YOU ARE THE BEST OPTION FOR LOW BACK PAIN
|
|
- Kristian Brian Little
- 5 years ago
- Views:
Transcription
1 YOU ARE THE BEST OPTION FOR LOW BACK PAIN Amy Garrigues PT, DPT Orthopaedic Clinical Specialist Fellow, American Academy of Orthopaedic and Manual Physical Therapists LBP in past 3 months 25% 307% 220% Increase in imaging Increase in spinal fusion surgery $ BILLION DOLLARS 20 Lumbar Fusion U.S. Foreign Aid Cancer Research (Breast, Lung, Prostrate) Cochrane Collaboration: the benefit of opiods in clinical practice for the longterm management of chronic LBP remains questionable. or otherwise used without express written permission of the authors. 1
2 Guidelines YET.. STRONG RECCOMENDATION; MODERATE-QUALITY EVIDENCE 108% INCREASE In Rx 423% INCREASE in cost Risks Chronic LBP Tricyclic Antidepressants Moderate short-term pain relief GI Complaints Overdose Hyperalgesia Hypogonadism Organ damage Death Pain medications don t fix the problem, they may help in the short term, but long term use leads to higher pain levels and poorer quality of life. or otherwise used without express written permission of the authors. 2
3 Guidelines What s Happening Here? STRONG RECCOMENDATION; MODERATE-QUALITY EVIDENCE Which of these is predictive of LBP? Physical Imaging Findings (MRI or Radiographs) 1. Bulging discs without herniation or root contact 2. Bulging discs without herniation but with root contact 3. Herniated / Prolapsed discs 4. Degenerative disk disease 5. Facet arthropathy 6. End plate changes/schmorl s nodes 7. Foraminal or canal stenosis Psychosocial Findings 1. History of depression 2. History of occupational-related LBP 3. Fearful beliefs about work as reported through a survey YET. Up 307% since 1996 Slide Courtesy of Tim Flynn Projected # of Future Cancers Due to Lumbar CT Scans Performed in the U.S. in 2007 Outcomes # of Scans Female Cancers 2.2 Million Male Cancers Total The Magnet is not Therapeutic! -- Tim Flynn PT, PhD Arch Intern Med 2009;169: Slide or otherwise used without express written permission of the authors. 3
4 Risks. Lumbar Spine CT scans result in increased cancer risk (Barringon de Gonzalez et al. 2009) MRIs lead to higher rates of surgical intervention (Jarvik et al. 2003) J Am Board Fam Med 2009;22:62 68 Slide Slide Findings on MRI are only important if they back up findings on physical exam. Furthermore, they are often completely unrelated to outcome other than predicting surgery. MRI s are indicated only when there is a medical history (cancer) or progressive neurological deficit cancers per year are attributed to undergoing CT scan. Guidelines or otherwise used without express written permission of the authors. 4
5 Inpatient Utilization Lumbar Fusions increased 220% from Total Expenditures ($ billion) Percent of all Treated Spine Patients Martin, et al SPINE. 34: In Your Backyard Re-operation Rates over 4 years: Decompression ~18% Spinal Fusion ~25% Major complication rates for elderly patients Neurologic injury occurs in 1 5% of patients. Infection occurs in 1 8%. Top Spine Surgeons Reap Royalties, Medicare Bounty, WSJ, Dec. 20, 2010 Martin et al. Reoperation rates following lumbar spine surgery and the influence of spinal fusion procedures. Spine 22(3) OUTCOME Simple Fusion Complex Fusion Lumbar instrumented fusion compared with cognitive intervention and exercises in patients with chronic back pain after previous surgery for disc herniation: A prospective randomized controlled study. Pain. 2006;122: Hospital Cardiac Event or Stroke Death within 30 days D/C to Nursing Home Hospital Charges $59,000 $81,000 or otherwise used without express written permission of the authors. 5
