Amin Nia, DC QME

– Participated in Clinical Grand Rounds reviewing the 2024 investigation by Martín-Noguerol et al. evaluating radiologist adoption of the ASSR, ASNR, and NASS Version 2.0 lumbar disc nomenclature using natural language processing (NLP). Discussion emphasized the rationale for standardized lumbar spine terminology, departmental adherence to consensus recommendations, variability in terminology among experienced radiologists, and the impact of inconsistent nomenclature on interdisciplinary communication, clinical decision-making, research standardization, and medicolegal documentation. Additional review examined the application of NLP as a quality improvement tool for objectively assessing reporting practices and identifying opportunities for continuing professional education and performance improvement.

Participated in Clinical Grand Rounds examining the clinical significance of incomplete adoption of standardized lumbar disc nomenclature and its implications for physicians responsible for spine management. Instruction emphasized the importance of correlating MRI findings with patient history, physical examination, and independent image review rather than relying exclusively on radiology report terminology. Discussion included contemporary lumbar disc classification, recognition of preferred versus legacy reporting terminology, communication between radiologists and treating providers, implications for surgical consultation and medicolegal case management, and the role of continuing education in promoting consistent evidence-based spinal imaging interpretation. Additional emphasis was placed on the value of standardized reporting in improving diagnostic accuracy, reducing ambiguity, and facilitating interdisciplinary communication across spine care specialties.

Participated in an advanced educational review of the scientific principles of causal inference in forensic medicine with emphasis on the distinction between clinical diagnosis and medicolegal causation analysis. Instruction examined the application of scientific reasoning to determine causal relationships between an alleged exposure and a subsequent injury or disease, the limitations of direct observation of causation, and the role of inductive inference in forensic medical investigations. Additional discussion addressed evidence-based approaches to causal analysis, reproducibility of expert methodology, current limitations in forensic causal frameworks, and the importance of applying objective scientific principles when developing defensible medicolegal opinions.

Participated in an advanced educational review of the scientific framework used to evaluate general and specific causation within forensic medicine. Instruction examined the distinction between determining whether an exposure is capable of producing an injury in a population versus whether that exposure caused injury in an individual patient. Discussion included epidemiologic evidence, biological plausibility, group-to-individual (G2i) inference, risk estimation, confounding variables, individual susceptibility, and the appropriate application of published medical literature in medicolegal investigations. Emphasis was placed on integrating population-based scientific evidence into individualized causation opinions while recognizing the assumptions and limitations inherent in causal attribution.

Participated in an advanced educational review of Bayesian reasoning and the Probability of Causation (PC) model as applied to forensic medical evaluations. Instruction examined probabilistic reasoning, the integration of prior knowledge with newly acquired evidence, and application of the "But-For Test" in determining factual causation. Additional discussion addressed transparency in expert methodology, documentation of assumptions, avoidance of unsupported conclusory opinions, communication of causation on a balance of medical probability, and the characteristics of scientifically reliable expert testimony. Emphasis was placed on producing objective, evidence-based forensic medical opinions capable of assisting judges and juries in evaluating issues of factual and proximate causation.

Advanced review of Ankylosing Spondylitis emphasizing disease pathophysiology, genetic predisposition, clinical presentation, laboratory evaluation, and multimodality imaging. Discussion included the association of HLA-B27 with axial spondyloarthritis, the role of the IL-23/IL-17 inflammatory pathway, differentiation of inflammatory versus mechanical spinal disorders, radiographic progression from sacroiliitis to syndesmophyte formation and spinal ankylosis, and the role of MRI in the early detection of active sacroiliitis. Additional topics included differentiation from Diffuse Idiopathic Skeletal Hyperostosis (DISH), interpretation of laboratory studies including ESR, CRP, and HLA-B27 testing, recognition of extra-articular manifestations, and current evidence supporting NSAIDs, TNF inhibitors, and IL-17 inhibitors in disease management.

