Important Predictors of Outcome in Patients with Cervical Spondylotic Myelopathy and Radiculopathy undergoing Surgery

Size: px
Start display at page:

Download "Important Predictors of Outcome in Patients with Cervical Spondylotic Myelopathy and Radiculopathy undergoing Surgery"

Transcription

1 Important Predictors of Outcome in Patients with Cervical Spondylotic Myelopathy and Radiculopathy undergoing Surgery Michael G. Fehlings Professor of Neurosurgery Vice Chair Research, Department of Surgery Halbert Chair in Neural Repair and Regeneration Co-Chairman Spinal Program University of Toronto Head Spinal Program Senior Scientist McEwen Centre for Regenerative Medicine Toronto Western Hospital, University Health Network

2 Overview The value of prediction in a surgical setting 1. Predicting outcome in cervical spondylotic myelopathy (CSM) Literature reviews Professional opinion Results from recent multicenter AOSpine CSM studies Clinical relevance and implications MRI predictors of outcome Conclusions 2. Predicting outcome in cervical radiculopathy Short and long term prediction of NDI and pain intensity Neurophysiological and imaging studies

3 Clinical Question Can we predict surgical outcome in patients with CSM? CASE 1 Demographics: 57-y. non-smoking male. Duration of symptoms: 34 months Diagnosis: Spondylosis, disk herniation and hypertrophied ligamentum flavum Baseline Severity Score: Mild, mjoa=15 Symptoms: Numb Hands Signs: Atrophy of intrinsic hand muscles Co-morbidities: Grade 1 Hypertension, Grade 1 Diabetes Surgery: ACDF C5-C7 Surgeon s Predicted Outcome: Subject will likely be the same as baseline

4 Why is prediction important? 1. To manage patients expectations of surgery: patient satisfaction is closely related to expectations. 2. To counsel concerned patients as to potential treatment options. 3. To influence practice and provide decision-making support. 4. To align surgeon perceptions with objective evidence.

5 What is known in the literature? Systematic reviews 1. Holly et al. (29) Literature published between 1997 and 27 Class II normal preoperative median nerve potentials and/or normalization of potentials in the early decompression period are associated with favorable outcomes. Class III age and duration of symptoms may be useful prognostic indicators of surgical outcome

6 2. Tetreault et al (212) 16 studies were rated Excellent Longer duration of symptoms and more severe preoperative myelopathy is associated with poor outcome in patients with CSM. Age may or may not be significant. Study Significantly Associated with Outcome Not Associated with Outcome Cheng et al (29) Age Chibbaro et al (26) Baseline severity score Age, duration of symptoms Ebersold et al (1995) Duration of symptoms Baseline severity score, age Furlan et al (211) Age Hasegawa et al (22) Age Kim et al (28) Diabetes King et al (25) Baseline severity score, age, duration of symptoms, lowerextremity numbness, clumsy hands, Babinski. Morio et al (21) Baseline severity score, age, duration of symptoms Nagashima et al (21) Age Rajshekhar/Kumar (25) Baseline severity score, duration of symptoms Age Shin et al (21) Baseline severity score Age, duration of symptoms Suri et al (23) Age, duration of symptoms Suzuki et al (29) Duration of symptoms Age Tanaka et al (1999) Baseline severity score, duration of symptoms Age Zhang et al (21) Age, duration of symptoms, Babinski. Zhang et al (211) Baseline severity score, age duration of symptoms.

7 3. Tetreault et al (213)

8 What do spine professionals think? Survey of members of AOSpine International (n=689) from regions in Africa, Asia, Europe, North America, the Middle East and South America. Conclusions Duration of symptoms and baseline severity score are the two most important predictors of outcome. Gender and smoking status are less relevant. Controversy surrounding the importance of age

9 A Clinical Prediction Rule: AOSpine Studies 272 patients enrolled: 11 sites from the USA site from Canada 471 patients enrolled: 6 sites from Asia Pacific 5 sites from Europe 3 sites from Latin America 2 sites from North America 77

10 Objectives To develop and externally validate a clinical prediction rule to determine functional outcomes in patients with CSM undergoing surgery. To distinguish between patients with mild myelopathy postoperatively (mjoa 16) and those with substantial residual neurological impairment (mjoa<16) Frequency ΔmJOA 2 ( MCID) Number of MCIDs ΔmJOA<2 (<MCID) mjoa at 1-year 16.2± ±2.93 mjoa < 16 mjoa 16

11

12 External Validation The model demonstrated external validity in the International CSM population. Key predictors Age Duration of symptoms Impaired gait Baseline severity score Smoking status Psychiatric disorders were not important globally. Why?

13 Psychiatric Disorders Psychiatric Disorders Grade 1 Grade 2 Grade 3 Unspecified CSM-North America (n=272) 66/ CSM- International 37/434** North America Subsample 31/ Europe Subsample 2/122** 2 Asia Pacific Subsample 3/139** 3 Latin America Subsample 1/82** 1 The incidence of depression and bipolar is significantly lower at sites outside of North America. Reporting bias? Surgical selection? Cultural reluctance to admit to mental illness?

14 Let s Return to Case 1 PP =.94 PP+.21 mmmmmmmm+.37 AA+.92 IIII+.81 SS+.25 DDDD ee ee PP+.21 mmmmmmmm+.37 AA+.92 IIII+.81 SS+.25 DDDD P=, mjoa=15, A=57, IG=1, S=, DS=5 P(mJOA 16)=81% Managing expectations: this patient is likely to improve and be either neurological normal or very mild postoperatively. Counseling patients: we recommend treatment at this stage rather than a wait and see approach to ensure optimal outcome Aligning surgeons perceptions with objective evidence: the surgeon s prediction of outcome was different than the outcome estimated by the model

15 MRI Measurements in CSM 1. Anatomical measures 2. Cord Properties

16 Importance in Predicting Outcome Univariate Analysis Odds Ratio p-value T2-WI Hyperintensity (n=98) T1-WI Hypointensity (n=95) T2 signal hyperintensity height (n=98) T2 signal hyperintensity area (n=98) Signal change ratio (n=98) Spinal cord compression (n=96) Spinal canal compromise (n=96) Multivariate Analysis Odds Ratio p-value T1-WI Hypointensity <.1 Baseline Severity Score Spinal canal compromise.93.5 MRI variables that can distinguish between reversible and irreversible histological damage are likely to be important predictors of surgical outcome. New imaging techniques, such as diffusion tensor imaging, can detect damage to the white matter tracts before a high signal lesion appears on T2-WI.

