Imaging of the Spine. Dr Nicola Bees Consultant Radiologist
|
|
- Alberta Ryan
- 7 years ago
- Views:
Transcription
1 Imaging of the Spine Dr Nicola Bees Consultant Radiologist
2 Imaging of the Spine Types of Imaging available Value of Imaging in back pain With red flags Without red flags Imaging Guidelines Terminology
3 Which investigation? Xray MRI CT is not useful as a first line except for trauma and should not be requested from primary care. Isotope bone scan not available at CUH but not usually a first line investigation
4 Source of Exposure Dental X-ray 135g bag of Brazil nuts Chest X-ray Lumbar Spine X-ray CT scan of the head UK annual average radon dose USA average annual radiation dose CT scan of the chest Average annual radon dose to people in Cornwall Whole body CT scan Dose msv msv 0.02 msv 0.7mSv 1.4 msv 1.3 msv 6.2 msv 6.6 msv 7.8 msv 10 msv Level at which changes in blood cells can be 100 msv readily observed Acute radiation effects including nausea and 1000 msv a reduction in white blood cell count
5 Comparative Radiation Doses ingradiationtopics/dosecomparisonsforionisingradiation/ ingradiationtopics/medicalradiation/medic_tedequivalent/
6 Red Flags Neurological: Sphincter or gait disturbance Severe/progressive motor loss Widespread neurological deficit (Single level nerve deficit) Other: Onset of pain < 20yrs or >55 yrs Previous or current malignancy Systemically unwell Raised CRP HIV Weight loss IV drug abuse Steroids Structural deformity Non-mechanical back pain (no relief with bed rest) Fever Thoracic pain
7 Metastases Discitis TB Cauda Equina Syndrome
8 Low Back Pain with no red flags No imaging required. No imaging that will alter management. Can refer to MCATS guidelines for advice on management Can refer to MCATS for triage, assessment and conservative treatment
9 Reasons for not imaging
10 HNP % pts with findings at at least one disc level Stenosis Bulging disc Degen disc Age (years) Incidence of HNP, spinal stenosis, bulging disc, degenerate disc on MRI of 67 asymptomatic patients Boden et al J. Bone Joint Surg. Am. 72: , 1990.
11 Lumbar Degenerative Disk Disease Michael T. Modic, MD and Jeffrey S. Ross, MD Radiology 2007;245:43-61 The etiology of pain in degenerative disease is more complex than a simple mechanical explanation. The prognostic value of imaging is confounded by the high prevalence of morphologic changes in the asymptomatic population. In patients with uncomplicated low back pain or radiculopathy, MR imaging may not have an additive value over clinical assessment.
12 20-28% of asymptomatic patients have disk herniations DG Borenstein et al J Bone Joint Surg Am 2001;83-A: Prevalence of disk herniation in symptomatic patients with Low back pain 57% Radiculopathy 65% Disk herniations esp large ones can dramatically reduce with conservative treatment One third of patients with disk herniation at presentation had significant resolution or disappearance at 6 weeks, two thirds at 6 months Type, size, location of herniation and presentation did not correlate with outcome. In fact presence of herniation on MRI was a positive prognosticator Modic MT, Obuchowski NA, Ross JS, et al. Radiology 2005;237:
13 Barzouhi et al N Engl J Med 2013;368: The natural history of sciatica is favorable, with spontaneous resolution of leg pain within 8 weeks in the majority of patients. During longer follow-up at least 15 to 20% of patients report recurring or persistent symptoms after a first episode of sciatica, regardless of whether they underwent surgery. Even after disk surgery, MRI studies have shown disk herniation in up to 53% of asymptomatic persons.
14 Barzouhi et al N Engl J Med 2013;368: In patients with symptomatic lumbar disk herniation at baseline who were treated with either surgery or conservative treatment and followed for 1 year, the presence of disk herniation on MRI at 1-year follow-up did not distinguish patients with a favorable clinical outcome from those with an unfavorable outcome. Patients asking for reimaging because of persistent or recurrent symptoms should be informed about the difficulty in MRI interpretation after a first episode of acute sciatica.
15 Acute Low Back Pain and Radiculopathy: MR Imaging Findings and Their Prognostic Role and Effect on Outcome. Modic et al. Radiology 2005; 237: In typical patients with LBP or radiculopathy, MR imaging does not appear to have measurable value in terms of planning conservative care. Patient knowledge of imaging findings does not alter outcome and is associated with a lesser sense of well-being.