6 Improving Decision-Making in Low Back Pain: How to Target the Right Treatment at the Surgery really is a last resort and indicated only with progressive neurological signs and declining function. Surgery has not been found to dramatically reduce central low back pain. WHO ARE THE BEST PRACTITIONERS TO ADDRESS THE LOW BACK PAIN EPIDEMIC? The GOOD news is, even though your MRI results aren t perfect you are a great candidate for conservative rehabilitation. Physical Therapists 1. Musculoskeletal Specialists 2. Direct Access 3. Positive Meaningful Functional Outcomes supported by evidence REFERENCES REFERENCES Fritz, J.M. et al., Is there a subgroup of patients with low back pain Brennan, G.P. et al., Identifying subgroups of patients with acute/subacute nonspecific low back pain: results of a randomized clinical trial. Spine, 31(6), p.623. Chou, R. & Huffman, L.H., Medications for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Annals of internal medicine, 147(7), p.505. Chou, R. et al., Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Annals of internal medicine, 147(7), p.478. Deyo, R.A. et al., United States trends in lumbar fusion surgery for degenerative conditions. Spine, 30(12), p Deyo, R.A., Mirza, S.K. & Martin, B.I., Back pain prevalence and visit rates: estimates from US national surveys, Spine, 31(23), p Deyo, R.A. et al., Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA: the journal of the American Medical Association, 303(13), p Deyo, R.A. et al., Overtreating Chronic Back Pain: Time to Back Off? The Journal of the American Board of Family Medicine, 22, pp likely to benefit from mechanical traction?: Results of a randomized clinical trial and subgrouping analysis. Spine, 32(26), p.e793. Martin, B.I. et al., Expenditures and health status among adults with back and neck problems. JAMA: the journal of the American Medical Association, 299(6), p.656. Martin, B.I., Mirza, S.K., Comstock, B.A., Gray, D.T., Kreuter, W. & Deyo, R.A., Are lumbar spine reoperation rates falling with greater use of fusion surgery and new surgical technology? Spine, 32(19), p Martin, B.I., Mirza, S.K., Comstock, B.A., Gray, D.T., Kreuter, W. & Deyo, R.A., Reoperation rates following lumbar spine surgery and the influence of spinal fusion procedures. Spine, 32(3), p.382. Martin, B.I., Turner, J.A., Mirza, S.K., Lee, M.J., Comstock, B.A. & Deyo, R.A., Trends in health care expenditures, utilization, and health status among US adults with spine problems, Spine, 34(19), p Nguyen, T.H. et al., Long-term Outcomes of Lumbar Fusion Among Workersʼ Compensation Subjects. Spine, p.1. or otherwise used without express written permission of the authors. 6
ACO #44 Use of Imaging Studies for Low Back Pain
Measure Information Form (MIF) DATA SOURCE Medicare Claims Medicare beneficiary enrollment data MEASURE SET ID ACO #44 VERSION NUMBER AND EFFECTIVE DATE Version 1, effective 01/01/18 CMS APPROVAL DATE
More informationImaging Degeneration of the Lumbar Spine: What It All Means.
Imaging Degeneration of the Lumbar Spine: What It All Means www.fisiokinesiterapia.biz Spine Nomenclature and Evidence for Imaging p, Talk Objectives Background Nomenclature for disc findings Who should
More informationDiagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society
Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society Annals of Internal Medicine October 2007 Volume 147,
More informationCorrelation between Clinical Features and Magnetic Resonance Imaging Findings in Lumbar Discopathy
Original research Correlation between Clinical Features and Magnetic Resonance Imaging Findings in Lumbar Mohammad Sobhanardekani1, Mohammad Reza Sobhan2, Seyed Mohammad Jalil Abrisham2, Majid Samiee1,
More informationCritical Appraisal of a Clinical Practice Guideline
Critical Appraisal of a Clinical Practice Guideline Goal: To critically evaluate a guideline, using the Users Guides (reference below). Objectives: 1. Assess the validity of a guideline 2. Understand the
More informationA Surgeon s Perspective for the Primary Care Physician Stephen Curtin M.D. Tucson Orthopeadic Institute
A Surgeon s Perspective for the Primary Care Physician Stephen Curtin M.D. Tucson Orthopeadic Institute 26th Annual Southwestern Conference on Medicine AXIAL MUSCULO- SKELETAL PACK PAIN: Common Self-limited
More informationWendy Field Advanced Physiotherapy Practitioner June 2018
Wendy Field Advanced Physiotherapy Practitioner June 2018 Radiculopathy???? Lumbar radicular pain is where the clinician suspects the pain is coming from a lumbar nerve root. Essentially we are looking
More informationGET BACK TO YOUR FUTURE WITH SPECIALIZED SPINE CARE. A Guide for Patients
GET BACK TO YOUR FUTURE WITH SPECIALIZED SPINE CARE A Guide for Patients Your Spine Deserves Special Care Your spine is at the center of a delicately balanced system that controls all of your body s movements.
