Diagnosing underlying serious pathology, cancer, traumatic fracture and more from spinal X-rays
As doctors of chiropractic we are constantly seeking ways to ensure positive responses to our patient care. We must use every tool available, including spinal X-rays, to design a careful and effective patient treatment plan.
It’s wonderful that we have tools available to us and our patients which reveal the exact composition and characteristic of each spinal vertebra. These diagnostic tools aid our search to understand the cause of the symptoms within the human body.
The four phases of deterioration
Application of X-ray analysis can reveal one or more of the four following phases of deterioration or abnormalities in a patient’s spine:
1. Clear, specific spinal X-rays build patient and doctor confidence
1) When patients threatened by disease or other troubling symptoms are shown (through X-ray) the possible causes for their spinal pain, they can visualize — with specific chiropractic treatment — restoring chances of success toward a healthier lifestyle.
2) The positive predictability of specific chiropractic spinal care is greatly increased by a doctor who understands what level of care is needed on each patient’s spine.
3) Each patient’s spine is unique.
4) Special specific care can also be unique.
Have you ever heard a patient say: “I used to run six miles every morning; I used to work out seven days a week; it takes me longer to limber up before my exercises; I just don’t have the flexibility I used to have in my spine; my joints ache and they never used to; I’ve never been the same since that last injury….”
Researchers at the University of California (Bone Research 3. Article number 15028, 2015) have discovered that listening carefully to what patients say and feel is important for diagnosing illness. The university has conducted a study that proves bone structure enlarges with injury and shows how preexisting injury affects the forces of trauma.
2. Spinal injury can cause an enlargement of one of the articular processes or even part of the vertebral body
1) Chronological age may have less to do with injury severity then physiological age.
2) Reduced tissue elasticity is a factor with profound impact on how forces are distributed during a traumatic event.
3) With decreased bone density, the more brittle is the bone matrix, and the more susceptible the victim is to compression fractures.
4) Damaged vascular beds, ligament and tendinous structures have limited vascularization, which prolongs healing time and increases the risk of reinjury. With increased physiological stress, these conditions get worse. As chiropractors, we must apply a positive force into a negative situation with a stabilizing healing result by knowing the state of each patient’s spine before treatment.
Who hasn’t seen a whole family sitting at a restaurant waiting for their food with all four heads looking down at their phones? “Text neck” is just one form of repetitive spinal compression injury. David DeWitt, MD, in Spine Health (Oct. 26, 2018) shares his findings in, “Forward Head Posture’s Effect on the Cervical Spine.” DeWitt reveals how the lower cervical spine goes into hyperflexion and flattens the lordosis curve. Also, the upper cervical spine goes into hyperextension with the lordosis curve becoming more pronounced.
3. Spinal X-rays allow us to show the patient how repetitive poor body mechanics can have a negative effect on their health and daily living
1) DeWitt adds that the unnatural, forward positioning of the head and cervical spine places an additional stress on the intervertebral disc, vertebra and facet joints, which may exacerbate or accelerate spinal degeneration.
2) Additionally, as the bottom of the cervical spine hyperflexes forward and the top of the cervical spine hyperextends in the opposite direction, the spinal canal lengthens through the neck, which increases stretching and tension on the spinal cord in nearby nerve roots.
3) The degeneration of the intervertebral discs, when subject to increased loads and shearing forces between adjacent vertebrae, wears down the outer and inner layers. Consequently, the inner layer leaks out inflammatory proteins which can cause pain and swelling if they confront nerve roots.
4) Facet joints wear down when they are subjected to greater loads and repeated traumas. The protective cartilage that facilitates smooth motion between the bones can also wear down. Bone grinding against bone causes the disc and the facet joints to degenerate so that the vertebral bones are more likely to rub directly against each other, which can result in bony overgrowth.
Patients come in with pain in their neck, upper back and even the shoulders. Once the patient can visualize the cause of their symptoms through spinal X-rays, they are more eager to listen to the doctor’s recommendations for treatment.
How many parents nowadays, and for the last 20 to 40 years, have their children begin sports as soon as they can run? Gymnastics, figure skating, soccer, volleyball, basketball, baseball, hockey, competition youth rodeo, wrestling, BMX, snowboarding, and skiing are just a few of the sports available in many of the communities we live in. Many families have the spending money to ensure their child is as competitive as they can be.
And how many of those children go on to play on multiple teams and then club teams and competitive sports through grade school, middle school and high school? How many of those have had knee surgeries, hip surgeries, shoulder surgeries, concussions and hours of physical therapy to keep them playing at a high level of competition?
4. Many do not realize that their general health and longevity can be affected by the accumulation of injuries and traumas
1) In an article published on 8/5/2020 by Aaron Province, MD, titled, “Growth Plate Injuries in Youth Athletes,” the author shows that over the last 70 years there’s been an increase in the prevalence of growth plate injuries in young athletes. The article reveals that many believe this increase is due to youth participation in year-round training and early sports specialization, and a decreased emphasis on free play.
2) Province also states that youth may participate when still skeletally immature. It is important to note that kids have both a chronological age and a skeletal bone age.
3) These ages are not synonymous and can be different based on the individual. For example, even if the adolescent is in his or her late teens, their adolescent bone age may still be skeletally immature.
4) Overuse can cause inflammation at the secondary ossification center, sites where tendons attach to bones. The American Academy of Pediatrics currently recommends that a child take at least one to two days off per week from their sport, or a total of three months off from their sport throughout the year, and limit the number of training hours not to exceed 16 hours or the child’s age per week.
We just saw in the 2022 Winter Olympics how the three young Russian teenage girls were pushed beyond their bodies’ ability through countless hours of figure skating practice, let alone drugs administered to them. A high health price to pay for a piece of gold around the neck. Time will tell what the effects of the drug and exercise abuse will have on these poor young athletes.
We need to realize that all our patients are an accumulation of their lifetime injuries, and our success of treatment is limited to the current condition of their spines which we can view through spinal X-rays.
X-rays and DC clinical management
A report from Johns Hopkins, titled “X-rays of the Spine, Neck or Back,” states the spinal cord is a major part of the central nervous system, is in the vertebral canal, and reaches from the base of the skull into the upper part of the lower back. The spinal cord is surrounded by the bones of the spine and a sac containing cerebral spinal fluid. The spinal cord carries sense and movement signals to and from the brain and controls many reflexes.
X-rays may be taken of the spine, neck or back to diagnose the cause of back or neck pain, fractures, broken bones, arthritis, spondylolisthesis (the dislocation or slipping of one vertebra over the one below it), degeneration of the disks, tumors, abnormalities in the curvature of the spine like kyphosis or scoliosis, or congenital abnormalities.
A chiropractor’s diagnosis of underlying serious pathology, cancer, infection, spondyloarthropathy, or traumatic fracture is important, as clinical management might necessitate referral to medical specialties which may contradict manipulative therapy. Spinal X-rays are well-established as a diagnostic modality to aid in the confirmation or elimination of suspected serious pathology or traumatic injury, as reflected in current imaging guidelines.
GARY BORING, BCAO (Board Certified Atlas Orthogonal), LCP (HON.), FICA, graduated from Cleveland Chiropractic K.C. in 1968. His father graduated in 1934 from CCC K.C., and his brother in 1966. Boring Chiropractic has served patients for 86 years.