16 /44343.pdf Do not offer X-ray of the lumbar spine for the management of nonspecific low back pain Consider MRI (magnetic resonance imaging) when a diagnosis of spinal malignancy, infection, fracture, cauda equina syndrome or ankylosing spondylitis or another inflammatory disorder is suspected Only offer an MRI scan for non-specific low back pain within the context of a referral for an opinion on spinal fusion.
17 irefer - England Login to To access the guidelines, please select the 'Launch irefer' link in the left hand menu and you will be taken directly to the irefer site. Any queries should be directed to support@elfh.org.uk
18 Lumbar Spine Imaging technique Pain and suspected osteoporotic collapse spondyloarthropathy in younger patient XR Sciatica: less than 6 weeks with no red flags* Sciatica with no red flags*, not responding to conservative management after 6-8 weeks Pain with red flags* (including foot drop) Imaging not usually indicated MRI MRI (Urgent) and refer for urgent Orthopaedic review. Back Pain in Children/Adolescents Refer to secondary care prior to imaging (usually MRI)
19 Nice guidelines for Ultrasound of Soft tissue lumps In patients presenting with a palpable lump, an urgent referral for suspicion of soft tissue sarcoma should be made if the lump is: greater than about 5 cm in diameter deep to fascia, fixed or immobile painful increasing in size a recurrence after previous excision. If there is any doubt about the need for referral, discussion with a local specialist should be undertaken.
20 Reporting terms Segmentation anomaly/transition Vertebra/Lumbarisation of S1/Sacralisation of L5 Bulge/Herniation/Protrusion/Extrusion/Prolapse Spondylolisthesis Degenerative/Spondyloytic Degenerate/Dehydrated/Reduced Signal in Disc Schmorl s nodes/intravertebral disc herniation Haemangioma Narrow spinal canal/spinal canal stenosis Nomenclature and Classification of Lumbar Disc Pathology Recommendations of the Combined Task Forces of the North American Spine Society, American Society. SPINE Volume 26, Number 5, pp E93 E113
21 Segmentation anomaly/transition Vertebra/Lumbarisation of S1/Sacralisation of L5
22 Degenerate/Dehydrated/Reduced Signal in Disc Bulge/Herniation/Protrusion/Extrusion/ Prolapse
23 Disc herniation Left central to subarticular focal disc extrusion
24 Schmorl s nodes
25 Spondylolisthesis/Anterolisthesis/Retrolisthesis
26 Image before referral/refer without imaging Refer to MCATS no need to image first Direct referral to Orthopaedics Request MRI plus bloods (FBC ESR CRP U+Es Cr) Patients with red flags Patients with back pain and specific/single level nerve root symptoms and signs
27 Summary Beware that in the lumbar spine MRI can correlate poorly with clinical symptoms and can be misleading therefore only image according to the guidelines Rely on clinical assessment to guide imaging and referral
Low Back Pain Protocols
Low Back Pain Protocols Introduction: Diagnostic Triage And 1. Patient Group Adults aged 18 years and over with routine low back problems. Patients who have had recent surgery should be referred directly
More informationMeasure Title X RAY PRIOR TO MRI OR CAT SCAN IN THE EVAULATION OF LOWER BACK PAIN Disease State Back pain Indicator Classification Utilization
Client HMSA: PQSR 2009 Measure Title X RAY PRIOR TO MRI OR CAT SCAN IN THE EVAULATION OF LOWER BACK PAIN Disease State Back pain Indicator Classification Utilization Strength of Recommendation Organizations
More informationMusculoskeletal: Acute Lower Back Pain
Musculoskeletal: Acute Lower Back Pain Acute Lower Back Pain Back Pain only Sciatica / Radiculopathy Possible Cord or Cauda Equina Compression Possible Spinal Canal Stenosis Red Flags Initial conservative