More informationThe Role of the Physical Therapist in the Prevention and Treatment of Chronic Pain. David Browder, PT, DPT, OCS Texas Physical Therapy Specialists
The Role of the Physical Therapist in the Prevention and Treatment of Chronic Pain David Browder, PT, DPT, OCS Texas Physical Therapy Specialists Who Are Physical Therapists? Physical therapists (PTs)
More informationLumbar Spinal Stenosis
Lumbar Spinal Stenosis This article is also available in Spanish: Estenosis de la columna lumbar (topic.cfm?topic=a00701). A common cause of low back and leg pain is lumbar spinal stenosis. As we age,
More informationWORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 2192/16
WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 2192/16 BEFORE: E. Kosmidis: Vice-Chair HEARING: August 30, 2016 at Toronto Written DATE OF DECISION: October 25, 2016 NEUTRAL CITATION: 2016
More informationWhen Clinical Reasoning Overrules the Evidence
When Clinical Reasoning Overrules the Evidence Breakout session Paul Mintken PT, DPT, OCS, FAAOMPT Kristin Carpenter PT, DPT, OCS, FAAOMPT Amy McDevitt PT, DPT, OCS, FAAOMPT Objectives Break Out Session
More informationRegional Pain Syndromes: Neck and Low Back
Regional Pain Syndromes: Neck and Low Back Srinivas Nalamachu, MD Disclosures Consultant/Independent Contractor/Honoraria: Ferring 1 Learning Objectives Identify the most common painful conditions in the
More informationEpidemiology of Low back pain
Low Back Pain Definition Pain felt in your lower back may come from the spine, muscles, nerves, or other structures in that region. It may also radiate from other areas like the mid or upper back, a inguinal
More informationThe Value of Adding Chiropractic Care to Worksite Health Clinics
4 th National Association of Worksite Health Centers Annual Forum September 8, 2016, Milwaukee, Wisconsin Curt A. Krause, DC, MS Cerner Healthe Clinic LinkedIn Profile: http://t.co/l0twuh2s9r Slide 1:
More informationInova. Spine Institute
Inova Spine Institute At Inova Spine Institute, you ll find a wide range of treatment alternatives, from physical therapy and rehabilitation to pain management. For patients who require surgery, Inova
More informationSpine Center. at Stamford Hospital s Orthopedic Institute
Spine Center at Stamford Hospital s Orthopedic Institute Back pain related to spinal deformity and injury or congenital conditions is a common health complaint, which can be very debilitating. At Stamford
More informationWhat is the role of imaging in acute low back pain?
Curr Rev Musculoskelet Med (2009) 2:69 73 DOI 10.1007/s12178-008-9037-0 What is the role of imaging in acute low back pain? Humaira Lateef Æ Deepak Patel Published online: 28 April 2009 Ó The Author(s)
More informationSession Objectives. Why We Need to Diagnose 4/2/18. Diagnosis: Defining the Patient Problem A prerequisite for treatment
Diagnosis: Defining the Patient Problem A prerequisite for treatment Marcia Spoto PT, DC, OCS Nazareth College of Rochester Session Objectives 1. Appreciate the role of Physical Therapist (PT) diagnosis
More informationOriginal Date: October 2015 LUMBAR SPINAL FUSION FOR
National Imaging Associates, Inc. Clinical guidelines Original Date: October 2015 LUMBAR SPINAL FUSION FOR Page 1 of 9 INSTABILITY AND DEGENERATIVE DISC CONDITIONS FOR CMS (MEDICARE) MEMBERS ONLY CPT4
More informationUniversity of Jordan. Professor Freih Abuhassan -
Freih Odeh Abu Hassan F.R.C.S.(Eng.), F.R.C.S.(Tr.& Orth.). Professor of Orthopedics University of Jordan 1 A. Sacroiliitis History Trauma is very common Repetitive LS motion--lumbar rotation or axial
More informationThe ABC s of LUMBAR SPINE DISEASE
The ABC s of LUMBAR SPINE DISEASE Susan O. Smith ANP-BC University of Rochester Department of Neurological Surgery Diagnosis/Imaging/Surgery of Lumbar Spine Disorders Objectives Identify the most common
More informationLumbar MR Imaging and Reporting Epidemiology: Do Epidemiologic Data in Reports Affect Clinical Management? 1
Note: This copy is for your personal non-commercial use only. To order presentation-ready copies for distribution to your colleagues or clients, contact us at www.rsna.org/rsnarights. Brendan J. McCullough,
More informationTherapeutic Exercise And Manual Therapy For Persons With Lumbar Spinal Stenosis
Therapeutic Exercise And Manual Therapy For Persons With Lumbar Spinal Stenosis The program consisted of manual therapy twice per week (eg, soft tissue and neural The components of the Boot Camp Program
More informationVertebral Axial Decompression
Vertebral Axial Decompression Policy Number: 8.03.09 Last Review: 11/2017 Origination: 11/2005 Next Review: 11/2018 Policy Blue Cross and Blue Shield of Kansas City (Blue KC) will not provide coverage
More informationCorporate Medical Policy
Corporate Medical Policy Epidural Steroid Injections for Back Pain File Name: Origination: Last CAP Review: Next CAP Review: Last Review: epidural_steroid_injections_for_back_pain 2/2016 4/2017 4/2018
More informationDECOMPRESSION, REDUCTION, AND STABILIZATION OF THE LUMBAR SPINE: A COST-EFFECTIVE TREATMENT FOR LUMBOSACRAL PAIN
American Journal of Pain Management Vol. 7 No. 2 April 1997 Emerging Technologies: Preliminary Findings DECOMPRESSION, REDUCTION, AND STABILIZATION OF THE LUMBAR SPINE: A COST-EFFECTIVE TREATMENT FOR LUMBOSACRAL
More informationBack Pain Update. Steven Andersen, MD Providence Physiatry Clinic 2016
Back Pain Update Steven Andersen, MD Providence Physiatry Clinic 2016 Back Pain is Very Common Lifetime prevalence 80% 12 month prevalence 40% Point prevalence 20% Centers for Disease Control and Prevention.
