Injuries to the Neck and Loss of Motion Segment Integrity

Neck and Loss of Motion Segment Integrity

Written by Jeremy D. Earle, JD

October 16, 2022

A loss of motion segment integrity (hence called LMSI) refers to the flexion and extension movement of two contiguous vertebral bodies. The term “intactness loss” refers to a change  in direction, such as a loss of range of motion or movement beyond what would be considered normal.

Any significant reduction in range of motion or an increase in range of activity above the permissible normal range in the spine’s motion segment would result in an  over-compromise of the neighboring levels of the spine. The nearby levels will now be taxed  at a higher rate than usual, and the increased wear and tear will make the adjacent levels more  prone to harm.

In the context of cervical (neck) injury cases, many lawyers and even doctors are at a loss for how to approach what seems to be direct soft tissue damage at first appearance. This point becomes stronger when a cervical MRI reveals no discernible discogenic disease (or injury). Many lawyers are at a loss for what to do next in the absence of significant discogenic  disease.

Additional information regarding what to do in the event of a negative cervical MRI may be found in this article.


Physicians often dismiss such claims as purely soft tissue injuries. If the patient/client complains of severe neck discomfort, they may have had neck ligament damage.

Ligamentous injuries are often as painful as discogenic injuries. Additionally, ligament  injuries are often more complicated than other injuries due to the absence of definite  treatments for the underlying pathology and accompanying symptoms.

A claim including ligament damage to the cervical spine, in my view, is much different from  a soft tissue claim. Indeed, according to the American Medical Association’s Guidelines for  the Evaluation of Permanent Impairment, a diagnosis of LMSI in the cervical spine amounts  to a 25% permanent impairment of the whole body. This is a big discovery.


LMSI cannot be diagnosed via a physical clinical examination. Rather than that, a  radiographic flexion-extension study, such as static flexion and extension x-rays of the  cervical spine or a digital motion x-ray, may be used to document LMSI (DMX). Joint translation of more than 3.5 mm is classified as an LMSI and results in a 25% permanent  disability.

Because this approach is exceedingly precise (computer measurements have a  margin of error of around 1%), it is ideal for establishing an injury in court. A value higher  than 3.5 mm is clinically significant and indicates cervical spine ligament degeneration and  ligamentous instability. As previously stated, the best way to identify LMSI injuries is using a  digital motion x-ray, but what are they?


Digital Motion X-Ray (DMX) is not a novel medical procedure. Indeed, it has been in use for decades under the more familiar term of fluoroscopy. However, the DMX has altered how medical experts and personal injury lawyers handle spine injury claims by demonstrating damage to jurors.

Digital Motion X-ray (a.k.a. fluoroscopy or videofluoroscopy) is a kind of x-ray that enables a physician to watch pictures in real-time on a screen rather than developing and viewing  them statically. This approach is effective in detecting conditions and injuries that  conventional x- rays miss.

Because the doctor can watch the patient while moving, DMX is very beneficial for  discovering and diagnosing cervical ligament issues. The doctor may next assess the cervical  spine’s range of motion and diagnose LMSI issues.

The doctor moves the patient in specific  ways during the operation while examining the x-ray picture on the screen. As the  practitioner observes restricted mobility, they may utilize this knowledge to better locate the  affected location.

As previously stated, many kinds of injuries might be difficult to show using more conventional imaging modalities such as MRI and x-ray. However, the introduction of  videofluoroscopy has altered this by enabling clinicians to more clearly assess and  demonstrate injuries that they previously suspected but could not demonstrate conclusively.  This is accomplished by assessing not the damaged tissue itself but the range of motion  available to the cervical spine.

This restriction of movement or extension beyond the usual  range of motion is then utilized to infer an injury in that location.

The DMX machine’s data may then be turned into hundreds of still images or video clips that can be zoomed in and out slowed down, or sped up. As one can guess, this kind of proof is incredibly beneficial when attempting to convince a jury of an injury claim.


Patient perceptions of this injury vary according to the severity of the LMSI itself and the placement of the stress in the spine. LMSI is classified as a Level IV injury in chiropractic terminology, meaning it is very painful. LMSI is “equivalent to a 50% or more spinal compression fracture with no residual neurological impairment,” according to the discipline’s injury severity and pain hierarchy.