More information6/3/2011. 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 informationHow To Get An Mri Of The Lumbar Spine W/O Contrast
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 informationSpinal 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 informationAdvanced Practice Provider Academy
(+)Dean T. Harrison, MPAS,PA C,DFAAPA Director of Mid Level Practitioners; Assistant Medical Director Clinical Evaluation Unit, Division of Emergency Medicine, Department of Surgery, Duke University Medical
More informationSample Treatment Protocol
Sample Treatment Protocol 1 Adults with acute episode of LBP Definition: Acute episode Back pain lasting
More informationCLINICAL PRACTICE GUIDELINES FOR MANAGEMENT OF LOW BACK PAIN
CLINICAL PRACTICE GUIDELINES FOR MANAGEMENT OF LOW BACK PAIN Low back pain is very common, up to 90+% of people are affected by back pain at some time in their lives. Most often back pain is benign and
More informationDiscogenic Low Backache A clinical and MRI correlative study A DISSERTATION SUBMITTED TO UNIVERSITY OF SEYCHELLES AMERICAN INSTITUTE OF MEDICINE
Discogenic Low Backache A clinical and MRI correlative study A DISSERTATION SUBMITTED TO UNIVERSITY OF SEYCHELLES AMERICAN INSTITUTE OF MEDICINE IN PARTIAL FULFILLMENT OF THE REGULATIONS FOR THE AWARD
More informationHealth Benchmarks Program Clinical Quality Indicator Specification 2013
Health Benchmarks Program Clinical Quality Indicator Specification 2013 Measure Title USE OF IMAGING STUDIES FOR LOW BACK PAIN Disease State Musculoskeletal Indicator Classification Utilization Strength
More informationLOW 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 informationHitting a Nerve: The Triggers of Sciatica. Bruce Tranmer MD FRCS FACS
Hitting a Nerve: The Triggers of Sciatica Bruce Tranmer MD FRCS FACS Disclosures I have no financial disclosures Objectives - Sciatica Historical Perspective What is Sciatica What can cause Sciatica Clinical
More informationSpine Trauma: When to Transfer. Alexander Ching, MD Director, Orthopaedic Spine Trauma OHSU
Spine Trauma: When to Transfer Alexander Ching, MD Director, Orthopaedic Spine Trauma OHSU Disclosures Depuy Spine Consultant (teaching and courses) Department education and research funds Atlas Spine
More informationTreating 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 informationClinical Guideline. Low Back Pain Orthopaedics. Princess Alexandra Hospital Emergency Department. 1 Purpose. 2 Background
Princess Alexandra Hospital Emergency Department Clinical Guideline Orthopaedics Review Officer: Katherine Isoardi Version no: 1 Approval date: 18/03/2015 Review date: 18/03/2017 Approving Officer Dr James
More informationDIFFERENTIAL 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 informationImaging degenerative disk disease in the lumbar spine. Elaine Besancon MS III Dr. Gillian Lieberman
Imaging degenerative disk disease in the lumbar spine Elaine Besancon MS III Dr. Gillian Lieberman Learning Objectives Anatomy review Pathophysiology of degenerative disc disease Common sequelae of disk
More information.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 informationInformation on the Chiropractic Care of Lower Back Pain
Chiropractic Care of Lower Back Pain Lower back pain is probably the most common condition seen the the Chiropractic office. Each month it is estimated that up to one third of persons experience some type
More informationSpine University s Guide to Vertebral Osteonecrosis (Kummel's Disease)
Spine University s Guide to Vertebral Osteonecrosis (Kummel's Disease) 2 Introduction Kummel's disease is a collapse of the vertebrae (the bones that make up the spine). It is also called vertebral osteonecrosis.