More informationFusion and repeat discectomy following single level open lumbar discectomies. Survival analysis
Fusion and repeat discectomy following single level open lumbar discectomies. Survival analysis Dr John Mortimer Mr Chris Hoffman CCDHB and TBI Health group Sciatica = Leg Dominant Pain Patients referred
More informationPost Operative Care Following Spinal Surgery For A Cervical Herniated Disc
Post Operative Care Following Spinal Surgery For A Cervical Herniated Disc The patient services department (PSD) supports LSI patients post surgery. Herniated Disc searching for the most effective solution
More informationThe ABC s of LUMBAR SPINE DISEASE
The ABC s of LUMBAR SPINE DISEASE Susan O. Smith ANP-BC University of Rochester Department of Neurological Surgery URMC Neurosurgery APP s Objectives Identify the most common pathology that leads to spine
More informationCommon Aches and Pains
Common Aches and Pains What You Need To Know and How Physical Therapy Can Help Gretchen Roman, PT, DPT Background Quinnipiac University, Hamden, CT Bachelor of Science in Physical Therapy, 1996 New York
More informationVertebral Axial Decompression
Vertebral Axial Decompression Policy Number: 8.03.09 Last Review: 11/2018 Origination: 11/2005 Next Review: 11/2019 Policy Blue Cross and Blue Shield of Kansas City (Blue KC) will not provide coverage
More informationCan a bulging disc cause dizziness
Can a bulging disc cause dizziness Sep 18, 2015. Given the many different potential causes of back pain, the signals sent to the brain can be affected in a number of different fashions. When this. Mar
More informationCommon fracture & dislocation of the cervical spine. Theerachai Apivatthakakul Department of Orthopaedic Chiangmai University
Common fracture & dislocation of the cervical spine Theerachai Apivatthakakul Department of Orthopaedic Chiangmai University Objective Anatomy Mechanism and type of injury PE.and radiographic evaluation
More informationDynaWell L-Spine Compression Device
L-Spine Compression Device The L-Spine was developed specifically to apply gravity to a patient s spine in supine position to simulate the upright position on your patient when scanned in your CT and/or
More informationChronic Low Back Pain Seminar Patient Engagement. NHS North West London CCGs 6 th February 2017
Chronic Low Back Pain Seminar Patient Engagement NHS North West London CCGs 6 th February 2017 Aims and Objectives Welcome and introductions Why are we here? To hear patient views as CCGs plan to adopt
More informationCan a bulging disc cause ear pain
Can a bulging disc cause ear pain that can be attributed to their nonotogenic ear pain: 37, cervical spine degenerative disease (eg, disc changes and herniation, osteophytes, spinal/ foramen. Surgeon says
More informationOriginal Policy Date
MP 8.03.07 Vertebral Axial Decompression Medical Policy Section Therapy Issue 12/2013 Original Policy Date 12/2013 Last Review Status/Date Reviewed with literature search/12/2013 Return to Medical Policy
More informationCopyright 2016 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
SPINE An International Journal for the study of the spine Publish Ahead of Print DOI : 10.1097/BRS.0000000000001506 How Effective is Physical Therapy for Common Low Back Pain Diagnoses? A multivariate
More informationNeck Pain: Help! Eric M. Massicotte, MD, MSc, MBA, FRCSC Associate Professor University of Toronto
Neck Pain: Help! Eric M. Massicotte, MD, MSc, MBA, FRCSC Associate Professor University of Toronto Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied,
More informationA Patient s Guide to Treatment Guidelines for Low Back Pain
A Patient s Guide to Treatment Guidelines for Low Back Pain 15195 Heathcote Blvd Suite 334 Haymarket, VA 20169 Phone: 703-369-9070 Fax: 703-369-9240 DISCLAIMER: The information in this booklet is compiled
More informationMedical Policy Vertebral Axial Decompression Section 8.0 Therapy Subsection 8.03 Rehabilitation. Description. Related Policies.