Clinical Decision Making, Advanced Imaging, and Medical-Legal Documentation – Advanced review of a patient presenting with persistent cervical, thoracic, lumbar, and left upper extremity complaints following a rear-end motor vehicle collision. Discussion included comprehensive history, neurological examination, orthopedic testing, quantitative cervical and lumbar range-of-motion analysis utilizing the AMA Guides to the Evaluation of Permanent Impairment, differential diagnosis of traumatic cervical radiculopathy, lumbar disc injury, ligamentous injury, post-traumatic headache, and mild traumatic brain injury. Additional topics included medical necessity for advanced imaging, contraindications to MRI in the presence of retained pacemaker leads, appropriate utilization of CT imaging, clinical implications of a prior renal transplant located within the iliac fossa, principles of causation analysis, specialist referral decision-making, and development of comprehensive medical-legal documentation supporting diagnosis, prognosis, treatment recommendations, and functional impairment following spinal trauma.

Participated in Clinical Grand Rounds reviewing the application of flexion-extension lumbar radiography and quantitative intervertebral motion analysis for the assessment of Alteration of Motion Segment Integrity (AOMSI). Instruction emphasized measurement of angular and translational motion, comparison with established normative databases, interpretation of segmental instability, and correlation with MRI findings. Discussion included the biomechanical principles underlying spinal instability, objective documentation methods, and the role of computerized motion analysis in enhancing diagnostic accuracy, impairment evaluation, and medicolegal reporting within personal injury case management.

– Participated in Clinical Grand Rounds examining the integration of functional lumbar radiographs with T2-weighted and STIR magnetic resonance imaging in the evaluation of traumatic lumbar spine disorders. Instruction emphasized independent image interpretation, recognition of disc pathology, assessment of ligamentous injury, and correlation of imaging findings with patient history, physical examination, and biomechanical dysfunction. Discussion reviewed evidence-based strategies for differentiating structural pathology from functional impairment while improving diagnostic confidence, treatment planning, surgical referral decision-making, and interdisciplinary communication among spine care providers.

Participated in Clinical Grand Rounds reviewing the application of the AMA Guides to the Evaluation of Permanent Impairment in conjunction with quantitative spinal biomechanics for the assessment of lumbar motion abnormalities. Instruction emphasized interpretation of angular rotation and translational thresholds associated with Alteration of Motion Segment Integrity (AOMSI), comparison with validated normative reference values, and objective documentation of functional spinal impairment. Discussion examined the integration of computerized biomechanical measurements, diagnostic imaging, and evidence-based clinical findings to support impairment ratings, medicolegal opinions, and defensible documentation in complex spinal injury cases.

highlighting optimal imaging protocols for accurate diagnosis and management of spinal injuries. Presented an in-depth case study involving a missed T2 spinal compression fracture in a patient with complex medical history, including a rear-end motor vehicle collision on October 17, 2024. The patient presented with severe spinal pain, persistent head and neck symptoms, and an unrelated diagnosis of hydrocephalus. The study emphasized the critical role of advanced imaging sequences, including T2-Weighted, STIR, and post-contrast imaging, in detecting acute spinal fractures and guiding interprofessional care pathways.

Completed a comprehensive course focusing on the roles and qualifications of medical professionals in personal injury litigation. This course emphasized the distinctions between treating physicians and medical experts, strategies for establishing expertise, and overcoming legal objections to credibility. Detailed exploration of courtroom dynamics, jury evaluation, and the effective use of CVs to demonstrate professional qualifications was included. Practical applications for managing objections and leveraging transcripts to maintain consistency in testimony were also discussed. This training provided advanced strategies to enhance credibility and professionalism in medical-legal contexts.

Completed specialized training on integrating advanced spinal diagnostics with legal testimony requirements. Emphasis was placed on bridging the gap between clinical care and expert analysis, including causation, prognosis, and future medical needs. Participants were instructed on meeting Rule 702 standards and ensuring credibility through clear communication and comprehensive documentation. This training has been instrumental in providing expert testimony with confidence and precision in complex legal settings.

