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18. Medical Necessity for DMX/CRMA is defined by Foreman/Croft.

Foreman and Croft have defined the medical necessity for a digital motion X-ray as follows:
1. History compatible with events know to result in ligamentous instability (trauma or disease).
2. Neck pain that is unresponsive to conservative management.
3. Evaluation of spinal fusion.
4. In cases of trauma in which initial studies reveal significant instability (i.e., more than 2.5 mm subluxation).
5. In cases of clinical instability in which follow-up plain films are unremarkable.
6. In cases in which radiographic and clinical instability are present, and the patient remains refractory to treatment
beyond 4 months.

In almost all cases where a static MRI had revealed AOMSI of any degree, a DMX will usually reveal AOMSI of a much greater degree.
What about safety??? A strong case can be made for the use of DMX studies in almost all significant trauma cases in order to protect
the patient from the results of inappropriate manipulation therapy administered to the victims of traumatically induced AOMSI. The
World Health Organization Guidelines for Safety in chiropractic practice list “Ligamentous laxity with anatomical subluxation or
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dislocation represents an absolute contraindication to joint manipulation in anatomical regions of involvement .”

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