A loss of motion segment integrity (hereinafter referred to as LMSI) relates to the movement of two adjacent vertebral bodies as measured in flexion and extension. The “loss” in integrity relates to the alteration in movement such as a loss in range of motion or movement beyond what would be considered normal limits. Any significant loss in the range of motion or a gain beyond the acceptable normal range in the motion segment of the spine will result in an over-compromise of the adjacent levels of the spine. The adjacent levels will now be taxed beyond normal and the excessive wear and tear making the adjacent levels more susceptible to injury.
In the context of cervical (neck) injury cases, many attorneys and even physicians are at a loss on how to deal with what may appear to be a mere soft tissue case at first glance. This issue becomes even more compelling in light of a cervical MRI that does not reflect significant discogenic pathology (or damage). In the absence of substantial discogenic pathology, many attorneys are at a loss of what to do next.
Check out this article for more information about what to do in the case of a negative cervical MRI.
Ligament Injuries in relation to LMSI
Physicians will often view such cases as merely a soft tissue claim. If the patient/client is still complaining of significant neck pain, they may have a neck ligament injury. Ligamentous injuries are often every bit as painful as their discogenic counterparts. Further, ligament injuries are generally more complex due to the lack of definitive solutions to alleviate such pathology and resulting symptomology.
A claim regarding a ligament injury of the cervical spine is much different in my opinion than a soft tissue claim. In fact, the A.M.A. ‘s Guidelines to the Evaluation of Permanent Impairment, states that a finding of LMSI in the cervical spine equates to a 25% permanent impairment of the whole body. This is clearly a very significant finding.
How do you document LMSI?
A physician cannot document LMSI from a physical clinical examination. Rather, LMSI can be documented by a radiographic flexion extension study such as static flexion and extension x-rays of the cervical spine or a digital motion x-ray (DMX). Joint translation of greater than 3.5 mm is deemed a LMSI and a 25% permanent impairment. This technique is extremely accurate (computer measurements have a margin of error of approximately 1%) so they are perfect for proving an injury in court. A measurement of greater than 3.5 mm is considered clinically significant and indicative of ligament damage and ligamentous instability of the cervical spine. As we mentioned, LMSI injuries are best diagnosed with a digital motion x-ray, but what are they?
What is a Digital Motion X-ray (DMX)?
Digital Motion X-Ray (DMX) is not a new technique in medicine. In fact, it has been used for decades under its more common name, fluoroscopy. However, the DMX has changed how medical professionals and personal injury attorneys are approaching spine injuries cases by utilizing the results in a definitive manner to prove injuries to juries.
Digital Motion X-ray (also known as fluoroscopy or video fluoroscopy) is a sort of x-ray that allows a doctor to view the images in real time on a screen instead of developing the results and viewing them statically. This technique has proved itself useful by finding conditions and injuries that regular x-rays miss.
DMX is particularly helpful in identifying and diagnosing cervical ligament injuries since the doctor is able to view the patient while they are moving. From this, they doctor is able to examine the range of motion of the cervical spine and identify LMSI conditions. During the procedure, the doctor moves the patient in specific ways while viewing the x-ray image on the screen. As limited motion is observed, the doctor can then use this information to further pinpoint the concerned area.
As we mentioned before, it can be hard to prove certain types of injuries with more common imaging techniques like MRI and x-ray. However, the use of video fluoroscopy has changed this by allowing doctors to more clearly examine and prove injury that they always knew were there but couldn’t show definitively. This is done by analyzing not the injured tissue itself, but by examining the range of motion that the cervical spine can or cannot go through. This hindrance in movement, or extension beyond normal range of movement, is then used to deduce an injury in that region.
The information provided by the DMX machine can then be converted into hundreds of still x-rays or video clips that can be zoomed in or out, slowed or sped up. As one can imagine, this sort of evidence is extremely helpful in proving an injury case to a jury in court.
Dolman Law Group
If you have suffered a neck injury and the MRI has come back as negative or is displaying non-significant discogenic pathology, do not lose hope. You may have suffered damage to the ligaments of the cervical spine. This is indeed a very serious injury and a major value driver with insurance carriers if the ligament damage is properly illustrated. If you have suffered an injury to the neck as a result of the negligence exhibited by an individual or corporation call the neck injury lawyers at the Dolman Law Group for a free consultation and case evaluation. We can be reached in one of the following ways:
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