to detect audible clicks or crepitus on range of motion. DMX has also been applied to the lumbar spine as well as to shoulder, wrist, hip, knee and ankle. Neurosurgeons and Orthopedists have found the test very helpful pre-operatively to show their patient true pathology. Watching the spine in motion with great clarity makes it easier for the patient to comply with treatment. A copy of the tape can also be sent to the insurance company to help ease the pre-certification process. Post spinal fusion can show non-unions, abnormalities of the internal hardware or other suspected levels of instability with much less exposure then typical tomography provides.

   When ligamentous damage is suspect, DMX should be the first imaging modality employed after plain radiographs have excluded fracture.

Call  904-424-9773 today to learn how you can offer this Diagnostic Service to your patients.


Links:

Guidelines (Link Not Active Temporally!)
   http://www.accr.org/vfstate.pdf   

Protocols (Link Not Active Temporally!)
   http://www.accr.org/ACCR_position_on_protocol_for_spinal_VF.pdf

Medical Necessities and Clinical Indications
   http://www.drbonesdc.com/Videofluoroscopyl.htm


Video Images:

Hand
   http://www.lifechiro.net/hand.avi

Neck
   http://www.lifechiro.net/neck.avi

Shoulder
   http://www.lifechiro.net/shoulder.avi