Welcome To Athletico s Webinar Wednesday Series 11/7/18
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1 Welcome To Athletico s Webinar Wednesday Series 11/7/18 Strategies for Success: Common Work Related Spine Injuries Dr. Matthew W Colman from Midwest Orthopaedics at Rush
2 888 Work4U Work Comp Customer Service Department Prompt and efficient scheduling Enhanced communication Easy to locate the closest clinic offering the service you need Speak directly to an Athletico Work Comp customer service representative Call: WORK4U Visit:
3 Webinar Agenda Today s Webinar is from 8:30am to 9:30am CST Agenda 8:20 am - 8:30 am: Participants join call 8:30 am: Host Introductions 8:35 am: Presentation begins 9:20 am: Q & A led by Heather Wilhelm, Athletico Account Executive 9:30 am: Closing Remarks/Poll
4 Participants Within 48 hours after the webinar you will receive an with links to download the following materials: 1.0 CEU for IL RN, CCMC, CRCC, Texas Dept. of Insurance IA RN will be mailed out after the event A copy of the power point slides If you have a question during the webinar you can enter your question in the Q & A section at the bottom of the page. At the end of the webinar our moderator will pose these questions to Dr Colman. Please complete the survey at the end of the webinar in order to receive the link to get your CEU s. Muted Lines/Operator Assisted Q & A
5 Today s Speaker: Dr. Matthew W Colman Orthopedic Oncology: Spine, Back and Neck Assistant Professor, Rush University Medical Center Dr. Matthew Colman specializes in spine surgery and musculoskeletal oncology. Dr. Colman completed his undergraduate training cum laude with honors from Dartmouth College, earned his medical degree with honors from the University of Chicago Pritzker School of Medicine, Chicago, IL, and went on to complete his residency in orthopedic surgery at the University of Pittsburgh Medical Center, Pittsburgh, PA. He has been fellowship trained in pediatric and adult musculoskeletal oncology at Harvard University and orthopedic and neurosurgical spine surgery at the University of Utah. Dr. Colman has an interest in treating bone and soft tissue tumors wherever they occur, including the spine. He also treats a comprehensive set of non-tumor-related spinal problems, including degenerative disease, deformity, and trauma. He is a member of the American Academy of Orthopaedic Surgeons (AAOS), AOSpine, the North American Spine Society, and Alpha Omega Alpha, University of Chicago Chapter.
6 Common and uncommon neck injuries in the injured worker Matthew Colman, MD Assistant Professor, Spine Surgery and Musculoskeletal Oncology Rush University Medical Center
7 Van Eerd Spine 2011 Incidence and Etiology Neck Pain in Workers is 27-48% 11-14% of workers limited in duties due to neck pain 14% of claimants have multiple episodes
8 Review of Cervical Anatomy
9 Common Problems are Common! Soft tissue injury HNP Fractures
10 Soft Tissue Cervical Sprain / Strain /Whiplash spectrum Myofascial-liagmentous overuse Exacerbation of preexisting degenerative disc disease / cervical stenosis
11 Acute Disc Herniation Just looks different than degenerative stenosis Results in a pain, weakness, numbness of the higher numbered root (C6 at C5/6) ACDF / TDA / Posterior Foraminotomy
12 Fractures Many different varieties depending on the mechanism Separate the benign from the unstable Treatment ranges from collar to major surgery
13 What about the uncommon and difficult to diagnose? Occult or hidden fracture Spinal cord injuries Ligament-only injuries Vascular injuries
14 Occult Fracture 46F s/p MVA at work Struck from behind while operating company vehicle Neck pain immediately, but much worse the following day No arm pain
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18 History and Physical Exam Denies pre-existing symptoms Neurologically normal Axial neck pain and bilateral trapezial pain
19 Initial Treatment Hard cervical collar for 6 weeks 2 sessions of PT NSAIDs, tramadol, gabapentin Trigger point injections.but after 6 months, persistent LEFT sided trapezial and periscapular pain and still unable to work despite light duty release
20 Injury 6 months s/p injury
21 9 months post injury LEFT RIGHT
22 Dislocations Unilateral Less than 50% slippage (sometimes none) Commonly missed
23 Incomplete Spinal Cord Injury Central cord syndrome From a pinch to the spinal cord, usually due to hyperextension Brown-Sequard Syndrome From a cord hemisection, ie sharp penetration
24 Complete Spinal Cord Injury
25 Anterior and Posterior Fusion
26 Vascular Injury Uncommon but potentially fatal Suspected any time a fracture exits into the vertebral foramen CT Angiogram Luckily, most people have redundant blood supply!