More informationNonoperative 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 informationPathophysiology of Acute and Chronic Low Back Pain
Pathophysiology of Acute and Chronic Low Back Pain Mary Beth Partyka MSN APN Adult Nurse Practitioner Adult Pain Service Advocate Christ Medical Center Presentation Objectives Review the incidence of acute
More informationX 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 informationThere are four main regions of the back; the cervical (C), thoracic (T), lumbar (L), and sacral (S) regions
Low Back Pain Overview Low back pain is one of the most common disorders in the United States. About 80 percent of people have at least one episode of low back pain during their lifetime. Factors that
More informationClinical guidance for MRI referral
MRI for cervical radiculopathy Referral by a medical practitioner (excluding a specialist or consultant physician) for a scan of spine for a patient 16 years or older for suspected: cervical radiculopathy
More informationThe Spine Center at Beth Israel Deaconess
Spinal Pain The Spine Center at Beth Israel Deaconess Medical Center developed the following detailed eplanation of our care pathways for primary care providers to help support your interactions with patients
More informationSpine conditionsnew treatments. Ben Okafor FRCS FRCS.orth Consultant Orthopaedic Surgeon
Spine conditionsnew treatments Ben Okafor FRCS FRCS.orth Consultant Orthopaedic Surgeon Certainties of life Death Taxes Back pain New Advances Minimal access surgery Indirect Lumbar decompression Dynamic
More informationBACK PAIN PATHWAY DEFINTIONS
BACK PAIN PATHWAY DEFINTIONS Cauda Equina Syndrome (CES) Current or imminent compression of the sacral nerve roots resulting in neurogenic bladder and bowel dysfunction. Symptoms typically include: severe
More informationHerniated Disk in the Lower Back
Nader M. Hebela, MD Fellow of the American Academy of Orthopaedic Surgeons http://orthodoc.aaos.org/hebela Cleveland Clinic Abu Dhabi Cleveland Clinic Abu Dhabi Neurological Institute Al Maryah Island
More informationSpine 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 informationWhite Paper: Reducing Utilization Concerns Regarding Spinal Fusion and Artificial Disc Implants
White Paper: Reducing Utilization Concerns Regarding Spinal Fusion and Artificial Disc Implants For Health Plans, Medical Management Organizations and TPAs Executive Summary Back pain is one of the most
More informationAcute low back pain. Key reviewers: Mr Chris Hoffman, Orthopaedic Surgeon, Mana Orthopaedics, Wellington
Acute low back pain Key reviewers: Mr Chris Hoffman, Orthopaedic Surgeon, Mana Orthopaedics, Wellington Dr John MacVicar, Medical Director, Southern Rehab, Christchurch Key concepts: Acute low back pain
More informationContents. Introduction 1. Anatomy of the Spine 1. 2. Spinal Imaging 7. 3. Spinal Biomechanics 23. 4. History and Physical Examination of the Spine 33
Contents Introduction 1. Anatomy of the Spine 1 Vertebrae 1 Ligaments 3 Intervertebral Disk 4 Intervertebral Foramen 5 2. Spinal Imaging 7 Imaging Modalities 7 Conventional Radiographs 7 Myelography 9
More informationLow back pain. Quick reference guide. Issue date: May 2009. Early management of persistent non-specific low back pain
Issue date: May 2009 Low back pain Early management of persistent non-specific low back pain Developed by the National Collaborating Centre for Primary Care About this booklet This is a quick reference
More informationNON 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 informationIf you or a loved one have suffered because of a negligent error during spinal surgery, you will be going through a difficult time.
If you or a loved one have suffered because of a negligent error during spinal surgery, you will be going through a difficult time. You may be worried about your future, both in respect of finances and
More informationThe Lewin Group undertook the following steps to identify the guidelines relevant to the 11 targeted procedures:
Guidelines The following is a list of proposed medical specialty guidelines that have been found for the 11 targeted procedures to be included in the Medicare Imaging Demonstration. The list includes only
More informationPractice Guidelines For Low Back Pain
Consumers Guide Practice Guidelines For Low Back Pain Copyright 2008 American Chronic Pain Association Page 1 Written by: Penney Cowan Founder Executive Director American Chronic Pain Association Editors:
More informationTemple 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 informationMinimally 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 informationReturn 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 informationLow 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 informationPhysiotherapy fees and utilization guidelines for auto insurance accident claimants
No. A-12/97 Property & Casualty ) Auto Physiotherapy fees and utilization guidelines for auto insurance accident claimants To the attention of all insurance companies licensed to transact automobile insurance
More information1 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 informationhttps://www.laserspineinstitute.com/back_problems/foraminal_stenosis/e...
Questions? Call toll free 1-866-249-1627 Contact us today. We're here for you seven days a week. MRI Review Consultation Live help Call 1-866-249-1627 Chat Live Home Laser Spine Institute Laser Spine Institute's
More informationSPINAL STENOSIS Information for Patients WHAT IS SPINAL STENOSIS?