8.03.09 Vertebral Axial Decompression Section 8.0 Therapy Subsection 8.03 Rehabilitation Effective Date October 31, 2014 Original Policy Date June 28, 2007 Next Review Date October 2015 Description Vertebral
More informationLumbar disc herniation
Lumbar disc herniation Thomas Kishen Spine Surgeon Sparsh Hospital for Advanced Surgeries Bangalore Symptoms and Signs Radicular Pain in the distribution of the involved nerve Neurological deficit motor,
More informationPAIN MEDICINE FOR THE NON-PAIN SPECIALIST 2017
PAIN MEDICINE FOR THE NON-PAIN SPECIALIST 2017 FEBRUARY 16-18, 2017 JW MARRIOTT DESERT SPRINGS RESORT & SPA PALM DESERT, CALIFORNIA Learn the latest treatment strategies and multidisciplinary management
More informationCLINICAL GUIDELINES. Primary Care Guideline Summary Lumbar Spine Thomas J. Gilbert M.D., M.P.P. 3/17/15 revision
CLINICAL GUIDELINES Primary Care Guideline Summary Lumbar Spine Thomas J. Gilbert M.D., M.P.P. 3/17/15 revision TRIAGE At the initial visit, a focused history and physical examination is performed to assign
More informationPeggers Super Summaries: The Aging Spine
Aging Spine: AGING PROCESS Osteopenia 10% of 50 year old males and 25% of 50 year females Disc dehydration Facet degeneration Soft tissue hypertrophy 2 0 deformity Leg pain worse than back pain from nerve
More informationDiscussion Points 10/17/16. Spine Pain is Ubiquitous. Interventional Pain Management
Interventional Pain Management Blake Christensen, D.O. Fellowship Trained Interventional Pain Management Board Eligible in Anesthesiology and Interventional Pain Management Oklahoma Interventional Pain
More informationMOTORIZED SPINAL TRACTION
MOTORIZED SPINAL TRACTION UnitedHealthcare Commercial Medical Policy Policy Number: PAI010 Effective Date: January 1, 2019 Table of Contents Page COVERAGE RATIONALE... 1 APPLICABLE CODES... 1 DESCRIPTION
More informationOSU Pre-PT Club. Northern Therapy and Rehabilitation. Physical Therapy. Ken Schaecher, DPT, OCS.
OSU Pre-PT Club Northern Therapy and Rehabilitation Physical Therapy Ken Schaecher, DPT, OCS Evolution and History AWPTA started in 1921 (reconstruction aides from WWI) American Physiotherapy Assoc in
More informationSpineFAQs. Lumbar Spondylolisthesis
SpineFAQs Lumbar Spondylolisthesis Normally, the bones of the spine (the vertebrae) stand neatly stacked on top of one another. The ligaments and joints support the spine. Spondylolisthesis alters the
More informationFirstCarolinaCare Spinal Surgery Prior authorization Guidelines
FirstCarolinaCare Spinal Surgery Prior authorization Guidelines Subject LUMBAR FUSION (arthrodesis) Next Review 06/2014 General Requirements for Lumbar Spinal Fusion: 1. Prior authorization is required
More informationPatient Selection and Lumbar Operative Interventions
Patient Selection and Lumbar Operative Interventions John C France MD Professor of Orthopaedic & Neurosurgery West Virginia University Low back pain is a symptom not a diagnosis Epidemiology of LBP General
More informationDiagnosis of Neck & Upper Extremity Pain
Diagnosis of Neck & Upper Extremity Pain David B. Bumpass, MD Assistant Professor, Spine Surgery UAMS Depts. of Orthopaedic Surgery & Neurosurgery May 12, 2018 Disclosures Medtronic Spine speaking fees
More informationAPPROPRIATE USE GUIDELINES
APPROPRIATE USE GUIDELINES Appropriateness of Advanced Imaging Procedures (MRI, CT, Bone Scan/PET) in Patients with Neck Pain CDI QUALITY INSTITUTE: PROVIDER LED ENTITY (PLE) Updated June, 2017 Contents