17 New Techniques Positive association between baseline fractional anisotropy measures and outcome evaluated by NDI. For patients with a mjoa<8, lower FA values were predictive of a worse outcome. The fiber tract ratio is correlated with the JOA recovery rate. A ratio <6% typically had a recovery rate <4%.

18 Predicting Short- and Long-term outcome in Cervical Radiculopathy Predictors of NDI and pain intensity in the short and long term. Variables at the top of the table have the greatest predictive value.

19 Neurophysiological and Imaging Predictors in Radiculopathy Alrawi et al (27) Group A (abnormal EMG) and Group B (normal EMG) Group A had a significantly better outcome in group A compared to group B based on the Prolo outcome score Group A also had significantly higher postoperative patient satisfaction Multivariate Analysis Not significant: age, number of levels involved, work status before and after surgery, dominant hand and symptom severities Significant: preoperative EMG findings (greater room for improvement)

20 Conclusions Important predictors of outcome in 1. Cervical Myelopathy Baseline severity score, duration of symptoms, lower extremity dysfunction Encourage early operation of myelopathic patients as well as surgery for milder disease stages. Smoking status: Promote smoking cessation prior to surgery Psychiatric disorders (in North America) Manage and control co-morbidities MRI variables that distinguish irreversible and reversible histological damage 2. Cervical Radiculopathy Preoperative severity score Active range of motion Smoking Hand strength Positive EMG findings

Cervical Spondylosis (Arthritis of the Neck)

Cervical Spondylosis (Arthritis of the Neck) Copyright 2009 American Academy of Orthopaedic Surgeons Cervical Spondylosis (Arthritis of the Neck) Neck pain is extremely common. It can be caused by many things, and is most often related to getting

More information

8 th Annual W/C Spine Summit. Ted A. Lennard, MD Feb. 12, 2015

8 th Annual W/C Spine Summit. Ted A. Lennard, MD Feb. 12, 2015 8 th Annual W/C Spine Summit Ted A. Lennard, MD Feb. 12, 2015 Case Study 45 y.o. male Truck Accident on 1/15/12 Slid on ice and crossed median. Case Study Taken by ambulance to ER in Texas +Loss of consciousness

More information

CERVICAL DISC HERNIATION

CERVICAL DISC HERNIATION CERVICAL DISC HERNIATION Most frequent at C 5/6 level but also occur at C 6 7 & to a lesser extent at C4 5 & other levels In relatively younger persons soft disk protrusion is more common than hard disk

More information

Khaled s Radiology report

Khaled s Radiology report Khaled s Radiology report Patient Name: Khaled Adli Moustafa Date 06/15/2014 The patient is not present. And the following report is based upon what was in the MRI of the cervical and lumbar spine report

More information

.org. Cervical Spondylosis (Arthritis of the Neck) Anatomy. Cause

.org. Cervical Spondylosis (Arthritis of the Neck) Anatomy. Cause Cervical Spondylosis (Arthritis of the Neck) Page ( 1 ) Neck pain can be caused by many things but is most often related to getting older. Like the rest of the body, the disks and joints in the neck (cervical

More information

Neck Pain Frequently Asked Questions. Moe R. Lim, MD UNC Orthopaedics (919-96B-ONES) UNC Spine Center (919-957-6789)

Neck Pain Frequently Asked Questions. Moe R. Lim, MD UNC Orthopaedics (919-96B-ONES) UNC Spine Center (919-957-6789) Neck Pain Frequently Asked Questions Moe R. Lim, MD UNC Orthopaedics (919-96B-ONES) UNC Spine Center (919-957-6789) Neck Pain Human Spine 25 bones Cervical (7) Thoracic (12) Lumbar (5) Sacrum Human Spine

More information

Cervical Spine Surgery. Orthopaedic Nursing Seminar. Dr Michelle Atkinson. Friday October 21 st 2011. Cervical Disc Herniation

Cervical Spine Surgery. Orthopaedic Nursing Seminar. Dr Michelle Atkinson. Friday October 21 st 2011. Cervical Disc Herniation Cervical Spine Surgery Dr Michelle Atkinson The Sydney and Dalcross Adventist Hospitals Orthopaedic Nursing Seminar Friday October 21 st 2011 Cervical disc herniation The most frequently treated surgical

More information

Postoperative C5 palsy in consequence of anterior cervical discectomy and fusion (ACDF)

Postoperative C5 palsy in consequence of anterior cervical discectomy and fusion (ACDF) Postoperative C5 palsy in consequence of anterior cervical discectomy and fusion (ACDF) *Takeshi Aoyama, *Kazutoshi Hida, *:Shunsuke Yano, *Tomohiro Yamauchi, **Motoyuki Iwasaki, *Kiyohiro Houkin *Department

More information

Options for Cervical Disc Degeneration A Guide to the Fusion Arm of the M6 -C Artificial Disc Study

Options for Cervical Disc Degeneration A Guide to the Fusion Arm of the M6 -C Artificial Disc Study Options for Cervical Disc Degeneration A Guide to the Fusion Arm of the M6 -C Artificial Disc Study Each year, hundreds of thousands of adults are diagnosed with Cervical Disc Degeneration, an upper spine

More information

A Patient s Guide to Artificial Cervical Disc Replacement

A Patient s Guide to Artificial Cervical Disc Replacement A Patient s Guide to Artificial Cervical Disc Replacement Each year, hundreds of thousands of adults are diagnosed with Cervical Disc Degeneration, an upper spine condition that can cause pain and numbness

More information

Each year, hundreds of thousands of adults are diagnosed with Cervical Disc Degeneration, The Cervical Spine. What is the Cervical Spine?

