Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 924
Clinical Information # 224 CI

From the Desk of Dr. Mark Studin
Academy of Chiropractic
Preamble: many of these issues are small, yet each issue is just that… an issue. If you take care of the small issues, then the larger issues often take care of themselves and you can focus on the larger issues… a larger, more profitable practice and more family time.

“Ligament Laxity in Cervical Lateral Flexion”

“I win because I ask the right questions” Mark Studin 2018

Brain Pollack from New Britain CT wrote: 

Are there any standards/measurements for lateral flexion? I met with an attorney yesterday that showed me a motion x-ray of space 9.2 mm, he said it was between C1 and I don't know what, to be honest I couldn't even interpret the image, had no idea what I was looking at....HE said another chiro determined this was ligament laxity. I'm not sure if it was the odontoid inner space orC1 in relation to the occiput??? I told the attorney I wasn't familiar with any lateral flexion views that we ratable by the AMA guides but is there any literature that you know of stating what is outside normal limits? Keep me posted thank you!

Ray Wiegand responded:

Yes, there are standards for cervical lateral flexion particularly at C1. 

As far as I know there are no direct whole body impairment rating procedure in the Guides for this injury. 

The findings are usually a surgical consideration. 

The findings, like 9.2 mm indicates significant ligament injury.

These measurements can be made on the x-ray.

Motion x-rays offer a lot of information for interpretation at every joint. 

There are plenty of specs out there as to normal upper cervical motion, spacing, translation, etc.

Ligament laxity is both a physiological finding. It may represent an impairment when threshold values are met as described by the AMA Guides using flexion and extension views. 

Excessive motion or gapping is a result of tissue yielding, avulsion or most likely both. 

Yielding (initial point of failure) of the ligament occurs with about 7% elongation of ligament tissue. 

Since it is impossible to measure the ligament length and the 7% elongation; translation and rotational values have been established for the inter-odontoid space and the overhang of the C1 lateral masses on C2. Other meaningful measurement indicating ligament injury are gleaned from video fluoroscopy.  

Typically speaking, any values outside of normal ranges indicates ligament injury and joint instability.



Adjunct Associate Professor of Chiropractic, University of Bridgeport, College of Chiropractic
Adjunct Post Graduate Faculty, Cleveland University-Kansas City, College of Chiropractic
Adjunct Professor, Division of Clinical Sciences, Texas Chiropractic College
Educational Presenter, Accreditation Council for Continuing Medical Education Joint Partnership with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences

Academy of Chiropractic
US Chiropractic Directory
PLEASE TAKE FURTHER NOTICE: CONFIDENTIALITY AND PROPRIETARY INFORMATION NOTICE:  This email including attachments is covered by the Electronic Communications Privacy Act (18 U.S.C. 2510-2521) and contains confidential information belonging to the sender.  Nothing contained in this message or in any attachment shall constitute an Electronic Signature or be given legal effect under 44 U.S.C. 3504 Sec. 1707.  The information is intended only for the use of the individual or entity to which it is addressed.  If the recipient of this message is not the intended recipient, you are at this moment notified that any unauthorized disclosure, dissemination, distribution or reproduction of this message or any attachments of this communications is strictly prohibited and may be unlawful.  If this communication has been received in error, please notify the sender immediately by return email, and delete or destroy this and all copies of this message and all attachments.