Alteration of Motion Segment Integrity
SOURCE: Dynamic Chiropractic
By Jeffrey Cronk, DC, CICE
Sometimes the internal discourse that is common in our profession seems to get in the way of our acceptance of real help so that we can expand our profession and better serve our patients. Alteration of motion segment integrity (AOMSI) is a significant gift from the AMA that allows us to methodically locate, substantiate and objectively prove the severity of the spinal subluxation. Of course, it comes as a gift only as long as we handle it with a high level of responsibility.
Alteration of motion segment integrity is determined by exact mensuration procedure published in the AMA Guides to the Evaluation of Permanent Impairment. It is a spinal subluxation that can be objectively identified with a high degree of accuracy, especially when one acknowledges the advancements that have occurred in assessment of stress imaging (X-ray, DMX).
Please remember that some of the most significant advancements in functional radiology assessment came from information gained from our profession’s very first federal research grant, awarded in the mid 1970s. It was University of Colorado scientist Chung Ha Suh, PhD, who secured the first chiropractic funding from the National Institutes of Health (NS 12226 01A1). Suh’s main areas of research focused on the development of computerized, kinematic models of the spine and three-dimensional, distortion-free X-ray analysis. This research improved our ability to more accurately measure articular deformations such as AOMSI.
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Historically, AOMSI first showed up in writing in June 1993, when the AMA developed the injury model of spinal assessment and listed the findings and criteria in its new DRE (Diagnosis Related Estimate) categories. This was the first open acknowledgment from the AMA that spinal subluxation’s could cause significant, and perhaps permanent, reductions in a patient’s health status. This meant that the AMA had validated what we had been stating for a very long time. Ironically, this validation came some six years after the resolution of the Wilk case.
Some in our profession understood this “open acknowledgement” for what it really was and made sure AOMSI was included in the first chiropractic practice guidelines to be published in the federal government’s National Guideline Clearinghouse Project (NGC). They had the foresight to make sure, with strong peer review, that AOMSI was within the scope of chiropractic management and listed as a component of the vertebral (spinal) subluxation complex.  These guidelines were first published in 1998 and have had two successful and very helpful revisions, still listed in the NGC today.