27 Accidents are not accidental : when the injured worker already had surgery Pseudarthrosis Can be silent until the new injury 5% per level in ACDF Anterior pseudo usually fixed by going posterior
28 Accidents are not accidental : when the injured worker already had surgery Adjacent segment disease Accepted to occur around 2.5% per year following surgery Injuries can accelerate Fix by going anterior again
29 Accidents are not accidental : when the injured worker already had surgery Hardware fracture Unlikely to happen from trauma Likely due to nonhealing of original surgery May not require treatment
30 Common Treatment Algorithms Conservative Care Physical therapy
31 Common Treatment Algorithms Conservative Care Physical therapy NSAIDs
32 Common Treatment Algorithms Conservative Care Physical therapy NSAIDs Neuromodulatory agents
33 Common Treatment Algorithms Conservative Care Physical therapy NSAIDs Neuromodulatory agents Epidural Injections
34 Common Treatment Algorithms Anterior Surgery Discectomy and Fusion Corpectomy Cervical Disc Replacement
35 Anterior Cervical Discetomy / Fusion
36 ACDF vs. CDR Most studies show equivalence or superiority in favor of CDR Neurologic recovery Reoperation rate Motion Narcotic use BUT.
37 Acute on Chronic Arthritis with Myelopathy
38 Anterior Corpectomy and Fusion
39 Common Treatment Algorithms Posterior Surgery Foraminotomy Laminoplasty Laminectomy and Fusion
40 Acute on Chronic Arthritis with Myelopathy
41 Posterior Laminectomy and Fusion
42 Outcomes
43 Outcomes WC vs Personal Injury Claimants WC with cervical disc herniation had significantly more lost days
44 Outcomes Poor Outcomes In WC patients? WC one of two independent predictors of poor outcomes
45 Outcomes Poor Outcomes In WC patients? But others show no difference in outcomes in carefully selected patients!
46 Outcomes CDR vs. ACDF in WC patients? No difference after 6 months, but more early return to work in CDR population
47 Outcomes Whiplash Injury in WC patients? Consulting a lawyer was an independent predictor of prolonged recovery!
48 Summary Most neck injuries at work can be treated without surgery Common conditions include herniated disc, sprain/strain, and minor fractures Uncommon diagnoses can be severe and require a high index of suspicion to properly diagnose and manage Surgical outcomes can be excellent for workman s compensation patients when imaging and symptoms correlate, and sources of secondary gain are elucidated
49 Thank You!
50 Thank you for joining us You will be receiving an within approximately 48 hours with the below link. You will need to complete the survey and at the end of the survey it will take you to a link to retrieve your CEU s (be sure to say yes when it takes you to the trusted site or you will not receive your CEU s).
Matthew Colman, MD Assistant Professor, Spine Surgery and Musculoskeletal Oncology Rush University Medical Center ACDF
is the most reliable option for twolevel anterior cervical surgery Matthew Colman, MD Assistant Professor, Spine Surgery and Musculoskeletal Oncology Rush University Medical Center Disclosures Medicrea:
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Minamide A*, Yoshida M*, Yamada H*, Hashizume H*, NakagawaY*, Iwasaki H*, Tsutsui S*, Hiroyuki Oka H**.
Efficacy of Posterior Segmental Decompression Surgery for Pincer Mechanism in Cervical Spondylotic Myelopathy -A retrospective case control study using propensity score matching Minamide A*, Yoshida M*,
A third back injury on April 28, 2003, resulted in a two-week time loss from work.
CLAIM HISTORY AND APPEAL PROCEEDINGS: The Worker injured his left knee in a workplace accident on July 28, 1989. Surgeries were performed in 1989 and 1994, and the Worker was awarded a 12 percent permanent
www.fisiokinesiterapia.biz Cervical Spine 7 Cervical Vertebrae - AKA The Neck 8 Cervical Nerves - Cervical/Brachial Plexus Most Mobile Region - Easily Injured Common Injury - Sprain, Strain, Herniated
If you have a condition that compresses your nerves, causing debilitating back pain or numbness along the back of your leg.
Below, we have provided some basic information for your benefit. Please use this information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk
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