Each year, hundreds of thousands of adults are diagnosed with Cervical Disc Degeneration, The Cervical Spine. What is the Cervical Spine? Each year, hundreds of thousands of adults are diagnosed with Cervical Disc Degeneration, an upper spine condition that can cause pain and numbness in the neck, shoulders, arms, and even hands. This patient

More information

BRYAN. Cervical Disc System. Patient Information

BRYAN. Cervical Disc System. Patient Information BRYAN Cervical Disc System Patient Information 3 BRYAN Cervical Disc System PATIENT INFORMATION BRYAN Cervical Disc System PATIENT INFORMATION 1 BRYAN Cervical Disc System This patient information brochure

More information

1 REVISOR 5223.0070. (4) Pain associated with rigidity (loss of motion or postural abnormality) or

1 REVISOR 5223.0070. (4) Pain associated with rigidity (loss of motion or postural abnormality) or 1 REVISOR 5223.0070 5223.0070 MUSCULOSKELETAL SCHEDULE; BACK. Subpart 1. Lumbar spine. The spine rating is inclusive of leg symptoms except for gross motor weakness, bladder or bowel dysfunction, or sexual

More information

.org. Cervical Radiculopathy (Pinched Nerve) Anatomy. Cause

.org. Cervical Radiculopathy (Pinched Nerve) Anatomy. Cause Cervical Radiculopathy (Pinched Nerve) Page ( 1 ) Cervical radiculopathy, commonly called a pinched nerve occurs when a nerve in the neck is compressed or irritated where it branches away from the spinal

More information

Spinal Surgery 2. Teaching Aims. Common Spinal Pathologies. Disc Degeneration. Disc Degeneration. Causes of LBP 8/2/13. Common Spinal Conditions

Spinal Surgery 2. Teaching Aims. Common Spinal Pathologies. Disc Degeneration. Disc Degeneration. Causes of LBP 8/2/13. Common Spinal Conditions Teaching Aims Spinal Surgery 2 Mr Mushtaque A. Ishaque BSc(Hons) BChir(Cantab) DM FRCS FRCS(Ed) FRCS(Orth) Hunterian Professor at The Royal College of Surgeons of England Consultant Orthopaedic Spinal

More information

Cervical Spondylotic Myelopathy Associated with Kyphosis or Sagittal Sigmoid Alignment: Outcome after Anterior or Posterior Decompression

Cervical Spondylotic Myelopathy Associated with Kyphosis or Sagittal Sigmoid Alignment: Outcome after Anterior or Posterior Decompression Cervical Spondylotic Myelopathy Associated with Kyphosis or Sagittal Sigmoid Alignment: Outcome after Anterior or Posterior Decompression 1 Journal of Neurosurgery: Spine November 2009, Volume 11, pp.

More information

NON SURGICAL SPINAL DECOMPRESSION. Dr. Douglas A. VanderPloeg

NON SURGICAL SPINAL DECOMPRESSION. Dr. Douglas A. VanderPloeg NON SURGICAL SPINAL DECOMPRESSION Dr. Douglas A. VanderPloeg CONTENTS I. Incidence of L.B.P. II. Anatomy Review III. IV. Disc Degeneration, Bulge, and Herniation Non-Surgical Spinal Decompression 1. History

More information

Cervical Deformity: Indications and Treatment Options. J. Patrick Johnson, MD

Cervical Deformity: Indications and Treatment Options. J. Patrick Johnson, MD Cervical Deformity: Indications and Treatment Options J. Patrick Johnson, MD Cervical Deformity Important structural components that are involved in deformity developing Muscular Bony Ligamentous Innervation

More information

Nonoperative Management of Herniated Cervical Intervertebral Disc With Radiculopathy. Spine Volume 21(16) August 15, 1996, pp 1877-1883

Nonoperative Management of Herniated Cervical Intervertebral Disc With Radiculopathy. Spine Volume 21(16) August 15, 1996, pp 1877-1883 Nonoperative Management of Herniated Cervical Intervertebral Disc With Radiculopathy 1 Spine Volume 21(16) August 15, 1996, pp 1877-1883 Saal, Joel S. MD; Saal, Jeffrey A. MD; Yurth, Elizabeth F. MD FROM

More information

1 Operative Management of Common Spinal Conditions

1 Operative Management of Common Spinal Conditions 1 Operative Management of Common Spinal Conditions 2 Brett Menmuir Reno Orthopedic Clinic ROC Overview What was I thinking? Herniated Disc Stenosis Low Back Pain Neck Pain Sacroiliac Joint Dysfunction

More information

Deuk Spine Institute s Guaranteed Spinal Surgery Outcomes

Deuk Spine Institute s Guaranteed Spinal Surgery Outcomes Deuk Spine Institute s Guaranteed Spinal Surgery Outcomes Ara Deukmedjian MD Deuk Spine Institute Surgery Center of Viera June 12 2015 Deuk Spine Institute Multispecialty Spine surgeons, orthopedic surgeons,

More information

Cervical Conditions: Diagnosis and Treatments

Cervical Conditions: Diagnosis and Treatments Cervical Conditions: Diagnosis and Treatments Mark R Mikles, M.D. Cervical Conditions: Diagnosis and Treatment Cervical conditions Neck Pain Radiculopathy Myelopathy 1 Cervical Conditions: Diagnosis and

More information

Treating Bulging Discs & Sciatica. Alexander Ching, MD

Treating Bulging Discs & Sciatica. Alexander Ching, MD Treating Bulging Discs & Sciatica Alexander Ching, MD Disclosures Depuy Spine Teaching and courses K2 Spine Complex Spine Study Group Disclosures Take 2 I am a spine surgeon I like spine surgery I believe

More information

Comparative Effectiveness Research

Comparative Effectiveness Research Comparative Effectiveness Research 2 Nelson F. SooHoo, MD Associate Professor UCLA Dept. of Orthopaedic Surgery 8 Objectives Define comparative effectiveness research Relevance to orthopaedic surgeons

More information

Temple Physical Therapy

Temple Physical Therapy Temple Physical Therapy A General Overview of Common Neck Injuries For current information on Temple Physical Therapy related news and for a healthy and safe return to work, sport and recreation Like Us

