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18899

Title

Radiographic findings that may alter treatment identified on radiographs of patients receiving chiropractic care in a teaching clinic [poster presentation; the Association of Chiropractic Colleges' Thirteenth Annual Conference, 2006]

URL

Journal

J Chiropr Educ. 2006 Spring;20(1):93-94

Author(s)

Subject(s)

Association of Chiropractic Colleges / congresses

Peer Review

Yes

Publication Type

Meeting Abstract

Abstract/Notes

Introduction: Chiropractors routinely expose patients to ionizing radiation for a variety of purposes. These include: determining the existence of pathology, anomalies, contraindications to the application of forces into the spine, determination of the extent of misalignment, determination of specific vectors to be applied in correction of subluxation and to further assess a region when faced with ¡§red flags¡¨. There has been some effort within the chiropractic profession to address x-ray utilization rates and needs. There is some contention within the profession regarding the extent of restrictions on the use of x-ray and whether or not such restrictions are in the best interest of the patient. Since chiropractors routinely apply forces to the spine these forces have potentially adverse effects if a given pathology, abnormality or anomaly was present and unknown to the practitioner. Further, chiropractors purporting to make structural corrections often justify the taking of radiographs to determine a vector in order to apply their particular technique. This article reports on the data gathered from a review of radiographs taken in the outpatient teaching clinic of a North American chiropractic college.

Methods: Five hundred patient files were chosen through a random search of a computerized, patient case management database in a chiropractic college teaching clinic for the period 1999 through 2004. These files were analyzed for the presence of pathologies, abnormalities and anomalies that might alter the management of the patient.

Results:Of the 500 files reviewed, 413 patients had x-rays of the cervical spine taken, 403 had thoracic spine x-rays taken, 402 had lumbar spine films taken and 390 had all three areas radiographed. 77 patients had no x-rays taken. Pathologies, abnormalities and anomalies that might alter the management of the patient were found in 91% of cervical spine radiographs, 70% x-rays of the thoracic spine and 79% of x-rays of the lumbar spine. Of the 500 files reviewed, the ages ranged from one to 86 years of age with a mean age of 35.6„b15.6. There were 242 males and 258 females.

The 10 most frequent anomalies in descending order were cervical hypolordosis; lumbar scoliosis; pelvic and sacral unleveling; cervical listing; decreased disc height (cervical spine); anterior lipping and spurring (cervical spine); anterior lipping and spurring (lumbar spine); kyphotic cervical curve; anterior lipping and spurring (thoracic spine); and decreased disc height (lumbar spine).

Discussion: It is questionable whether or not the existence of anomalies and/or abnormalities such as those identified in this study should or do affect the management of the patient and if so, under what circumstances. There are some studies demonstrating utilization of radiographs to characterize the biomechanical manifestations of vertebral subluxation. These include studies that demonstrate changes in atlas position following chiropractic adjustments and studies that demonstrate changes in the lateral cervical curvature as a result of chiropractic care. A large percentage of patients in this study had pathologies, abnormalities and/or anomalies that might alter the management of the patient. Further research and analysis is necessary to determine if the existence of these abnormalities/anomalies actually alter the course of care and whether or not biomechanical changes occurring as a result of chiropractic care are clinically meaningful.

This abstract is reproduced with the permission of the publisher.

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