SPINAL STENOSIS Information for Patients WHAT IS SPINAL STENOSIS? The spinal canal is best imagined as a bony tube through which nerve fibres pass. The tube is interrupted between each pair of adjacent
More informationCervical 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 informationHigh Impact Rheumatology
High Impact Rheumatology Evaluation and Management of Low Back Pain Back Pain in the Primary Care Clinic 90% of low back pain is mechanical Injury to muscles, ligaments, bones, disks Spontaneous resolution
More informationSciatica Yuliya Mutsa PTA 236
Sciatica Yuliya Mutsa PTA 236 Sciatica is a common type of pain affecting the sciatic nerve, which extends from the lower back all the way through the back of the thigh and down through the leg. Depending
More informationDiagnosis and Treatment of Lumbar Spinal Canal Stenosis
Low Back Pains Diagnosis and Treatment of Lumbar Spinal Canal Stenosis JMAJ 46(10): 439 444, 2003 Katsuro TOMITA Department of Orthopedic Surgery, Kanazawa University Abstract: Lumbar spinal canal stenosis
More informationSpine DJD Nomenclature. Sonia K Ghei, MD
Spine DJD Nomenclature Sonia K Ghei, MD Recommendations of the Combined Task Forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology http://www.asnr.org/spine_nomenclature/
More informationTest Request Tip Sheet
With/Without Contrast CT, MRI Studies should NOT be ordered simultaneously as dual studies (i.e., with and without contrast). Radiation exposure is doubled and both views are rarely necessary. The study
More information.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 informationOrthopaedic Approach to Back Pain. Seth Cheatham, MD
Orthopaedic Approach to Back Pain Seth Cheatham, MD 262 Seth A. Cheatham, MD VCU Sports Medicine I have no financial disclosures. Focus on clinical situations where a referral to an orthopaedic surgeon
More informationBack & 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 informationUPPER LUMBAR DISC HERNIATION WITH CENTRAL AND FAR LATERAL STENOTIC CHANGES RESULTING IN ANTERIOR THIGH PAIN
Cox Technic Case Report #60 sent 5/13/08 1 UPPER LUMBAR DISC HERNIATION WITH CENTRAL AND FAR LATERAL STENOTIC CHANGES RESULTING IN ANTERIOR THIGH PAIN History, Examination & Imaging Review: A 53-year-old
More informationAppropriate Use of Lumbar Imaging for Evaluation of Low Back Pain
Appropriate Use of Lumbar Imaging for Evaluation of Low Back Pain Roger Chou, MD a,b, *, Richard A. Deyo, MD, MPH a,c,d,e,f,g, Jeffrey G. Jarvik, MD, MPH h,i,j KEYWORDS Low back pain Radiography MRI CT
More informationHerniated Disk. This reference summary explains herniated disks. It discusses symptoms and causes of the condition, as well as treatment options.
Herniated Disk Introduction Your backbone, or spine, has 24 moveable vertebrae made of bone. Between the bones are soft disks filled with a jelly-like substance. These disks cushion the vertebrae and keep
More informationGUIDELINES FOR ASSESSMENT OF SPINAL STABILITY THE CHRISTIE, GREATER MANCHESTER & CHESHIRE. CP57 Version: V3
GUIDELINES FOR ASSESSMENT OF SPINAL STABILITY THE CHRISTIE, GREATER MANCHESTER & CHESHIRE Procedure Reference: Document Owner: CP57 Version: V3 Dr V. Misra Accountable Committee: Acute Oncology Group Network
More informationManagement of spinal cord compression
Management of spinal cord compression (SUMMARY) Main points a) On diagnosis, all patients should receive dexamethasone 10mg IV one dose, then 4mg every 6h. then switched to oral dose and tapered as tolerated
More informationHow To Know If You Have A Lumbosacral Spine Tumor
2015 Education Modules for Appropriate Imaging Referrals ACUTE LOW BACK PAIN This document is part of a set of ten education modules which are aimed at improving the appropriateness of referrals for medical
More informationTABLE OF CONTENTS Page
TABLE OF CONTENTS Page INTRODUCTION 3 CONCLUSIONS AND RECOMMENDATIONS 5 EVALUATION AND TREATMENT OF ACUTE LOW BACK PROBLEMS IN ADULTS 9 SPECIAL STUDIES IN DIAGNOSTIC CONSIDERATIONS 15 PSYCHOLOGICAL RISK
More information.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 informationDiagnostic Imaging Exams
