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Chiropractic Research Review

Radiographic Line-Drawing Analysis: Influence of Axial Rotation

Radiographic examinations are frequently utilized in chiropractic practice, to determine the presence of subluxation and to determine spinal segmental listings. According to the NBCE, 96% of DCs use full-spine techniques, while nearly 59% utilize the Gonstead technique.

The latter technique relies on analysis of radiographic pelvic line drawings to direct the type of adjustment to be delivered. However, questions regarding the this type of analysis have been raised, owing to possible errors in magnification and distortion that may occur if a radiograph is taken with the subject in the incorrect position.

The purpose of this study was to investigate the relationship between errors in axial rotation positioning and pelvic line drawing analysis. In the study, an examiner with five years of clinical experience, including advanced certification in the Gonstead technique, conducted line drawing analyses of 11 radiographs of a phantom lumbopelvic model. After each radiograph, the model was rotated axially one degree. Analyses were performed consistent with a well-known Gonstead textbook, and used to determine internal (IN) or external (EX) misalignments of the ilium with respect to the sacrum.

Changes in axial rotation resulted in small but "artificial" IN/EX listings, along with changes in sacral width measurement and height differences in innominate bones and femur heads, depending on whether the bone moved closer to, or away from, the radiograph film during rotation. According to the study author, these measurements "directly influence chiropractic pelvic listings" and "may appreciably change pelvic listings."

Conclusion: "Significant associations between axial rotation and chiropractic pelvic line analyses obtained from radiographs were found. The magnitude of these influences may be within the domain of clinical significance, raising questions of the clinical usefulness of pelvic radiographic line analysis of iliac and sacral rotation. To be valid, radiographic line drawing analysis of the pelvis will need to account for the confounding influence of patient rotation. Further investigation is warranted to determine whether the degrees of phantom rotation used in this study is within the expected ranges of patient placement in the clinical setting."

Weinert DJ. Influence of axial rotation on chiropractic pelvic radiographic analysis. Journal of Manipulative and Physiological Therapeutics, February 2005;28(2):117-121.

Chiropractic Research Review

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