Spinal Ligament Injury Treatment

Back pain is the leading cause of disability worldwide, with many people missing a diagnosis of a pathoanotomic lesion, or cause. How many people go to their physician with back pain, and leave with a diagnosis of “back pain”? People are commonly diagnosed with “lumbago” and “cervicalgia”, which is nothing more than a description of their symptoms. Unfortunately, without a better diagnosis of the cause of a patient’s back pain, such as disc herniation, facet syndrome, circumferential or radial tear, spinal stenosis, or alteration of motion segment integrity (spinal ligament instability) patient outcomes are poor and the cost of treatment is higher. When a person does not have an accurate diagnosis, how can they be prescribed proper ligament injury treatment? Obviously, they can’t be prescribed the most appropriate ligament injury treatment for their particular condition, and here lies the heart of our problem and worldwide back pain and opiate addiction/abuse epidemic.

The most common diagnosis for back pain in medicine, is the sprain/strain diagnosis. A sprain/strain is a diagnosis of a torn ligament (sprain) and a torn muscle (strain). Sprains and strains can be graded based on how much of the muscle or ligament is torn. A grade one sprain has no change in ligament length (thus no instability), but a grade three sprain is torn from 2/3 to a complete tear, and causes laxity in the joint resulting in increased pain, arthritic degeneration and possible nerve and spinal cord compression. Grade 3 and 4 spinal ligament sprains are serious medical conditions and can cause spinal ligament instability, or “Alteration of Motion Segment Integrity”, that carries up to a 25% whole person impairment according to the AMA Guides to Impairment. The definition of spinal instability is well established in the medical peer reviewed literature, and has been defined by White and Panjabi, who are considered world leading spinal bio mechanists. You would think there would be a standard way to “work up” and diagnosis these injuries, which are the most common cause for back pain in the world wouldn’t you? Until Computerized Radiographic Mensuration Analysis (CRMA), there has not been an efficient way to grade and diagnosis the degree of a spinal ligament sprain.