During an accident, injury to the head and neck typically results when the neck is forced backwards and then forwards combined with either the downward pressure or upward movement of the head and neck. This type of severe trauma causes damage to the ligaments and supporting structures of the spine known as AOMSI. Unfortunately, while AOMSI is a severe spinal injury, it is routinely misdiagnosed by treating doctors.
What is AOMSI? AOMSI stands for “alteration of segment integrity.” AOMSI is one of the highest and most severe trauma injury recognized by the American Medical Association (AMA) in auto accidents. However, AOMSI is often overlooked and is misdiagnosed by physicians most of the time. The human eye cannot detect the presence of AOMSI, which leads to these misdiagnoses. In order to detect AOMSI, the AMA requires special medical software. The Diagnostic Radiographic Mensuration Analysis is used by physicians to detect AOMSI within a 0.01 millimeter and 0.01 degree of accuracy. This innovative process allows physicians to methodically locate, substantiate, and objectively prove the severity of spinal joint dysfunction.
How Common is AOMSI? Research finds that 65% of individuals involved in car accidents receive an AOMSI injury. The theory of whiplash injury, or injury to the soft tissue, is replaced by new studies finding that the end result of dynamic trauma is ligament laxity and muscle atrophy. This can have lasting impact on patients who are not treated properly. The AMA finds that AOMSI is a rare occurrence without severe trauma.
What is ligament laxity? Ligament laxity is a loss of functional stability between two adjacent vertebra. Ligament laxity is an objective clinical finding based on mathematical models rather than opinion. When ligament laxity is identified, it represents a 25-28% whole body impairment.
What are the consequences of ligament laxity? Ligament laxity can be more subtle and complicated to diagnose than irritation to nerves from disc herniation. Disc herniation is typically caused by direct pressure or irritation to the nerve root. Ligament laxity, however, involves aberrant joint motion and aberrant joint loading, both of which over time produces irritation to the innervating nervous tissues and to adjacent tissues such as joint capsules, mechanoreceptors, etc. Where normal joint alignment and loading is compromised, functional stenosis along with structural degeneration occurs. Accordingly, this results in a vicious cycle of destabilization and overload that is driven by gravity and normal daily activities. If overlooked, an injured person may return to activities that can further damage the cervical spine.
Why is functional stability so important? The spine is a multi-component and semi-rigid elastic structure. Semi-rigid is a term used to describe the nature and properties of a single material or behavior of a system of mixed materials. The spinal column is a system of mixed materials consisting of alternating rigid vertebra and interconnected elastic ligaments. This sequential and alternating combination of the vertebra and ligaments allows for the transmission of forces and limitation of motion while also sharing and minimizing forces imposed on the system.
What is motion segment? Motion segment is a term used to describe the smallest functional unit of the spine. The motion segment includes any two adjacent vertebra and the interconnecting ligaments. The range and direction of each vertebral motion unit is dictated by the shape of the joint articulation. The ligaments strength, elasticity and integrity confine joint motion to protect the stability of each vertebral unit. The vertebra are interconnected by the strongest ligaments in the body, the discs. The primary role of the disc is to transfer motion and forces through the spine. The disc attaches to the top and bottom of each vertebra across the whole surface area of the vertebra. The disc provides continuity of the vertebra to function as a continuous structure.
What is range of motion? Range of motion are determined by joint design and is constrained by ligaments. Where range of motion is increased in any direction, it engages multiple ligaments that when stretched become more rigid and resistant. The resistive force pulls the vertebra back to its original, neutral position. When a vertebra reaches and endpoint range of motion it is fully confined by the strength and elasticity of the ligaments.
How is AOMSI diagnosed? Sophisticated diagnostic tests are required to diagnose AOMSI. A precise measurement known as radiographic mensuration analysis, sometimes referred to as “Digital Radiographic Mensuration Analysis,” is used to diagnose and locate torn ligaments.
What is the measuring method used to diagnose AOMSI? As far back as the 1980s, the AMA Guides to the Evaluation of Permanent Impairment has described the measurement method used to determine ligament instability. The method involves measuring the rotation and translation of the vertebrae from a cervical or lumbar x-ray in the flexion or extension positions. When the range of motion of adjacent motion segments differs by 11 degrees or more, it is classified as AOMSI. This differentiation is a direct consequence of a loss of ligament integrity. A translation of any motion segment exceeding 3.5 millimeters in the cervical region is classified as AOMSI.
What is the procedure for measuring AOMSI? To measure AOMSI, the four corners of each vertebra are identified to calculate the disc angle for each motion segment. Then, the range of motion of each motion segment is calculated by taking the difference of the flexion and extension disc angles. From here, the spinal geometry and disc angle range of motion are calculated and displayed in tabular and graphical formats. These results are compared to the threshold values as determined by the AMA Guides to the Evaluation of Permanent Impairment. Where the impairment threshold of 11 degrees is exceeded, the patient qualifies for a 25% whole body impairment.
When should you be tested for AOMSI? Anyone involved in a sudden impact injury should be tested for AOMSI. Where a person is involved an automobile accident of any kind, AOMSI testing is appropriate. Sports injuries, forceful falls, or any forceful incidents of acceleration or deceleration where neck or low back pain are involved should also trigger AOMSI testing. Given the high amount of misdiagnosis of this injury, whenever it is suspect that there is a greater than 50% reasonable medical probability that a motor vehicle accident could cause this injury (and because it is misdiagnosed 35% to 55% of the time), a qualified doctor should order the radiographic mensuration analysis procedure. The AMA has made clear that this type of injury should not be taken lightly.
What does an AOMSI diagnosis mean? Where ligament laxity is found, it alerts physicians to implement precautionary treatment procedures. In some instances, surgical intervention can be required to stabilize the motion segment. An AOMSI diagnosis can help patients understand the extent of their injury and the potential future consequence of their injury. Likewise, physicians treating patients diagnosed with AOMSI can develop a long-term treatment pain to ensure stability. While most physicians are good at assessing damage to the bone, muscle and nerve, most have no diagnostic work up for the spinal ligaments. Ligament tissue can be the most debilitating tissue to damage because the condition is usually permanent and progressive, either now or in the future. This can result in a lot of acute and chronic pain as well as other neurological consequences. A test allowing for an objective determination of ligament injury is helpful in developing an appropriate treatment plan. An AOMSI diagnosis can also be helpful where litigation is involved, because it objectively identifies injury independently of a positive or negative MRI. AOMSI creates the opportunity for fair and equitable settlements based upon insurance carrier algorithms using objective information.
Why is a proper AOMSI diagnosis important to a personal injury case? A proper diagnosis of AOSMI is important to accurately, thoroughly and honestly describe the extent of an injury to claim adjusters and attorneys. The extent of a patient’s injuries are used to determine the basis for personal injury settlements. A misdiagnosis of AOMSI may not only have a negative impact on your personal injury claim, but may also be considered malpractice. Insurance companies are more likely to pay policy limits upon receipt of reports that clearly demonstrate AOSMI damage and the seriousness of a patient’s injuries. Further, it is important for the jury to understand the extent of an injury when they are determining how much to award to an injured patient in a trial verdict. Misdiagnosing or missing an AOMSI diagnosis can have dire consequences to both the injured and their personal injury case. Many insurance adjusters, administrators and adjudicators have not heard of AOSMI because the diagnostic test has not been available until recently. In fact, most doctors did not screen patients for AOMSI because it required manual measurements on x-ray films that carried error rates of 26%. However, the measurement done as required by the AMA protocol is now done by a computer and has a negligible error rate. Insurance companies now assign a case settlement reserve value of $66,000 for a diagnosis of AOMSI.