More information

BEFORE THE ARKANSAS WORKERS COMPENSATION COMMISSION CLAIM NUMBER F205928 DOUGLAS EUGENE WHIPKEY, EMPLOYEE CLAIMANT XPRESS BOATS, EMPLOYER RESPONDENT

BEFORE THE ARKANSAS WORKERS COMPENSATION COMMISSION CLAIM NUMBER F205928 DOUGLAS EUGENE WHIPKEY, EMPLOYEE CLAIMANT XPRESS BOATS, EMPLOYER RESPONDENT BEFORE THE ARKANSAS WORKERS COMPENSATION COMMISSION CLAIM NUMBER F205928 DOUGLAS EUGENE WHIPKEY, EMPLOYEE CLAIMANT XPRESS BOATS, EMPLOYER RESPONDENT CONTINENTAL CASUALTY CO., INSURANCE CARRIER RESPONDENT

More information

Options for Cervical Disc Degeneration A Guide to the M6-C. clinical study

Options for Cervical Disc Degeneration A Guide to the M6-C. clinical study Options for Cervical Disc Degeneration A Guide to the M6-C clinical study Each year, hundreds of thousands of adults are diagnosed with Cervical Disc Degeneration, an upper spine condition that can cause

More information

Sample Treatment Protocol

Sample Treatment Protocol Sample Treatment Protocol 1 Adults with acute episode of LBP Definition: Acute episode Back pain lasting

More information

ABNORMALITIES IN DISC MORPHOLOGY

ABNORMALITIES IN DISC MORPHOLOGY ABNORMALITIES IN DISC MORPHOLOGY The terminology for disc abnormalities is very CONFUSING and INCONSISTENT in the literature. To address the remaining needs and in hopes of securing endorsement sufficient

More information

Cervical Stenosis & Myelopathy

Cervical Stenosis & Myelopathy Cervical Stenosis & Myelopathy North American Spine Society Public Education Series What Are Cervical Stenosis and Myelopathy? The cervical spine (neck) is made up of a series of connected bones called

More information

6/3/2011. High Prevalence and Incidence. Low back pain is 5 th most common reason for all physician office visits in the U.S.

6/3/2011. High Prevalence and Incidence. Low back pain is 5 th most common reason for all physician office visits in the U.S. High Prevalence and Incidence Prevalence 85% of Americans will experience low back pain at some time in their life. Incidence 5% annual Timothy C. Shen, M.D. Physical Medicine and Rehabilitation Sub-specialty

More information

Electrodiagnostic Testing

Electrodiagnostic Testing Electrodiagnostic Testing Electromyogram and Nerve Conduction Study North American Spine Society Public Education Series What Is Electrodiagnostic Testing? The term electrodiagnostic testing covers a

More information

Low Back Injury in the Industrial Athlete: An Anatomic Approach

Low Back Injury in the Industrial Athlete: An Anatomic Approach Low Back Injury in the Industrial Athlete: An Anatomic Approach Earl J. Craig, M.D. Assistant Professor Indiana University School of Medicine Department of Physical Medicine and Rehabilitation Epidemiology

More information

Chiari Malformation: Treatment

Chiari Malformation: Treatment Chiari Malformation: Treatment SYMPTOMS DIAGNOSIS LIVING WITH CHIARI TREATMENT Rick Labuda, Executive Director director@conquerchiari.org 724-940-0116 Disclaimer: This presentation is intended for informational

More information

Patient Information. Anterior Cervical Discectomy and Fusion Surgery (ACDF).

Patient Information. Anterior Cervical Discectomy and Fusion Surgery (ACDF). Patient Information. Anterior Cervical Discectomy and Fusion Surgery (ACDF). Understanding your spine Disc Between each pair of vertebrae there is a disc that acts as a cushion to protect the vertebra,

More information

The Final Ruling. Presented by: L. Timothy Wilson Administrative Law Judge Missouri Division of Workers Compensation Springfield Adjudication Office

The Final Ruling. Presented by: L. Timothy Wilson Administrative Law Judge Missouri Division of Workers Compensation Springfield Adjudication Office The Final Ruling Presented by: L. Timothy Wilson Administrative Law Judge Missouri Division of Workers Compensation Springfield Adjudication Office Factual Outline of Hypothetical Description of Accident:

More information

Surgery for cervical disc prolapse or cervical osteophyte

Surgery for cervical disc prolapse or cervical osteophyte Mr Paul S. D Urso MBBS(Hons), PhD, FRACS Neurosurgeon Provider Nº: 081161DY Epworth Centre Suite 6.1 32 Erin Street Richmond 3121 Tel: 03 9421 5844 Fax: 03 9421 4186 AH: 03 9483 4040 email: paul@pauldurso.com

More information

Brown-Sequard Syndrome Caused by Cervical Disc Herniation

Brown-Sequard Syndrome Caused by Cervical Disc Herniation 62 CASE REPORT Brown-Sequard Syndrome Caused by Cervical Disc Herniation Chih-Hsiu Wang, Chun-Chung Chen, Der-Yang Cho Department of Neurosurgery, China Medical University Hospital, Taichung, Taiwan, R.O.C.

More information

Assessing equity of use and outcome of hip replacement surgery using PROMs data. Jenny Neuburger, King s Fund Conference 22 nd November 2012

Assessing equity of use and outcome of hip replacement surgery using PROMs data. Jenny Neuburger, King s Fund Conference 22 nd November 2012 Assessing equity of use and outcome of hip replacement surgery using PROMs data Jenny Neuburger, King s Fund Conference 22 nd November 2012 Structure of talk 1. Patient pathway points at which in differences

More information

Diagnosis and Management for Chronic Back Pain: Critical for your Recovery

Diagnosis and Management for Chronic Back Pain: Critical for your Recovery Diagnosis and Management for Chronic Back Pain: Critical for your Recovery Dr. Connie D Astolfo, DC, PhD (candidate) In past articles I have stressed that the causes of back pain can be very complex. This

More information

THORACIC OUTLET SYNDROME & BRACHIAL PLEXUS INJURIES

THORACIC OUTLET SYNDROME & BRACHIAL PLEXUS INJURIES THORACIC OUTLET SYNDROME & BRACHIAL PLEXUS INJURIES I. THORACIC OUTLET SYNDROME TOS is a compression of nerves or blood vessels, or both, in the thoracic outlet region, which is the space between the collarbone

More information

White Paper: Cervical Disc Replacement: When is the Mobi-C Cervical Disc Medically Necessary?