Participated in an intensive training on creating impactful CVs for medical-legal applications. The session highlighted essential elements of a strong CV, such as education, certifications, and prior testimony, ensuring alignment with legal standards like Rule 702 of the Federal Rules of Evidence. Instruction covered practical methods for streamlining direct examinations and addressing objections through pre-prepared documentation. The training underscored the importance of maintaining updated, organized CVs to showcase qualifications and strengthen courtroom credibility.

Attended a targeted lecture on the importance of effective communication and professionalism during legal proceedings. The program focused on presenting complex medical information clearly, handling objections with composure, and aligning testimony with legal standards. Practical examples included cross-examination preparation, transcript review for consistency, and collaboration with attorneys to frame evidence effectively. This training emphasized the integration of medical knowledge with legal processes to enhance the impact and reliability of expert testimony.

Learners reviewed the roles of Personal Injury Protection (PIP) and liability insurance in each system and discussed the impact of legal frameworks on claim resolution. The program presented scenarios illustrating the serious injury threshold and limitations on non-economic damage claims. Participants explored comparative examples from states like New York, Florida, and Texas. Key legal principles and practical implications were analyzed to foster deeper comprehension of legal processes and their effects on injured parties. The course concluded with a discussion of litigation risks and strategic considerations for attorneys and insurance adjusters.

This program reviewed medicolegal documentation requirements for injuries caused by traffic accidents. Participants were introduced to the importance of recording both external and internal injuries with precision to support accident reconstruction and legal proceedings. The course discussed methodologies for documenting typical injuries based on their mechanisms and severity, including the use of the Abbreviated Injury Scale (AIS) and AO fracture classifications. Participants analyzed case studies to evaluate documentation practices and their role in litigation outcomes. Additional topics included forensic photography, injury diagrams, and the ethical responsibilities of medical practitioners. The session emphasized the intersection of clinical expertise and legal evidence requirements.

This course provided a comprehensive overview of depositions as a pivotal element of the discovery process in personal injury litigation. Participants discussed the structure and function of depositions, including their role in fact-finding, preserving testimony, and shaping litigation boundaries. The curriculum reviewed techniques for questioning witnesses, assessing credibility, and uncovering new evidence. Real-world examples illustrated how depositions influence settlement strategies and trial preparation. The session highlighted the interplay between deposition records and courtroom testimony, emphasizing the importance of consistency and strategic communication. Practical exercises included drafting deposition questions and analyzing transcripts.

This course offered an in-depth review of PIP insurance regulations across various states, focusing on the financial and legal nuances of no-fault systems. Participants explored mandatory and optional coverage levels, subrogation rights, and the interaction between PIP and health insurance. The curriculum highlighted significant differences in coverage requirements between states like Michigan, New York, and Florida. Case studies presented challenges in coordinating benefits and navigating waiver options. Learners reviewed the legal mechanisms of subrogation and discussed how PIP impacts settlement negotiations and claimant recovery strategies.

Interprofessional Spine Care Review focused on lumbar synovial cysts, encompassing etiology, diagnosis, and management strategies. Acquired advanced knowledge of imaging modalities, particularly the use of MRI for diagnosing spinal pathologies such as synovial and ganglion cysts, and their differentiation based on histological and clinical criteria using T1, T2 and STIR imaging sequences in both the sagittal and axial plane. Gained expertise in conservative and surgical treatment options for lumbar spine conditions, emphasizing the role of facet joint degeneration and mechanical instability in cyst development. Enhanced understanding of biomechanical instability and its implications in degenerative spinal disorders through review of clinical case studies and white papers. Applied insights into clinical decision-making for non-surgical interventions, including the utility and limitations of epidural steroid injections and cyst aspirations within the context of both the Pfirrmann scale for intervertebral disc degeneration and the Fujiwara scale for facet degeneration. Strengthened collaborative skills for multidisciplinary patient management, integrating knowledge from chiropractic care, radiology, and surgical perspectives to optimize outcomes for individuals with complex spine conditions.