Guide for Chiropractors Diagnostic Imaging Exams CREATED FOR OUR CHIROPRACTIC PARTNERS This document has been prepared by the specialized, board-certified radiologists who interpret patient exams for Center
More informationObjectives. Spinal Fractures: Classification Diagnosis and Treatment. Level of Fracture. Neuro exam Muscle Grading
Objectives Spinal Fractures: Classification Diagnosis and Treatment Johannes Bernbeck,, MD Review and apply the understanding of incidence and etiology of VCF. Examine conservative and operative management
More informationSpinal 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 informationAdvances In Spine Care. James D. Bruffey M.D. Scripps Clinic Division of Orthopaedic Surgery Section of Spinal Surgery
Advances In Spine Care James D. Bruffey M.D. Scripps Clinic Division of Orthopaedic Surgery Section of Spinal Surgery Introduction The Spine - A common source of problems Back pain is the #2 presenting
More informationAdult Spine Rotation Specific Evaluation Orthopaedic Surgery Training Program School of Medicine, Queen s University
Adult Spine Rotation Specific Evaluation Orthopaedic Surgery Training Program School of Medicine, Queen s University CanMEDS Roles / Competencies Name: PGY Rotation Dates: s s Exceeds N/A Attending Staff:
More informationLumbar Disc Herniation/Bulge Protocol
Lumbar Disc Herniation/Bulge Protocol Anatomy and Biomechanics The lumbar spine is made up of 5 load transferring bones called vertebrae. They are stacked in a column with an intervertebral disc sandwiched
More informationElectrodiagnostic 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 informationENTITLEMENT ELIGIBILITY GUIDELINES SPONDYLOLISTHESIS AND SPONDYLOLYSIS
ENTITLEMENT ELIGIBILITY GUIDELINES SPONDYLOLISTHESIS AND SPONDYLOLYSIS MPC 01414 ICD-9 756.12; 738.41; 756.11 DEFINITION Spondylolisthesis is generally defined as an anterior or posterior slipping or displacement
More informationIMPAIRMENT RATING 5 TH EDITION MODULE II
IMPAIRMENT RATING 5 TH EDITION MODULE II THE SPINE AND ALTERATION OF MOTION SEGMENT INTEGRITY (AOMSI) PRESENTED BY: RONALD J. WELLIKOFF, D.C., FACC, FICC In conjuction with: The chapter on the spine includes
More informationDiagnosis 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 informationLow Back Pain (LBP) Prevalence. Low Back Pain (LBP) Prevalence. Lumbar Fusion: Where is the Evidence?
15 th Annual Cleveland Clinic Pain Management Symposium Sarasota, Florida Lumbar Fusion: Where is the Evidence? Gordon R. Bell, M.D. Director, Cleveland Clinic Low Back Pain (LBP) Prevalence Lifetime prevalence:
More informationMagnetic Resonance Imaging
Magnetic Resonance Imaging North American Spine Society Public Education Series What Is Magnetic Resonance Imaging (MRI)? Magnetic resonance imaging (MRI) is a valuable diagnostic study that has been used
More informationSPINE 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 informationREVIEW DECISION. Review Reference #: R0103014 Board Decision under Review: March 3, 2009
REVIEW DECISION Re: Review Reference #: R0103014 Board Decision under Review: March 3, 2009 Date: Review Officer: Lyall Zucko The worker requests a review of the decision of WorkSafeBC (the Board) dated
More informationPreventing & Treating Low Back Pain
Preventing & Treating Low Back Pain An Introduction to Low Back Pain Low back pain is the number two reason that Americans see a health care practitioner second only to colds and flu. While most people
More informationBiomechanical Basis of Lumbar Pain. Prepared by S. Pollak. Introduction:
Biomechanical Basis of Lumbar Pain Prepared by S. Pollak Introduction: The lumbar area of the back is made up of five movable L1-L5 vertebrae which have intervertebral discs in between them 1. The intervertebral
More informationSubject: BlueCross BlueShield of North Carolina Lumbar Spine Fusion Surgery Notification
, 2010 Don W. Bradley, M.D. Senior Vice President, Healthcare & Chief Medical Officer Blue Cross and Blue Shield of North Carolina 5901 Chapel Hill Road Durham, NC 27707 Subject: BlueCross BlueShield of
More informationOUTLINE. 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 informationBACK PAIN MEASURES GROUP OVERVIEW
