ACA Guidelines What You Should Know

occupying lesion) pathology, the aberrant verified biomechanics indicates failure at the connective tissue level (ligaments and tendons) and the mechanical source/rationale of the ensuing nociceptive, mechanoreceptive and proprioceptive neuro- pathological cascade. This in turn allows the practitioner to conclude an accurate diagnosis, prognosis and/or treatment plan based upon the pathological “listings” visualized. As reflected above with the 98.42% response, it is clear that when considering the biomechanical assessment of the human spine, x-ray analysis outside of simple anatomic pathology can change how a doctor of chiropractic manages and treats their patients. The following is from a small sampling of responses we received from another survey of doctors nationwide. The instructions were to send over examples of how x-ray had changed their diagnoses, prognoses and/or treatment plans within the last 2-3 months. These responses underscored why chiropractors utilize x-ray and often need it to determine accurate mechanical diagnoses, prognoses and treatment plans prior to rendering care. Please note, the clinical protocols presented and x-ray diagnoses are all taught in CCE accredited chiropractic colleges and underscore the quality of a chiropractic education.

Kentucky:

Male 70-year old. Presented in my office for 2nd opinion after the prior doctor of chiropractic did not take films. Focal sacral pain unchanged by position or movement. Plain lumbar/pelvic films revealed large radiolucency in sacrum. Patient referred out to MD/oncology for follow up. Diagnosis: Metastatic in nature.

North Carolina:

Here is an example of how x-ray helped save a life. I had a patient 6 weeks ago come in with lumbar pain. The patient is 68yr old male with a history of lumbar pain but the pain recently became worse. During the history the patient relayed that they had recently been to their cardiologist for his regular checkup. I completed a thorough physical exam where the only positive findings were limited range of motion with pain in extension and left lateral flexion. I took lumbar x-rays of the patient. While reviewing the x-rays I noticed the outline of an Abdominal Aortic Aneurysm that measured 5cm on my lateral films. I immediately told the patient to go to the emergency room and sent the films with him. The patient stated he did not want to go and he just was at his cardiologist. I insisted and the patient finally listened. The patient had immediate surgery to repair the aneurysm and I received a thank you call from the cardiologist!! More important the patient thanked me for saving his life!! Abdominal Aortic Aneurysms have a symptom of back pain. I will never touch a patient without being able to x-ray a patient. Who would have been blamed if my patient's aneurysm ruptured??

Michigan:

We had female patient in her thirties present to our office complaining of severe and unrelenting neck pain, with bilateral pain into her shoulders. She did not want an x-ray, however one of the other associates that I worked with convinced her to have two films, AP and lateral cervical. Those films revealed a lyric metastasis of the C5 vertebra, with almost a complete destruction of the vertebral body. Had she been adjusted without the images; the results would have been catastrophic.

Georgia:

54-year old male post MVA, Primary complaint = Low back pain, examination findings revealed positive orthopedic tests in the cervical and lumbar spine with diminished reflexes, upper and lower muscle strength 5/5. Cervical spine x-rays revealed a 3.28 mm anteriorlisthesis of C4 on C5, flexion view revealed an increased displacement to 8.28 mm. Extension view measured 5.48 mm. Imaging altered treatment plan: Without the x-ray study, the unstable C4 would go undetected and as a result of the x-ray findings the patient was recommended to wear a c-spine collar and have a c-spine MRI. The MRI revealed a 4 x 10 mm left paracentral herniated disc with annular tear compressing the cord by 75% with myelomalacia. It also leaked into the right neural canal compressing the right C4 nerve root. I called my neurosurgeon and he will be in surgery tomorrow. Given the fragmentation of the cord seen on MRI, I shudder to think what would have happened if a high velocity thrust was introduced to his neck!

New York:

A patient presented with mild to moderate low back pain. Images revealed a secondary spondylolesthesis and contraindicated in a lumbar side posture. This has happened many times before and once again, prevented me from hurting my patient.

Ohio

I had a patient that presented with low back pain. The lumbar film showed a 66mm aneurysm. I immediately sent him to the hospital where he was admitted and went into emergency surgery for repair. This could have ended very badly without those x-rays.

California:

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