White Paper: Cervical Disc Replacement: When is the Mobi-C Cervical Disc Medically Necessary? White Paper: Cervical Disc Replacement: When is the Mobi-C Cervical Disc Medically Necessary? For Health Plans, Medical Management Organizations and TPAs Cervical Disc Disease: An Overview The cervical

More information

SPINE SERVICE ROTATION ROTATION SPECIFIC OBJECTIVES (RSO) DEPT. OF ORTHOPEDICS AND PHYSICAL REHABILITATION UNIVERSITY OF MASSACHUSETTS

SPINE SERVICE ROTATION ROTATION SPECIFIC OBJECTIVES (RSO) DEPT. OF ORTHOPEDICS AND PHYSICAL REHABILITATION UNIVERSITY OF MASSACHUSETTS SPINE SERVICE ROTATION ROTATION SPECIFIC OBJECTIVES (RSO) DEPT. OF ORTHOPEDICS AND PHYSICAL REHABILITATION UNIVERSITY OF MASSACHUSETTS The purpose of this RSO is to outline and clarify the objectives of

More information

Prevalence of annular tears and disc herniations on MR images of the cervical spine in symptom free volunteers

Prevalence of annular tears and disc herniations on MR images of the cervical spine in symptom free volunteers Prevalence of annular tears and disc herniations on MR images of the cervical spine in symptom free volunteers 1 European Journal of Radiology September 2005, 55, 409 414 C.W. Ernst, T.W. Stadnik, E. Peeters,

More information

Return to same game if sx s resolve within 15 minutes. Return to next game if sx s resolve within one week Return to Competition

Return to same game if sx s resolve within 15 minutes. Return to next game if sx s resolve within one week Return to Competition Assessment Skills of the Spine on the Field and in the Clinic Ron Burke, MD Cervical Spine Injuries Sprains and strains Stingers Transient quadriparesis Cervical Spine Injuries Result in critical loss

More information

Differentiating Cervical Radiculopathy and Peripheral Neuropathy. Adam P. Smith, MD

Differentiating Cervical Radiculopathy and Peripheral Neuropathy. Adam P. Smith, MD Differentiating Cervical Radiculopathy and Peripheral Neuropathy Adam P. Smith, MD I have no financial, personal, or professional conflicts of interest to report Radiculopathy versus Neuropathy Radiculopathy

More information

Proving Causation and Damages in Spinal Fusion Cases

Proving Causation and Damages in Spinal Fusion Cases Page 1 of 7 Ben Brodhead on proving causation and damages in spinal fusion cases. Friend on Facebook Follow on Twitter Forward to a Friend Proving Causation and Damages in Spinal Fusion Cases By: Ben C.

More information

Minimally Invasive Spine Surgery For Your Patients

Minimally Invasive Spine Surgery For Your Patients Minimally Invasive Spine Surgery For Your Patients Lukas P. Zebala, M.D. Assistant Professor Orthopaedic and Neurological Spine Surgery Department of Orthopaedic Surgery Washington University School of

More information

Clinical and patient-reported outcomes after anterior cervical decompression and fusion surgery A focus on functioning and daily life

Clinical and patient-reported outcomes after anterior cervical decompression and fusion surgery A focus on functioning and daily life Linköping University Medical Dissertations No. 1443 Clinical and patient-reported outcomes after anterior cervical decompression and fusion surgery A focus on functioning and daily life Anna Hermansen

More information

X Stop Spinal Stenosis Decompression

X Stop Spinal Stenosis Decompression X Stop Spinal Stenosis Decompression Am I a candidate for X Stop spinal surgery? You may be a candidate for the X Stop spinal surgery if you have primarily leg pain rather than mostly back pain and your

More information

Spinal Surgery Functional Status and Quality of Life Outcome Specifications 2015 (01/01/2013 to 12/31/2013 Dates of Procedure) September 2014

Spinal Surgery Functional Status and Quality of Life Outcome Specifications 2015 (01/01/2013 to 12/31/2013 Dates of Procedure) September 2014 Description Methodology For patients ages 18 years and older who undergo a lumbar discectomy/laminotomy or lumbar spinal fusion procedure during the measurement year, the following measures will be calculated:

More information

Patient Guide to Stenosis

Patient Guide to Stenosis Patient Guide to Stenosis For Your Spinal Education Compliments of Your Spine Health Professional Dr. Schlesinger & Dr. Thomas Arkansas Neurosurgery Clinic 501-661-0077 www.arneuro.com Stenosis Description:

More information

Surgical Procedures and Clinical Results of Endoscopic Decompression for Lumbar Canal Stenosis

Surgical Procedures and Clinical Results of Endoscopic Decompression for Lumbar Canal Stenosis Surgical Procedures and Clinical Results of Endoscopic Decompression for Lumbar Canal Stenosis Munehito Yoshida, Akitaka Ueyoshi, Kazuhiro Maio, Masaki Kawai, and Yukihiro Nakagawa Summary. The purpose

More information

Martin Harrow s Long-Term Study of. Psychotic Patients

Martin Harrow s Long-Term Study of. Psychotic Patients Martin Harrow s Long-Term Study of Patient Enrollment Psychotic Patients 64 schizophrenia patients 81 patients with other psychotic disorders 37 psychotic bipolar patients 28 unipolar psychotic patients

More information

Patient Information. Lateral Lumbar Interbody Fusion Surgery (LLIF).