Participated in a case study focused on the evaluation and management of a patient involved in a motor vehicle collision on September 1, 2024. The patient, a belted driver, was rear-ended on the I-290 West, experiencing a rapid acceleration-deceleration mechanism that caused hyperextension and flexion of the cervical spine. Immediately following the impact, the patient reported neck, mid-back, and lower back pain. Initial management included over-the-counter medications, rest, and ice, with a follow-up appointment with their primary care physician on September 5, 2024. The patient presented with a prior posterior laminectomy and fusion C4-C7. The case incorporated advanced biomechanical principles and finite element modeling (FEM) to assess the cervical spine's response to whiplash forces, as described in the provided research. FEM simulations quantified spinal stress distribution and highlighted potential areas of adjacent segment degeneration (ASD) due to the sudden impact. Emphasis was placed on restoring proper biomechanics through a combination of spinal adjustments, postural correction, and rehabilitative exercises, leveraging insights from finite element analysis to guide care. Management strategies focused on addressing persistent symptoms through targeted interventions, including neuromuscular re-education, to reduce biomechanical stress on the cervical spine and adjacent structures. The integration of patient-specific modeling, derived from imaging data, supported personalized care planning and highlighted the value of finite element analysis in predicting long-term outcomes for whiplash-associated disorders.

receivedadvanced educational materials on cervical spine anatomy, neuroanatomy, and radiculopathy to practicing healthcare providers, focusing on the motor and sensory functions of cervical spinal nerves. Was presented withcomprehensive white papers, quizzes, and instructional content that emphasized the clinical relevance of cervical nerve exit patterns, muscular innervation, and dermatomal sensory distributions in the upper extremities. Providedevidence-based insights on cervical radiculopathy, integrating pathophysiology, diagnostic strategies, and management approaches to enhance interprofessional understanding and patient outcomes. Discussed collaborationwith multidisciplinary teams to ensure alignment of educational content with current best practices and emerging trends in spinal biomechanics and trauma management. Demonstrated expertise in translating complex anatomical and neurological concepts into actionable knowledge for improving patient care in the clinical setting.

This course provided healthcare providers with advanced imaging interpretation skills to differentiate traumatic from degenerative spinal injuries, particularly in motor vehicle collision cases. Participants developed expertise in utilizing imaging biomarkers, such as Modic changes and STIR sequences, to assess acute and chronic spinal pathology. The curriculum covered key distinctions between traumatic disc herniations and degenerative disc bulges, emphasizing the role of inflammation and tissue morphologyin diagnostic accuracy. Clinicians gained proficiency in causation analysis by integrating imaging findings with clinical presentations, enhancing their ability to support injury claims with objective evidence. The course also included case-based learningto apply these principles in real-world scenarios. Completion of this program demonstrated a provider’s commitment to evidence-based spinal injury assessment and improved patient outcomes through precise diagnostic differentiation.

This course explored critical aspects of personal injury (PI) cases, including liability and personal injury protection (PIP) insurance, strategies for documenting causality, bodily injury, and persistent functional loss, and the effective use of ICD-10 S and M codes. The program integrated personalized treatment plans, standard operating protocols (SOPs), and macros for streamlined documentation while addressing primary care challenges in managing PI cases. Practical case studies emphasized collaboration and precision to optimize patient outcomes and ensure compliance with insurance and legal standards

This session emphasized the importance of accurate documentation in PI claims, exploring the nuances of liability insurance, medical expenses coverage, and the role of causality in linking injuries to incidents. The lecture included strategies for managing acute and chronic conditions using ICD-10 coding, employing macros in documentation to enhance efficiency, and collaborating with attorneys and other providers. Participants gained actionable insights for integrating ethical and detailed recordkeeping into their practices.

This session provided an in-depth analysis of exceeding policy limits in PI cases, leveraging umbrella insurance policies, and documenting persistent functional loss for fair compensation. It highlighted the role of chiropractors in supporting legal efforts through comprehensive records, causation evidence, and expert testimony. The workshop emphasized integrating technology, adhering to ethical standards, and maintaining objective measures to ensure credibility and optimize patient outcomes.