Ligament and disc injuries may be rather painful in comparison to other types of injuries.  They may also be difficult to resolve and heal, requiring a precise balance of rest, stretching,  and strengthening activities around the injured area to reestablish stability and flexibility.

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Alteration of Motion Segment Integrity (AOMSI) is an acronym for Alteration of Motion Segment Integrity. The loss of motion segment integrity (increased translational or angular motion) or the reduction of motion due to developmental fusion, fracture healing, healed infection, or surgical arthrodesis is examples of altered motion segment integrity.

It is one of the most serious types of car accident damage. Injury to the spine, particularly when it happens in the back, is exceedingly dangerous.

American Medical Guidelines assign it a 25% impairment level because research indicates that individuals will develop degenerative disc degeneration during the following five years. This disability classification places AOMSI on a level with other types of injuries such as amputations and fusions.

Chiropractic research paved the foundation for the development of guidelines and technologies connected to AOMSI in several ways. Much of the information and inspiration for further investigation on this issue comes from chiropractic and sports medicine practices.



There are many significant reasons why LMSI is often misdiagnosed or completely ignored. The human eye cannot detect AOMSI (or LMSI), which results in an estimated 45 percent of cases being ignored. Second, people may be oblivious to it.

Due to the delayed onset of symptoms after an accident, the patient may not identify the primary cause of the LMSI, or they may believe it is not as bad as they believe due to the delayed onset of symptoms.

Finally, the symptom overlap between LMSI and more conventional strains or sprains has historically prompted physicians to discount the possibility. They may instead believe the patient is suffering from a more typical mild soft tissue injury due to the patient’s restricted range of motion, discomfort, and so forth.


LMSI diagnostic criteria are quite stringent. Due to the extremely precise alterations in the vertebral range of motion that characterize the disorder, measuring it needs highly sophisticated equipment and software with an accuracy of 0.01 mm and 0.01 degrees. The resultant imaging must be evaluated for appropriate diagnosis by board-certified radiologists.

The radiographic flexion-extension study is used to get the images. This often involves static cervical spine flexion and extension x-rays, or more commonly, a digital motion x-ray (DMX).

Historically, DMX was more widely called to by the name of the research from which it is derived: fluoroscopy. In essence, the technique involves the acquisition of a moving x-ray picture to study and quantify the mobility of a physical component.


There are two primary reasons why these stringent diagnostic approaches are necessary. To begin, your healing and recovery are only enhanced by the highest degree of diagnostic accuracy and specificity. Second, an LMSI diagnosis has a substantial impact on your insurance claim and case.


Because LMSI has been linked to degenerative disc disease, you risk worsening these injuries if you are not informed and take remedial action immediately after the accident. Stretching and strengthening the muscles around the LMSI injury site is critical for healing and teaching the body to rebuild the damaged region. You run a more significant chance of aggravating damage with a misdiagnosis.

Suppose you are unaware that you have LMSI and continue with routine activities as if you are nursing a slight soft tissue injury, such as a sprain. In that case, this behavior may accelerate the progression of the injury to the point of additional, or even permanent, harm. Compounding injuries of this kind have resulted in paraplegia in certain situations.


Without particular and defined criteria of validation, insurers are contemptuous  of LMSI. They may claim that this is not the extent of the problem and that you had a soft tissue injury. Their rationale is that a soft tissue injury has a much lower claim value.


When LMSI is diagnosed and established conclusively, it is beneficial during insurance negotiations and in court. This is owing to the degree of precision provided by modern diagnostic procedures.

Insurance companies despise verified LMSI diagnoses because they are almost unrefutable and costly to them. However, if you have been diagnosed with LMSI, you are facing significant health and therapeutic struggle. You are entitled to that settlement money as compensation.


Do not despair if you have a neck injury and the MRI reveals no discogenic disease or just little discogenic pathology. You may have sustained an injury to the cervical spine’s ligaments. Indeed, this is a highly severe injury and a significant value driver for insurance companies if the ligament damage is correctly documented.

If you have sustained a neck injury due to another person’s or corporation’s carelessness, contact the neck injury attorneys at Warrior Car Accident Lawyers, for a free consultation and case review.  

Warrior Personal Injury Lawyers
1902 W. Colorado Ave., Ste. 100
Colorado Springs, CO 80904

Free Consultation


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