2014 PQRS OPTIONS F MEASURES GROUPS: BACK PAIN MEASURES GROUP OVERVIEW 2014 PQRS MEASURES IN BACK PAIN MEASURES GROUP: #148. Back Pain: Initial Visit #149. Back Pain: Physical Exam #150. Back Pain: Advice
More informationREFERRAL GUIDELINES: NEUROSURGERY
Outpatient Referral Guidelines Page 1 1 REFERRAL GUIDELINES: NEUROSURGERY Essential Referral Content Date of birth Demographic Contact details (including mobile phone) Referring GP details Interpreter
More informationSpinal 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 informationSpine Injury and Back Pain in Sports
Spine Injury and Back Pain in Sports DAVID W. GRAY, MD 1 Back Pain Increases with Age Girls>Boys in Teenage years Anywhere from 15 to 80% of children and adolescents have back pain depending on the studies
More informationAcute Low Back Pain. North American Spine Society Public Education Series
Acute Low Back Pain North American Spine Society Public Education Series What Is Acute Low Back Pain? Acute low back pain (LBP) is defined as low back pain present for up to six weeks. It may be experienced
More informationSPINE ANATOMY AND PROCEDURES. Tulsa Spine & Specialty Hospital 6901 S. Olympia Avenue Tulsa, Oklahoma 74132
SPINE ANATOMY AND PROCEDURES Tulsa Spine & Specialty Hospital 6901 S. Olympia Avenue Tulsa, Oklahoma 74132 SPINE ANATOMY The spine consists of 33 bones called vertebrae. The top 7 are cervical, or neck
More informationKhaled 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 informationThe goals of modern spinal surgery are to maximize
SPRING 2013 Robot-Guided Spine Surgery Christopher R. Good, M.D., F.A.C.S. and Blair K. Snyder, P.A.-C. The goals of modern spinal surgery are to maximize patient function and accelerate a return to a
More informationNeck 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 informationClinical Signs of Low Back Pain
Review of Clinical Signs Series Editor: Bernard Karnath, MD Clinical Signs of Low Back Pain Bernard Karnath, MD Back pain has been cited as the fifth most common reason that patients visit a physician.
More informationMN Community Measurement Low Back Pain Measure Impact and Recommendation Document June 2010
MN Community Measurement Low Back Pain Measure Impact and Recommendation Document June 2010 Impact Relevance to Consumers, Employers and Payers Improvability Inclusiveness Mechanical low back pain (LBP)
More informationEPIDURAL STEROID AND FACET INJECTIONS FOR SPINAL PAIN
MEDICAL POLICY EPIDURAL STEROID AND FACET INJECTIONS FOR SPINAL PAIN Policy Number: 2015T0004W Effective Date: December 1, 2015 Table of Contents BENEFIT CONSIDERATIONS COVERAGE RATIONALE APPLICABLE CODES..
More informationWhiplash injuries can be visible by functional magnetic resonance imaging. Pain Research and Management Autumn 2006; Vol. 11, No. 3, pp.
Whiplash injuries can be visible by functional magnetic resonance imaging 1 Bengt H Johansson, MD FROM ABSTRACT: Pain Research and Management Autumn 2006; Vol. 11, No. 3, pp. 197-199 Whiplash trauma can
More informationAppointment Types First outpatient. Clinic Types CATS Spine CATS Hip and Knee CATS General Orthopaedic Injection Clinic Podiatry/Foot and Ankle
Clinic Types CATS Spine CATS Hip and Knee CATS General Orthopaedic Injection Clinic Podiatry/Foot and Ankle Conditions Treated Ankle & foot pain & stiffness Back pain & stiffness Carpal Tunnel/ Nerve impingement/entrapment
More informationCERVICAL 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 informationNerve Root Pain. Your back pain diagnosis. Contact Details. Spinal Triage Nuffield Orthopaedic Centre Windmill Road Headington Oxford OX3 7LD
Nerve Root Pain Contact Details Spinal Triage Nuffield Orthopaedic Centre Windmill Road Headington Oxford OX3 7LD Phone: 01865 738051 Fax: 01865 738027 Web Site www.noc.nhs.uk Nerve Pain Patient Information
More informationSurgical Procedures of the Spine
Surgical Procedures of the Spine Jaideep Chunduri, M.D. Orthopaedic Spine Surgeon Beacon Orthopaedics and Sports Medicine Beacon Spine Center Objectives Discuss the 4 most common procedures performed in
More information