More informationRational Approach to Treating Low Back Pain
Rational Approach to Treating Low Back Pain Susie Jang, MD Faculty, Department of Anesthesia, Critical Care & Pain Medicine Beth Israel Deaconess Medical Center Instructor, Harvard Medical School Learning
More informationCervical Spine in Baseball
Cervical Spine in Baseball Robert G Watkins, IV, MD Co-Director, Marina Spine Center Marina del Rey, CA Vice Chief of Staff Cedars-Marina del Rey Hospital Disclosures n Pioneer / RTI Consulting, Royalties
More informationLUMBAR SPINE CASE 3. Property of VOMPTI, LLC. For Use of Participants Only. No Use or Reproduction Without Consent 1. L4-5, 5-S1 disc, facet (somatic)
LUMBAR SPINE CASE 3 A.J. Lievre, PT, DPT, OCS, CMPT Aaron Hartstein, PT, DPT, OCS, FAAOMPT Orthopaedic Manual Physical Therapy Series Richmond 2018-2019 L4-5, 5-S1 disc, facet (somatic) L5/S1 Radiculopathy
More informationSpinal Stenosis Surgical
Spinal Stenosis Surgical Disclaimer This movie is an educational resource only and should not be used to make a decision on. All decisions about surgery must be made in conjunction with your surgeon or
More informationA.J. Lievre, PT, DPT, OCS, CMPT Aaron Hartstein, PT, DPT, OCS, FAAOMPT
LUMBAR SPINE CASE #3 A.J. Lievre, PT, DPT, OCS, CMPT Aaron Hartstein, PT, DPT, OCS, FAAOMPT Orthopaedic Manual Physical Therapy Series Charlottesville 2017-2018 L4-5, 5-S1 disc, facet (somatic) L5/S1 Radiculopathy
More informationA PROSPECTIVE STUDY OF INCIDENTAL DURAL TEARS IN MICROENDOSCOPIC LUMBAR DECOMPRESSION SURGERY: INCIDENCE AND OUTCOMES
A PROSPECTIVE STUDY OF INCIDENTAL DURAL TEARS IN MICROENDOSCOPIC LUMBAR DECOMPRESSION SURGERY: INCIDENCE AND OUTCOMES Takahiro Tsutsumimoto, Mutsuki Yui, Masashi Uehara, Hiroki Ohba, Hiroshi Ohta, Hidemi
More informationComprehension of the common spine disorder.
Objectives Comprehension of the common spine disorder. Disc degeneration/hernia. Spinal stenosis. Common spinal deformity (Spondylolisthesis, Scoliosis). Osteoporotic fracture. Anatomy Anatomy Anatomy
More informationAnterior Cervical Discectomy and Fusion Surgery
Disclaimer This movie is an educational resource only and should not be used to manage orthopaedic health. All decisions about the management of orthopaedic conditions must be made in conjunction with
More informationKey Primary CPT Codes: Refer to pages: 7-9 Last Review Date: October 2016 Medical Coverage Guideline Number:
National Imaging Associates, Inc. Clinical guidelines CERVICAL SPINE SURGERY: ANTERI CERVICAL DECOMPRESSION WITH FUSION CERVICAL POSTERI DECOMPRESSION WITH FUSION CERVICAL ARTIFICIAL DISC CERVICAL POSTERI
More informationIncomplete cauda equina syndrome in adult monozygotic twins
Incomplete cauda equina syndrome in adult monozygotic twins J. Mohar, R. Kramar, N. Hero, R. J. Cirman Department of Spine Surgery and Paediatric Orthopaedics, Orthopaedic Hospital Valdoltra, Ankaran,
More informationClinical Study. Overview
Clinical Study David A. Mayer, MD, JD, FICS Associate Professor of Clinical Surgery New York Medical College Chairman of Surgery Emeritus Overview A practice based prospective study of 31 consecutive patients
More informationOUTCOMES, ACCESS, AND COST THE CHIROPRACTIC ANSWER: COPAY PARITY
OUTCOMES, ACCESS, AND COST THE CHIROPRACTIC ANSWER: COPAY PARITY N C C H I R O P R AC T I C AS S O C I A T I O N Dr. Joe Siragusa Executive Director www.ncchiro.org drjoe@ncchiro.org 919-832-0611 ext.
