An Interview with Dr. Todd Cielo on Digital Motion X-Rays – Video Transcript:
Dr. Todd Cielo: My name’s Dr. Todd Cielo. I’ve been a chiropractor in Tampa, Florida, for 20 years. Welcome to the practice.
WHAT CAN A CLIENT EXPECT WHEN THEY GO TO YOUR OFFICE TO GET AN X-RAY?
Dr. Todd Cielo: One, I want them to sit down, fill out some general paperwork, patient demographics. Number two is I wanna sit down and have a consultation with them, let them tell me their signs and symptoms, the reasons why they’re in my office, and how this injury has affected their daily life.
Once I get back those signs and symptoms, how it’s affected the duration, intensity, and frequency of those pains and complaints, then we’ll do a series of either three or six x-rays.
The actual test should not take us more than one to three minutes and it’s gonna be in an open room and the x-ray, you’re gonna have at least two or three feet all around you in the open room and you’re gonna be looking down and looking up, going left, going right, and we’re looking for movement of the bones. And that’s it.
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WHAT DO YOU LOOK FOR IN THE DIGITAL MOTION X-RAYS?
Dr. Todd Cielo: For DXD (digital motion x-rays) reporting we’re looking for movement of bones. Whether it’s in the neck, the thoracic spine or the lumbar spine, we’re trying to see if the bones are shifting forward or backward or wedging. So, here is the front of your throat, here’s the back of your spine which you can touch on your own.
So, whenever you look down and whenever you look up we’re actually asking the bones to flex and extend. And the bones should be able to flex and extend only a certain amount of millimeters and only a certain amount of degrees per a normal spine.
When you’re injured, bones usually slip forward more or backward more, therefore, we want to get an exact measurement to the hundredth of a degree, hence that’s why we’re doing the digital motion x-rays.
WHAT DOES IT MEAN IF YOU SEE “MOVEMENT OF THE BONES” IN A DIGITAL MOTION X-RAYS?
Dr. Todd Cielo: The only reason why bones move a significant movement is from severe trauma.
It’s not from repetitive trauma, it’s always severe trauma, a whiplash movement. And whenever there’s degeneration, all the degeneration is is the bone is actually deforming or the disc space is actually getting smaller. When it comes to the movement of a bone it’s simple, the bone is moving forward or backward or extending or actually opening up. And with the Digital motion x-rays, we’re trying to actually measure that to a hundredth of a degree.
WHAT IS A “LIGAMENT LAXITY” AND WHY IS THAT SO IMPORTANT?
Dr. Todd Cielo: Ligaments have one responsibility in the human body, connect bone to bone. Just like in your knee, just like in your neck, just like in your fingerprints.
So whenever we’re flexing the spine we’re actually stressing out ligaments only. And when the bones are moving too much forward or too much backward that’s telling me the ligaments are relaxed, hence that’s why we wanna get a measurement and then we compare that measurement to the normal population.
Ligament laxity, over a certain degree of millimeters or of a certain degree of degrees, is from one thing, severe trauma.
Any time there is a movement of the bone too much over a certain parameter, over the 3.5 millimeters, especially in the neck, that’s telling us that that joint, and when I say joint that means two bones, is more lax.
Therefore that disc that’s in between is gonna have more chance of wear and tear, and more rapid than age. Therefore, we need to be able to document that, hence that’s why you’re sending them to me, so then you’re fighting for the future damages.
HOW DO YOU CONCLUDE WHETHER THERE HAS BEEN PERMANENT DAMAGE?
Dr. Todd Cielo: For the neck alone, it’s either 3.5 millimeters combined of looking down and looking up or 11 degrees.
And 3.5 millimeters is the height of two quarters on top of each other. That’s how small 3.5 millimeters is. 3.5 millimeters is a quarter mile to the human body, so if it breaches that there’s a permanent injury involved.
Any time that we’re dealing with a permanent injury the American Medical Association allows physician like myself to utilize that permanent impairment rating evaluation, so the injury attorney that’s involved in the case can utilize that as a compensation table for future damages, for future medical expenses.
HOW ARE YOU ABLE TO DETERMINE WHEN AND HOW THE DAMAGE OCCURRED?
