An issue at the center of much controversy is: What does an x-ray show and what does it miss? In court cases and third-party reimbursement, chiropractors need to help others understand that an x-ray does not always reveal injuries that DCs can find with their hands.
A study published in a 1991 issue of the Journal of Spinal Disorders1 makes this issue very clear. The paper, "Hidden Cervical Spine Injuries in Traffic Accident Victims with Skull Fractures," was conducted by four Swedish physicians who summarized:
"We studied 22 cervical spines from traffic accident victims with fatal craniocerebral injuries (19 male victims and three female victims; mean age, 26 years). Two had parietal fractures, 20 had skull base fractures (seven ring fractures) and 16 had severe polytrauma. The spines with all soft tissues were frozen in situ and removed. Fine-focus specimen radiograms were taken in special views and elevated by an expert orthopedic radiologist. The specimens were then cryosectioned, and all injuries were recorded at submillimeter intervals on high resolution film. Ten radiological fracture diagnoses were incorrect; six were false positive, and four were false negative. In the upper cervical spine, only one of 10 gross ligamentous disruptions was suspected on the radiograms. In the lower cervical spine, 198 lesions were missed on the radiograms: 77 facet joint and ligamentum flavum injuries, 77 uncovertebral, and 22 disc lesions. In two adolescents, eight cartilaginous end-plate avulsions of the discs were found. At second-look evaluation, only four of the 245 unrecognized bone and discoligamentous lesions were detected on radiograms. All spines were injured. Multiple-level soft tissue injuries were common."Among their conclusions, the authors note:
1. Cervical spine injuries are common in trafficThis study not only gives new appreciation of the seriousness of spinal injuries that x-rays miss, it should also enhance the appreciation every chiropractor has in what they do. This is an important paper to reference as we educate other providers. For a reprint please contact:
accident victims.2. The majority of lesions are soft tissue injuries.
3. Plain film radiograms fail to show many fractures; they show virtually no soft-tissue lesions.
Journal of Spinal Disorders
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Reference
1. Jonsson H Jr., Bring G, Rauschning W, Sahlstedt B: Hidden cervical spine injuries in traffic accident victims with skull fractures. Journal of Spinal Disorders, 1991:Vol. 4, No. 3 pp 251-263. Raven Press, Ltd., New York.
Editor's note: Dr. Halldor Jonsson Jr., may be contacted at: Academic University Hospital, Dept. of Orthopaedic Surgery, S-75185, Uppsala, Sweden.
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