This session was designed to equip healthcare providers with tools for effective PI case handling. Topics included understanding pre-determined treatment plans versus SOPs, overcoming administrative and financial challenges in PI cases, and accurately coding acute and chronic conditions using ICD-10 standards. Emphasis was placed on creating tailored documentation strategies, utilizing macros for efficiency, and balancing automation with personalization. Attendees were trained to strengthen collaborations with legal teams and improve multidisciplinary patient care.

Completed a specialized training program focused on the critical role of medical records in legal proceedings, emphasizing their impact on court testimony and litigation outcomes. Gained expertise in creating comprehensive and defensible documentation that aligns with healthcare standards and legal requirements. Developed skills in recording objective findings, patient history, causation, and treatment rationales to support testimony. Enhanced proficiency in preparing for depositions and trial testimony by ensuring consistency and clarity in records. This training underscored best practices for addressing challenges posed by opposing counsel and highlighted strategies for maintaining credibility under cross-examination. Graduates of this program are equipped to provide medical-legal documentation that strengthens both litigation success and patient advocacy.

- Completed an advanced workshop on effective jury communication through medical testimony, focusing on the simplification of complex medical concepts. Acquired practical skills in using layperson-friendly language to explain technical terms and presenting compelling visual aids like MRIs and anatomical models. Developed expertise in structuring testimony to engage jurors and maintain their attention while addressing the legal and medical aspects of a case. Learned techniques for managing cross-examination with professionalism, emphasizing objectivity and neutrality. The program also covered strategies to frame the long-term impacts of injuries in relatable ways for jurors. This training equips practitioners to clearly and effectively convey medical findings, ensuring they resonate with lay audiences and legal professionals alike.

Expert Witness Training and Litigation Preparedness - Completed a comprehensive course on the roles and responsibilities of expert witnesses in personal injury litigation. This program focused on the admissibility of expert opinions, preparation for depositions, and courtroom testimony. Gained critical knowledge in delivering impartial, evidence-based opinions to assist courts in understanding complex medical issues. Developed the ability to align testimony with established legal precedents and effectively handle cross-examination. The course emphasized the importance of independence, integrity, and clarity in presenting evidence, ensuring practitioners are prepared to navigate the legal system as trusted experts. This training provided the tools necessary to support litigation outcomes while maintaining professional credibility.

Understanding Legal Precedent and Its Role in Personal Injury Litigation - Completed a detailed educational series on legal precedent in personal injury litigation, focusing on its application in evaluating negligence, causation, and damages. Explored the significance of established diagnostic and treatment standards in ensuring predictability and fairness in court rulings. Gained insights into the challenges of introducing innovative medical techniques within the framework of legal precedent. Learned how precedent influences admissibility of evidence, calculation of damages, and settlement negotiations. This program emphasized the importance of aligning medical practices with recognized legal standards to mitigate risk and improve case outcomes. Graduates are well-equipped to navigate the intersection of healthcare and law, ensuring their practices meet both clinical and legal benchmarks.

his course provided an in-depth review of incidental thyroid pathology identified on MRI, focusing on the appropriate follow-up for an enlarged thyroid. Participants analyzed the pathophysiology of thyroid enlargement, including benign and malignant differentials, and reviewed best practices for interdisciplinary communication. The course emphasized the role of ultrasound as the primary diagnostic modality, the indications for fine needle aspiration biopsy, and the interpretation of thyroid function tests.Through case-based discussions, attendees enhanced their ability to integrate incidental findings into comprehensive patient management, improving their diagnostic acumen and referral strategies in clinical practice.