Dr. Todd Cielo: Any time that something happened years ago, your body always tries to fixate the segment involved. So, you’re gonna have hypo-mobility, you’re gonna have less motion than more motion.
Hyper-mobility means that the bone is actually moving too much, which means it’s from recent severe trauma. Your body tries to fixate to the best of its ability, to stabilize an unstable segment.
Whether it’s your knee or your spine, your body’s always laying down scar tissue or some type of calcification to shut down the movement of the joint. And if that’s the case, it’s old.
But when something is moving to a higher degree, over that 3.5 millimeters threshold, it’s new, severe trauma.
CAN WE TELL WHETHER THE INJURY IS OLD OR NEW?
Dr. Todd Cielo: I would see osteophyte formation, some type of arthritis and a joint that’s not nice and plump.
It would be actually dislocated, dehydrated and much smaller than a normal joint like this.
IF IT’S A NEW INJURY WHAT WOULD YOU SEE?
Dr. Todd Cielo: I would see the hyper-mobility of the bone moving forward and/or the bone moving backward over that 3.5 millimeters.
CAN YOU SHOW US THE DIFFERENCE BETWEEN AN OLD INJURED SPINE AND A NEW INJURED SPINE?
Dr. Todd Cielo: So, on a normal disc height and a normal joint segment, these are two bones right here and then we have a disc in between. The height of this disc is very healthy, normal, good disc height. But when we have something that’s arthritic there’s a big decrease in disc height, so we know two things are going on with this old joint.
We know that the disc space has gotten smaller and we see that all arthritis and all the lipping and spurring has formed. So, this is an old trauma. The body’s trying to fixate, stabilize the joint on its own.
What we’re trying to do here is on the same x-ray we’re trying to see if it’s moving forward or backward and if it’s moving forward or backward, even in an arthritic joint, that’s telling me that there’s a new joint, there’s a new trauma.
These are two bones that comprise a joint. This is the disc space. The disc has one responsibility, separate these two bones. Since they’re separating these two bones, this is a nice healthy disc, normal disc height, and the bones are very box-like in shape. Therefore there’s no trauma.
If we have an older disc, older arthritis, that’s telling me that this disc has gone through trauma because you can see the difference between a nice healthy disc and an older disc. And still on the x-ray that we’re asking them to look down and look up, even if it’s arthritic we’re still looking for this motion. And if this motion takes place, that’s telling me that there’s new trauma involved even though this is an old injured segment.
IF SOMEONE HAS AN OLD INJURY AND THEN SUSTAINS NEW TRAUMA, CAN THERE BE FURTHER DAMAGE?
Dr. Todd Cielo: Yes, because since this is moving forward or backward, the spinal cord is right there.
So, that’s getting extended and flexed upon and the nerve roots, we have a pair of nerve roots at each section, those nerve roots are actually gonna get encroached or compressed.
So, not only is the disc irritated or aggravated or permanently aggravated, but the actual nerve roots and the spinal cord are being impinged from excessive movement.
WHAT DOES THE X-RAY ROOM LOOK LIKE?
Dr. Todd Cielo: So, this is the actual digital motion x-rays unit that we’ll be utilizing for x-ray analysis. It’s really simple.
I’m going to have your shoulder touching the bucky, you have a big open space here, big open space on the left side of your body and we’re just be doing three simple pictures. One in neutral, one inflection, one in extension. And depending on if there are other signs and symptoms,
I might have you bend forward, bend backward and neutral.
So, we’ll be taking approximately three to six views of you, but each view will not take more than about four to five seconds.
WHAT HAPPENS AFTER THE DIGITAL MOTION X-RAYS?
Dr. Todd Cielo: So, once we finish the digital motion x-rays process, which should not take more than a handful of minutes, we’re going to import those x-rays into the software and we’re going to be looking for two things; millimeters, the forward movement of a bone or the backwards movement of a bone, and/or we’re looking at the wedging of the bone.
Once we’re done with the x-ray procedure and we get those three x-rays of flection, neutral and extension, I’m gonna send a copy of the 14-page report to yourself, to your car accident attorney, to your treating physician, and to the insurance company.
If you have any questions or concerns, you can either call me and I can go over the report with you over the phone and correlate that with your signs and symptoms, or you can come back into my office.