Patient Information. Lateral Lumbar Interbody Fusion Surgery (LLIF). Patient Information. Lateral Lumbar Interbody Fusion Surgery (LLIF). Understanding your spine Disc Between each pair of vertebrae there is a disc that acts as a cushion to protect the vertebra, allows

More information

Chiari Malformation: An Overview

Chiari Malformation: An Overview Chiari Malformation: An Overview SYMPTOMS DIAGNOSIS LIVING WITH CHIARI TREATMENT Rick Labuda, Executive Director director@conquerchiari.org 724-940-0116 Disclaimer: This presentation is intended for informational

More information

Update to the Treatment of Degenerative Cervical Disc Disease

Update to the Treatment of Degenerative Cervical Disc Disease Update to the Treatment of Degenerative Cervical Disc Disease Michael Lynn, MD Neurosurgeon, Southeastern Neurosurgical & Spine Institute Adjunct Assistant Clinical Professor of Bioengineering, Clemson

More information

Ms. Jackson is the Manager of Health Finance and Reimbursement, Division of Health Policy and Practice Services, Washington, DC.

Ms. Jackson is the Manager of Health Finance and Reimbursement, Division of Health Policy and Practice Services, Washington, DC. Electrodiagnostic Testing with Same Day Evaluation Management By: Shane J. Burr, MD; Scott I. Horn, DO; Jenny J. Jackson, MPH, CPC; Joseph P. Purcell, DO Dr. Burr practices general inpatient and outpatient

More information

OUTLINE. Anatomy Approach to LBP Discogenic LBP. Treatment. Herniated Nucleus Pulposus Annular Tear. Non-Surgical Surgical

OUTLINE. Anatomy Approach to LBP Discogenic LBP. Treatment. Herniated Nucleus Pulposus Annular Tear. Non-Surgical Surgical DISCOGENIC PAIN OUTLINE Anatomy Approach to LBP Discogenic LBP Herniated Nucleus Pulposus Annular Tear Treatment Non-Surgical Surgical Facet Joints: bear 20% of weight Discs bear 80% of weight Neural Foramen

More information

Standard of Care: Cervical Radiculopathy

Standard of Care: Cervical Radiculopathy Department of Rehabilitation Services Physical Therapy Diagnosis: Cervical radiculopathy, injury to one or more nerve roots, has multiple presentations. Symptoms may include pain in the cervical spine

More information

DIFFERENTIAL DIAGNOSIS OF LOW BACK PAIN. Arnold J. Weil, M.D., M.B.A. Non-Surgical Orthopaedics, P.C. Atlanta, GA

DIFFERENTIAL DIAGNOSIS OF LOW BACK PAIN. Arnold J. Weil, M.D., M.B.A. Non-Surgical Orthopaedics, P.C. Atlanta, GA DIFFERENTIAL DIAGNOSIS OF LOW BACK PAIN Arnold J. Weil, M.D., M.B.A. Non-Surgical Orthopaedics, P.C. Atlanta, GA MEDICAL ALGORITHM OF REALITY LOWER BACK PAIN Yes Patient will never get better until case

More information

Spinal Cord Diseases in Bernese Mountain Dogs

Spinal Cord Diseases in Bernese Mountain Dogs Spinal Cord Diseases in Bernese Mountain Dogs 0 A N O V E R V I E W F O R BERNER O W N E R S O R G A N I Z E D B Y N A N C Y M E L O N E, P H. D. Based on materials obtained from the Berner Garde Foundation

More information

ReviewTex, Inc. 1818 Mountjoy Drive San Antonio, TX 78232 (phone) 210-598-9381 (fax) 210-598-9382 reviewtex@hotmail.com

ReviewTex, Inc. 1818 Mountjoy Drive San Antonio, TX 78232 (phone) 210-598-9381 (fax) 210-598-9382 reviewtex@hotmail.com Date notice sent to all parties: May 27, 2014 IRO CASE #: ReviewTex, Inc. 1818 Mountjoy Drive San Antonio, TX 78232 (phone) 210-598-9381 (fax) 210-598-9382 reviewtex@hotmail.com Notice of Independent Review

More information

Patient Information. Anterior Lumbar Interbody Fusion

Patient Information. Anterior Lumbar Interbody Fusion Patient Information Anterior Lumbar Interbody Fusion Table of Contents Anatomy of the Spine 2 The Healthy Spine 3 General Treatment Options 4 General Conditions of the Lumbar Spine 5 What is Spondylolisthesis?

More information

1 Risk Factors for Prolonged Disability After Whiplash Injury: A Prospective Study. Spine: Volume 30(4), February 15, 2005, pp 386-391

1 Risk Factors for Prolonged Disability After Whiplash Injury: A Prospective Study. Spine: Volume 30(4), February 15, 2005, pp 386-391 1 Risk Factors for Prolonged Disability After Whiplash Injury: A Prospective Study Spine: Volume 30(4), February 15, 2005, pp 386-391 Gun, Richard Townsend MB, BS; Osti, Orso Lorenzo MD, PhD; O'Riordan,

More information

MALIGNANT SPINAL CORD COMPRESSION. Kate Hamilton Head of Medical Oncology Ballarat Health Services

MALIGNANT SPINAL CORD COMPRESSION. Kate Hamilton Head of Medical Oncology Ballarat Health Services MALIGNANT SPINAL CORD COMPRESSION Kate Hamilton Head of Medical Oncology Ballarat Health Services OVERVIEW Background Epidemiology Pathophysiology Diagnosis Investigation Differential Diagnosis Management

More information

Whiplash and Whiplash- Associated Disorders

Whiplash and Whiplash- Associated Disorders Whiplash and Whiplash- Associated Disorders North American Spine Society Public Education Series What Is Whiplash? The term whiplash might be confusing because it describes both a mechanism of injury and

More information

Cervical Spine Radiculopathy: Convervative Treatment. Christos K. Yiannakopoulos, MD Orthopaedic Surgeon

Cervical Spine Radiculopathy: Convervative Treatment. Christos K. Yiannakopoulos, MD Orthopaedic Surgeon Cervical Spine Radiculopathy: Convervative Treatment Christos K. Yiannakopoulos, MD Orthopaedic Surgeon Laboratory for the Research of the Musculoskeletal System, University of Athens & IASO General Hospital,

More information

Notice of Independent Review Decision DESCRIPTION OF THE SERVICE OR SERVICES IN DISPUTE:

Notice of Independent Review Decision DESCRIPTION OF THE SERVICE OR SERVICES IN DISPUTE: Notice of Independent Review Decision DATE OF REVIEW: 08/15/08 IRO CASE #: NAME: DESCRIPTION OF THE SERVICE OR SERVICES IN DISPUTE: Determine the appropriateness of the previously denied request for physical

More information

Spine Section Strategic Plan

Spine Section Strategic Plan Spine Section Strategic Plan I. INTRODUCTION A. Definition of the subspecialty or section The section is comprised of those members of the American Academy of Neurology who have an interest in treating

More information

LOW BACK PAIN; MECHANICAL

LOW BACK PAIN; MECHANICAL 1 ORTHO 16 LOW BACK PAIN; MECHANICAL Background This case definition was developed by the Armed Forces Health Surveillance Center (AFHSC) for the purpose of epidemiological surveillance of a condition

More information

Lateral Lumbar Interbody Fusion (LLIF or XLIF)

Lateral Lumbar Interbody Fusion (LLIF or XLIF) Lateral Lumbar Interbody Fusion (LLIF or XLIF) NOTE: PLEASE DO NOT TAKE ANY NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDs like Advil, Aleve, Ibuprofen, Motrin, Naprosyn, Mobic, etc) OR ASPIRIN PRODUCTS

More information

CONCOMITANT COMBINED DEGENERATIVE COMPRESSION OF THE SPINAL CORD AND CAUDA EQUINA: A REPORT ON THREE CASES

CONCOMITANT COMBINED DEGENERATIVE COMPRESSION OF THE SPINAL CORD AND CAUDA EQUINA: A REPORT ON THREE CASES CASE REPORT CONCOMITANT COMBINED DEGENERATIVE COMPRESSION OF THE SPINAL CORD AND CAUDA EQUINA: A REPORT ON THREE CASES Atanas Davarski 1, Ivo Kehayov 1, Tanya Kitova 2, Christo Zhelyazkov 1, Borislav Kitov

More information

The Surgical Spine. Sergio Rivero M.D.

The Surgical Spine. Sergio Rivero M.D. The Surgical Spine Sergio Rivero M.D. Goals: Review Current literature in spinal surgery. To utilize evidence based medicine to treat spinal pathology. It is much more important to know what sort of a

More information

First Year. PT7040- Clinical Skills and Examination II

First Year. PT7040- Clinical Skills and Examination II First Year Summer PT7010 Anatomical Dissection for Physical Therapists This is a dissection-based, radiographic anatomical study of the spine, lower extremity, and upper extremity as related to physical

More information

Soft-tissue injuries of the neck in automobile accidents: Factors influencing prognosis

Soft-tissue injuries of the neck in automobile accidents: Factors influencing prognosis Soft-tissue injuries of the neck in automobile accidents: Factors influencing prognosis 1 Mason Hohl, MD FROM ABSTRACT: Journal of Bone and Joint Surgery (American) December 1974;56(8):1675-1682 Five years

More information

Spinal Cord Stimulation (SCS) Therapy: Fact Sheet

Spinal Cord Stimulation (SCS) Therapy: Fact Sheet Spinal Cord Stimulation (SCS) Therapy: Fact Sheet What is SCS Therapy? Spinal cord stimulation (SCS) may be a life-changing 1 surgical option for patients to control their chronic neuropathic pain and

More information

A Healthy Lumbar Spine...2. Lumbar Discectomy...3. Understanding Discectomy Surgery...4. Lumbar Decompression...5

A Healthy Lumbar Spine...2. Lumbar Discectomy...3. Understanding Discectomy Surgery...4. Lumbar Decompression...5 Table of Contents A Healthy Lumbar Spine...2 Lumbar Discectomy...3 Understanding Discectomy Surgery...4 Lumbar Decompression...5 Understanding Decompression Surgery....6 Preparing for Surgery....7 After

More information

Spine University s Guide to Cauda Equina Syndrome

Spine University s Guide to Cauda Equina Syndrome Spine University s Guide to Cauda Equina Syndrome 2 Introduction Your spine is a very complicated part of your body. It s made up of the bones (vertebrae) that keep it aligned, nerves that channel down

More information

Marc A. Cohen, MD, FAAOS, FACS Diplomate American Board of Spinal Surgery Fellow American College of Spinal Surgery

Marc A. Cohen, MD, FAAOS, FACS Diplomate American Board of Spinal Surgery Fellow American College of Spinal Surgery Marc A. Cohen, MD, FAAOS, FACS Diplomate American Board of Spinal Surgery Fellow American College of Spinal Surgery 221 Madison Ave Morristown, New Jersey 07960 (973) 538 4444 Fax (973) 538 0420 Patient

More information

Background. Kinematic MRI of the Lumbar Spine The UMMC Experience. Background. Background

Background. Kinematic MRI of the Lumbar Spine The UMMC Experience. Background. Background Kinematic MRI of the Lumbar Spine The Experience DR TOK CHUNG HONG SENIOR LECTURER DEPARTMENT OF BIOMEDICAL IMAGING FACULTY OF MEDICINE UNIVERSITY OF MALAYA Magnetic resonance imaging provides excellent

More information

Three-level cervical disc herniation Case report and review of the literature

Three-level cervical disc herniation Case report and review of the literature Romanian Neurosurgery (2015) XXIX 3: 305-311 305 Three-level cervical disc herniation Case report and review of the literature Andrei St. Iencean 1,3, Ion Poeata 2,3 1 PhD Student, Grigore T. Popa University

More information

Appropriate Use Criteria

Appropriate Use Criteria Appropriate Use Criteria Cervical Fusion North American Spine Society 2013 1 2 Cervical Fusion Appropriate Use Criteria Work Groups Oversight Charles A. Reitman, MD, Chair Orthopedic Surgery Christopher

More information

.org. Herniated Disk in the Lower Back. Anatomy. Description

.org. Herniated Disk in the Lower Back. Anatomy. Description Herniated Disk in the Lower Back Page ( 1 ) Sometimes called a slipped or ruptured disk, a herniated disk most often occurs in your lower back. It is one of the most common causes of low back pain, as