Delivered a one-hour educational course examining the anatomical, clinical, and medicolegal implications of developmental spinal stenosis in the cervical spine, with a focus on its significance in personal injury litigation. The presentation provided an in-depth review of normal spinal canal dimensions, the anatomical boundaries of the cervical canal, and the pathophysiology of central canal narrowing. Special attention was given to cases where intervertebral disc herniation contributes to symptomatic stenosis, particularly in individuals with pre-existing developmental narrowing. Discussed the role of advanced imaging modalities in assessing canal diameter, di@erentiating congenital predisposition from trauma-induced exacerbation, and supporting causation analysis in legal cases. Emphasized the importance of objective documentation in establishing the impact of spinal injuries on long-term function and prognosis, as well as its relevance in determining case valuation and settlement considerations.

coursework in MRI and disc pathology analysis in personal injury, covering the historical evolution of MRI, quality standards for imaging, application of Fardon classification for disc injuries, and causation documentation strategies. Evaluated acute versus chronic pathology on imaging and were trained in correlating MRI findings with clinical examination for legal defensibility

an advanced course in Personal Injury Case Management, emphasizing patient intake standardization, lien negotiation strategies, billing compliance under PIP/MedPay frameworks, and risk management protocols. The training focused on optimizing communication with legal representatives, understanding state-specific prompt pay laws, and utilizing lien and letter of protection agreements to secure payment for services.

advanced instruction in Biomarker and Genetic Profiling in Traumatic Brain Injury (TBI) assessment, including the clinical application of circulating protein biomarkers (GFAP, S-100B, UCH-L1, NF-H) and genetic risk profiling (ApoE, MTHFR). The course emphasized integrating biomarker results with clinical findings and neuroimaging to improve TBI diagnosis and prognosis, with a focus on medico-legal application

completed training on ligamentous injury assessment and impairment ratings based on the AMA Guides to the Evaluation of Permanent Impairment. Focus was placed on Alteration of Motion Segment Integrity (AOMSI) diagnosis through flexion-extension radiographs, validation of measurements via inter-rater reliability, reproducibility standards, and automation to ensure legal defensibility. The curriculum prepared providers to identify and document ligament instability with high evidentiary standards

Completed technical coursework on Deposition and Trial Testimony Preparation, addressing pre-litigation procedures, deposition defense strategies, and courtroom testimony practices for chiropractors. Emphasis was placed on narrative clarity, record review, understanding fact versus expert witness roles, and the strategic use of visuals to enhance testimony credibility

Successfully completed coursework in Introduction to MRI Hardware and Imaging Physics, detailing the operation of BO main magnetic fields, RF coils, gradient systems, and the Fourier transform's role in image reconstruction. Providers gained an understanding of MRI signal formation, the importance of field homogeneity, and the impact of imaging parameters on diagnostic accuracy.

Completed detailed training in CT Imaging Principles for Spine Management, focusing on the Lambert-Beer Law, Radon transform, filtered back projection techniques, and Hounsfield Unit calibration. Instruction covered diagnostic applications in fracture and disc injury identification, artifact management, and strategies for minimizing radiation exposure under ALARA principles.

Completed a specialized program in Clinical Documentation Strategies for Personal Injury Cases, including structured E/M SOAP notes, narrative report construction, impairment rating documentation, and causality statements. Providers were trained to align subjective complaints with objective findings and treatment plans, enhancing both clinical management and legal defensibility.

Completed advanced coursework in Concussion Diagnosis and Management, with a focus on clinical symptom classification, Rivermead Post-Concussion Symptoms Questionnaire scoring, and integration of biomarkers for objective injury confirmation. Participants learned strategies for early identification and management of post-concussion syndrome and traumatic brain injuries

Successfully completed training on the Use of Circulating Biomarkers and Diffusion Tensor Imaging (DTI) in the Assessment of Mild Traumatic Brain Injury (mTBI), covering the interpretation of UCH- L1, GFAP, and S-100B results, and the application of DTI for microstructural brain injury visualization. Emphasis was placed on integrating blood biomarker analysis with neuroimaging findings for legal and clinical documentation.

Completed focused instruction on Concussion Subtypes, Clinical Categorization, and Personalized Care Pathway Development. Participants were trained to identify cognitive, vestibular, ocular, cervical, and mood/anxiety-related concussion presentations and design targeted treatment strategies based on symptomatology.