More informationAm I eligible for the TOPS study? Possibly, if you suffer from one or more of the following conditions:
Am I eligible for the TOPS study? Possibly, if you suffer from one or more of the following conditions: Radiating leg pain Greater leg / buttock pain than back pain Severe pain sets in when walking as
More informationInsert heading depending. cover options once. other cover options once you have chosen one. 20pt. Ref: N-SC/031
Insert heading depending Insert Interim Insert heading Clinical Commissioning depending on line on on Policy: line length; length; please please delete delete on line line Spinal length; Surgery please
More informationProDisc-L Total Disc Replacement. IDE Clinical Study.
ProDisc-L Total Disc Replacement. IDE Clinical Study. A multi-center, prospective, randomized clinical trial. Instruments and implants approved by the AO Foundation Table of Contents Indications, Contraindications
More informationINTERQUAL IMAGING CRITERIA BIBLIOGRAPHY: SPINE
INTERQUAL IMAGING CRITERIA BIBLIOGRAPHY: SPINE BIB-1 BIB-2 InterQual IMAGING Criteria: SPINE McKesson Clinical Evidence Classification References cited in the clinical content are classified according
More informationThe evidence for SMT in CLBP
The evidence for SMT in CLBP Peter Tuchin BSc, GradDipChiro, DipOHS PhD FACC Associate Professor, MU (1991 - ) Past President, COCA 1 Peter Tuchin Peter Tuchin 2 WCA 2007 Peter Tuchin 3 Number of injuries
More informationPREOPERATIVE RETROLISTHESIS IS A RISK FACTOR OF LUMBAR DISC HERNIATION AFTER FENESTRATION WITHOUT DISCECTOMY
PREOPERATIVE RETROLISTHESIS IS A RISK FACTOR OF LUMBAR DISC HERNIATION AFTER FENESTRATION WITHOUT DISCECTOMY Shota Takenaka*, Noboru Hosono, Yoshihiro Mukai, Kosuke Tateishi, Takeshi Fuji Osaka Kosei-nenkin
More informationDegenerative Disease of the Spine
Degenerative Disease of the Spine Introduction: I. Anatomy Talk Overview II. Overview of Disease Processes: A. Spondylosis B. Intervertebral Disc Disease III. Diagnosis IV. Therapy Introduction: Myelopathy
More informationSamir Lapsiwala, MD. Fort Worth Brain and Spine Institute Fort Worth Brain and Spine Institute GEN-SP-32
Samir Lapsiwala, MD Fort Worth Brain and Spine Institute Fort Worth Brain and Spine Institute In 2010, 40 million people age 65 and over lived in the United States, accounting for 13 percent of the total
More informationMDT and the Relevant Lateral Component: Strategies for the Challenging Cervical Spine Patient
MDT and the Relevant Lateral Component: Strategies for the Challenging Cervical Spine Patient Ron Schenk PT, PhD, OCS, FAAOMPT, Dip MDT Amy Fletcher PT, DPT, FAAOMPT, Dip MDT Brian McClenahan PT, MS, OCS,
More information2015 Part 3 Cox Certification in Chicago, IL
Cox Technic Case Report #166 published at www.coxtechnic.com 2015 Part 3 Cox Certification in Chicago, IL Multi-level cervical disc displacement with stenosis and adjacent levels retrolistethesis, 16 years
More informationUsage of Outcomes Measurements in Chiropractic Care
2013 Usage of Outcomes Measurements in Chiropractic Care Table of Contents I. Executive Summary II. Overview of Chiropractic Care of Minnesota, Inc. III. Planning the Outcomes Program IV. Background; Chiropractic
More informationLumbar Disc Prolapse. Dr. Ahmed Salah Eldin Hassan. Professor of Neurosurgery & Consultant spinal surgeon
Lumbar Disc Prolapse By Dr. Ahmed Salah Eldin Hassan Professor of Neurosurgery & Consultant spinal surgeon 1-What are the Functions of the Spine Structural support for upright posture Protection of Spinal
More informationSpectrum of magnetic resonance imaging findings in chronic low back pain
Original article: Spectrum of magnetic resonance imaging findings in chronic low back pain Dr Sanjeev Sharma (1), Dr Monika Sharma (2), DR Bhardwaj (3), MD; Dr Asha Negi, (4) Department of Radiodiagnosis,
More informationCommon Thoraco- Lumbar Problems in the Mature Athlete
Common Thoraco- Lumbar Problems in the Mature Athlete Diana Heiman, MD Associate Professor, Family Medicine Residency Director East Tennessee State University Objectives Review the pathophysiology of the
More informationAlan H Daniels, MD. Spine Division, Department of Orthopaedics Warren Alpert School of Medicine of Brown University
Spinal and Orthopaedic Surgery in the Elderly Alan H Daniels, MD Spine Division, Department of Orthopaedics Warren Alpert School of Medicine of Brown University As the population ages, and patients remain
More information4. On, the Appellant s Request for Hearing was received by the Michigan Administrative Hearing System.
