Frequently asked questions
When should a patient be refered to ORM?
All patients who have suffered a hyperflexion-extension injury to the neck and/or lower back should obtain an x-ray image screening test.
This type of mechanical force can create more than just sprains, strains and subluxation patterns in a spine. It can create spinal instabilities in the spine of a ligament nature and/or disc-type.
These injuries may be graded as Major Injuries with Whole Body Impairments as high as 40% when present in the neck and lower back.
What are the patient acceptance clinical markers used by ORM for the x-ray image screening test?
Even though spinal instabilities can be asymptomatic, ORM has created evidence-based patient entry criteria which are to be used for all patients.
The entry criteria ask questions specific to a trauma-induced spinal instability of the ligament-type. Out of 10 questions, we require that three be positive in order to qualify the patient for the x-ray screen for spinal instabilities.
What are the protocols for ordering these films?
What are the protocols for ordering these films?
Some of the symptoms are as follows: pain/tingling/numbness in the extremities following a particular pattern/map, dizziness/visual disturbances/tinnitus, spinal cracking noises or sensations during movements, and of course, history of trauma.
You can review the sympoms on the ORM website Treatment tab then MVA ORM Medical History.
Can ORM review films from outside Toronto?
Absolutely! ORM is of service to the entire province. We are the only facility in the province who not only conducts the complex x-ray measurements looking for trauma-based injuries but proceeds to write detailed medical-legal reports involving the x-ray findings (objective medical evidence) with the actual trauma and the symptoms the patient is experiencing. Therefore, we work with all Ontario hospital radiology departments as well as numerous private x-ray taking facilities throughout the province.
If the screening tests are positive, the patient can either see the doctor at our Markham location, in downtown Toronto or at a pre-arranged location near their work or home using their rehabilitation facility, home visit or family physician’s office.
What does roentgenometric mean?
Roentgenometric is the use of lines and anatomical landmarks to measure angles and distances on X-rays.
The values obtained are then compared with standard figures.
The AMA Guides to the Evaluation of Permanent Impairment (4th Edition) is the guideline used in the Province of Ontario. They set the standard numerical limits that determine if a neck or lower back has major injuries such as instabilities or not.
How much more accurate is the computer when compared to the acetate and ruler methods learned in roentgenometric curriculums?
The use of a d.p.i. palette image resolution calibration is no longer used because the AMA requires all measures to be performed manually.
In keeping with the auto-insurance laws, it is best to not use methods such as digital palettes, even if they are significantly more accurate and the only methods used for surgical procedures such as hip replacement measurements.
Does ORM follow the AMA Guide for Permanent Impairment? Does ORM quantify the patient’s impairment using the AMA guides?
Yes – we function strictly through the Guide’s 4th Edition.
We will quantify all of our positive x-ray and examination findings. As well, we are qualified to write an Impairment Rating report involving all of the patient’s physical injuries (WPI Whole Person Impairment Rating).
What is the difference between MRI and ORM’s radiology assessment?
It is a known fact that ligament rupture and consequent spinal instabilities such as LMSI are not always visible on MRI. MRI is not the tool of authority confirming spinal instabilities.
A recent study conducted by the Journal of Korean Neurosurgery (J Korean Neurosurg Soc 45:24-31,2009) concluded that when evaluating for spinal instabilities, radiographic studies is the most efficient imaging tool. It should be noted that the MRI utilized in this study was a motion MRI because static MRI was noted to not be efficient when assessing for ligament damage.
There is only one motion MRI in Canada, currently in Vancouver British Columbia.
What if there was no instability present?
Confirming the absence of any instability, luxation or spondylolisthesis injuries is as important as finding them. Think of this as being equivalent to a physician suspecting there is a brain tumor and ordering a CT Scan to find out if it exists or not.
The actual radiology assessment is a mere imaging tool utilized by ORM to eliminate the possibilities of existing hidden diagnostics that may:
prolong recovery if treated or;
Eliminating the possibilities of an instability is as valuable as finding one. As well, ORM not only reports all bony and soft tissue pathologies as does all radiology reports but it also takes numerous spinal measurements that will assist the treatment team with a more accurate treatment direction.
What is a spinal instability?
An spinal instability is defined as a vertebral motor segment (two adjoining vertebra) with excess motion in either the translocation (forward/back) or angular plane of motion.
This type of instability is termed severe as our automobile legislation categorizes it as a Major Catastrophic Impairment. There are other causes of instability to consider which can easily be excluded from a proper medical history and x-ray.
What are the signs and symptoms of a spinal instability?
Like vertebral fractures, instabilities can be at one extreme asymptomatic (no pain) or mimic the symptoms of a minor primary sprained neck.
At the other extreme, severe symptoms will exhibit hard neurological signs. It is important to take note that the spinal instability’s clinical presentation can be asymptomatic and that, similar to the routine cautionary measures taken at the accident site for possible neck fracture, screening for the presence of spinal instabilities is equally important. This is the basis of ORM’s mission statement and purpose.
ORM objectively assesses for post-traumatic spinal instabilities and other trauma-based x-ray tests in order to properly quantify the patient’s spinal integrity.