More information

Patients with chronic low back pain will be considered for surgical management under the following circumstances:

Patients with chronic low back pain will be considered for surgical management under the following circumstances: T17 Spinal Surgery for Non Acute Lumbar Conditions Policy Policy author: Ipswich and East Suffolk and West Suffolk CCGs Policy start date: September 2014 Review date: September 2016 Policy summary This

More information

DROP FOOT AND TREATMENTS YOUNGMEE PARK

DROP FOOT AND TREATMENTS YOUNGMEE PARK DROP FOOT AND TREATMENTS YOUNGMEE PARK WHAT IS FOOT DROP Foot drop / Drop foot the inability to lift the front part of the foot not a disease a symptom of some other medical problems a sign of an underlying

More information

Differences in type of comorbidity and complications in young and elderly

Differences in type of comorbidity and complications in young and elderly Differences in type of comorbidity and complications in young and elderly 5.1 Relation between age, comorbidity, and complications in patients undergoing major surgery for head and neck cancer Peters TTA

More information

J of Evolution of Med and Dent Sci/ eissn- 2278-4802, pissn- 2278-4748/ Vol. 4/ Issue 55/ July 09, 2015 Page 9518

J of Evolution of Med and Dent Sci/ eissn- 2278-4802, pissn- 2278-4748/ Vol. 4/ Issue 55/ July 09, 2015 Page 9518 POST-OPERATIVE NEUROLOGICAL RECOVERY PATTERN IN DEGENERATIVE CERVICAL MYELOPATHY AND RADICULOPATHY Raju B. Mundhe 1, Arvind B. Goregaonkar 2, Anuraag G. Gupta 3 HOW TO CITE THIS ARTICLE: Raju B. Mundhe,

More information

Lumbar Laminectomy and Interspinous Process Fusion

Lumbar Laminectomy and Interspinous Process Fusion Lumbar Laminectomy and Interspinous Process Fusion Introduction Low back and leg pain caused by pinched nerves in the back is a common condition that limits your ability to move, walk, and work. This condition

More information

Spinal Disorders Claims in Long Term Care Insurance

Spinal Disorders Claims in Long Term Care Insurance Spinal Disorders Claims in Long Term Care Insurance It s such a pain, why bother? Stephen K. Holland, MD Chief Medical Officer Univita Health, Inc. Long Term Care International Forum, May 2011 Albuquerque,

More information

Neck Injuries and Disorders

Neck Injuries and Disorders Neck Injuries and Disorders Introduction Any part of your neck can be affected by neck problems. These affect the muscles, bones, joints, tendons, ligaments or nerves in the neck. There are many common

More information

Pathoanatomical Changes of the Brachial Plexus and of C5-C6 Following Whiplash-Type Injury: A Case Report

Pathoanatomical Changes of the Brachial Plexus and of C5-C6 Following Whiplash-Type Injury: A Case Report Pathoanatomical Changes of the Brachial Plexus and of C5-C6 Following Whiplash-Type Injury: A Case Report 1 Journal Of Whiplash & Related Disorders Vol. 1, No, 1, 2002 Gunilla Bring, Halldor Jonsson Jr.,

More information

Artificial Intervertebral Disc: Cervical Spine

Artificial Intervertebral Disc: Cervical Spine dapplies to all products administered or underwritten by Blue Cross and Blue Shield of Louisiana and its subsidiary, HMO Louisiana, Inc.(collectively referred to as the Company ), unless otherwise provided

More information

CERVICAL SPONDYLOSIS

CERVICAL SPONDYLOSIS CERVICAL SPONDYLOSIS Dr. Sahni B.S Dy. Chief Medical Officer, ONGC Hospital Panvel-410221,Navi Mumbai,India Introduction The cervical spine consists of the top 7 vertebrae of the spine. These are referred

More information

HEALTH EVIDENCE REVIEW COMMISSION (HERC) COVERAGE GUIDANCE: DIAGNOSIS OF SLEEP APNEA IN ADULTS DATE: 5/9/2013 HERC COVERAGE GUIDANCE

HEALTH EVIDENCE REVIEW COMMISSION (HERC) COVERAGE GUIDANCE: DIAGNOSIS OF SLEEP APNEA IN ADULTS DATE: 5/9/2013 HERC COVERAGE GUIDANCE HEALTH EVIDENCE REVIEW COMMISSION (HERC) COVERAGE GUIDANCE: DIAGNOSIS OF SLEEP APNEA IN ADULTS DATE: 5/9/2013 HERC COVERAGE GUIDANCE The following diagnostic tests for Obstructive Sleep Apnea (OSA) should

More information

Chronic whiplash and whiplash-associated disorders: An evidence-based approach

Chronic whiplash and whiplash-associated disorders: An evidence-based approach Chronic whiplash and whiplash-associated disorders: An evidence-based approach 1 Journal of the American Academy of Orthopedic Surgeons October 2007;15(10):596-606 Schofferman J, Bogduk N, Slosar P. FROM

More information

Back & Neck Pain Survival Guide

Back & Neck Pain Survival Guide Back & Neck Pain Survival Guide www.kleinpeterpt.com Zachary - 225-658-7751 Baton Rouge - 225-768-7676 Kleinpeter Physical Therapy - Spine Care Program Finally! A Proven Assessment & Treatment Program

More information

What factors determine poor functional outcome following Total Knee Replacement (TKR)?

What factors determine poor functional outcome following Total Knee Replacement (TKR)? Specific Question: What factors determine poor functional outcome following Total Knee Replacement ()? Clinical bottom line All groups derived benefit from undergoing a, reviews suggests that the decision

More information

Symptoms and Signs of Irritation of the Brachial Plexus in Whiplash Injuries

Symptoms and Signs of Irritation of the Brachial Plexus in Whiplash Injuries 1 Symptoms and Signs of Irritation of the Brachial Plexus in Whiplash Injuries J Bone Joint Surg (Br) 2001 Mar;83(2):226-9 Ide M, Ide J, Yamaga M, Takagi K Department of Orthopaedic Surgery, Kumamoto University

More information