4. On, the Appellant s Request for Hearing was received by the Michigan Administrative Hearing System. CONCLUSIONS OF LAW The Medical Assistance Program is established pursuant to Title XIX of the Social
More informationSPINAL PAIN. Mr. Yagnesh Vellore FRACS Neurosurgeon and Spine Surgeon
SPINAL PAIN Mr. Yagnesh Vellore FRACS Neurosurgeon and Spine Surgeon PAIN GENERATORS IN THE SPINE Ligaments: ALL,PLL Muscle Periosteum bone Outer 1/3 annulus disc Facet joints Sacro-iliac joint sinuvertebral
More informationObjectives. Identify and differentiate appropriate surgical cases. Good Surgical Outcomes
ECHO February 5 th, 2015 Surgical Selection for Low Back Pain Objectives Identify and differentiate appropriate surgical cases Disclosures Medical director for UHN Rehabilitations Solution Back and Neck
More informationd EFFECTIVE DATE: POLICY LAST UPDATED:
Medical Coverage Policy Epidural Injections for Pain Management d EFFECTIVE DATE: 04 01 2018 POLICY LAST UPDATED: 03 20 2018 OVERVIEW Epidural injections are generally performed to treat pain arising from
More informationPrior Authorization Review Panel MCO Policy Submission
Prior Authorization Review Panel MCO Policy Submission A separate copy of this form must accompany each policy submitted for review. Policies submitted without this form will not be considered for review.
More informationManual Therapy Interventions For Patients With Lumbar Spinal Stenosis A Systematic Review
Manual Therapy Interventions For Patients With Lumbar Spinal Stenosis A Systematic Review symptomatic lumbar spinal stenosis have difficulty walking for extended periods. Physical Therapy Treatment Programs
More informationA 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
More informationMEDICAL HISTORY CHIRO PHYSICAL
Overview of Spinal Injection Procedures Blake A. Johnson, MD, FACR 1 PATIENT MANAGEMENT EVALUATION TREATMENT P.T. MEDICAL CHIRO S SURGICAL Effective treatment requires a precise diagnosis! HISTORY PHYSICAL
More informationThe Complex/Challenging Spine Patient Steve Wisniewski, M.D. Department of PM&R
The Complex/Challenging Spine Patient Steve Wisniewski, M.D. Department of PM&R 2011 MFMER slide-1 Disclosures None 2011 MFMER slide-2 Learning Objectives Review indications for obtaining imaging studies
More informationInterventional Pain Management
Origination: 5/21/08 Revised: 10/02/17 Annual Review: 11/02/17 Purpose: To provide interventional pain management clinical coordination criteria for the Medical Department staff to reference when making
More informationManagement of Lumbar Spinal Stenosis An Evidence Based Medicine Approach
Management of Lumbar Spinal Stenosis An Evidence Based Medicine Approach H A L L E T T M AT H E W S, M D, M B A E V P, C H I E F M E D I C A L O F F I C E R W i l l i a m s b u r g, VA From Quantity To
More informationVertebral Axial Decompression
Applies 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 informationWhat guidelines are available for sciatica and radicular pain?
Chapter 5 What guidelines are available for sciatica and radicular pain? Paolo Marchettini Guidelines for the management of low back pain (LBP) and lumbar or cervical radiculopathy resulting from sciatica
More informationManaging back pain a new approach
Managing back pain a new approach David Rogers Clinical Lead Functional Restoration Service Extended Scope Physiotherapist Royal Orthopaedic Hospital Setting the scene Back pain is one of the most common
More informationStraight Leg Raising Test a snapshot summary of evidence (May 2013) Key messages
Straight Leg Raising Test a snapshot summary of evidence (May 2013) Key messages The passive straight leg raising test (PSLR) is commonly used as an aid to the diagnosis of Lower Back Pain and is considered
More informationRegional Back Pain and Radicular Pain Pathway Frequently asked Questions and Answers
In Partnership with Regional Back Pain and Radicular Pain Pathway Frequently asked Questions and Answers Moving BACK to health Don t let your back pain get the better of you! The Regional Back Pain and
More information