Completed expert-level training in the diagnostic evaluation of Alteration of Motion Segment Integrity (AOMSI) in the cervical spine using AMA Guides (5th and 6th Editions). Emphasis was placed on the application of objective criteria including >3.5 mm of translational motion and >11° of angular rotation to identify functional segmental instability. The program detailed the biomechanical rationale for these thresholds and instructed on standardized methods for identifying ligamentous damage based on motion segment behavior. Proficiency was demonstrated in integrating radiographic findings into the impairment rating process and using motion analysis to support clinical and legal documentation.

Received advanced clinical instruction on cervical spine ligament biomechanics, with particular focus on diagnostic interpretation of motion-based instability. Training included radiographic recognition of ALL, PLL, interspinous, supraspinous, ligamentum flavum, and facet capsular ligament injury based on observed translation and angular abnormalities. Coursework emphasized differential diagnosis between structural instability and degenerative changes, and trained participants to correlate imaging findings with symptomatology and patient history. Gained working knowledge of using segmental instability findings to inform rehabilitation, surgical referral, and medico-legal reporting.

Participated in an intensive educational module addressing the legal, regulatory, and procedural implications of AOMSI analysis in trauma care. Learned how to apply objective measurements to support causation, permanency, and impairment in personal injury and workers’ compensation cases. Instruction included strategies for achieving Frye admissibility of digital motion analysis tools, the legal standards for expert witness qualification, and the use of calibrated systems for forensic-level imaging evaluation. Participants were trained to construct defensible reports and testify to clinical findings with biomechanical validity, reinforcing their credibility in litigation settings.

Completed advanced instruction in the technical and clinical components of flexion-extension radiograph acquisition for AOMSI assessment. Focused on the avoidance of common errors such as poor patient effort, non-neutral positioning, and improper sagittal plane alignment. Emphasized the impact of these variables on the validity of diagnostic motion measurements and provided structured protocols for improving reproducibility and clarity in radiographic imaging. Gained hands-on guidance in instructing imaging facilities, refining standard operating procedures, and improving diagnostic yield for motion-based cervical spine pathology.

Focused on the evaluation of lumbar spinal instability through the application of Alteration of Motion Segment Integrity (AOMSI). Emphasized biomechanical principles and radiographic criteria for identifying translational (>4.5 mm) and angular motion abnormalities (>15°–25°, depending on segment) using flexion-extension radiographs. Included instruction on the use of these findings in accordance with the AMA Guides to the Evaluation of Permanent Impairment, 5th Edition (Range of Motion model) and 6th Edition (Diagnosis-Based Impairment model), with application to trauma documentation, impairment rating, and surgical triage.

Addressed radiographic protocols for flexion-extension motion studies, measurement reproducibility, and standardization of lumbar instability thresholds. Included comprehensive review of key lumbar stabilizing ligaments (ALL, PLL, interspinous, supraspinous, ligamentum flavum, facet capsules) and their role in post-traumatic motion segment failure. Emphasized detection of overt instability and early translational micro-movements (≥1 mm), integrating clinical biomechanics with AMA Guides to the Evaluation of Permanent Impairment, 5th and 6th Editions.

Provided training in interpretation and documentation of lumbar segmental instability for personal injury, workers’ compensation, and disability claims. Included objective validation of motion abnormalities and application of radiographic findings to causation analysis, permanency evaluations, and impairment ratings under the AMA Guides to the Evaluation of Permanent Impairment, 5th and 6th Editions. Emphasized preparation of records and testimony meeting Frye and Daubert evidentiary standards

Provided instruction in the interpretation of functional radiographs and their integration into the impairment evaluation process. Emphasized application of translational and angular thresholds established in the AMA Guides to the Evaluation of Permanent Impairment, including the 5th Edition’s Range of Motion model and the 6th Edition’s Diagnosis-Based Impairment framework. Included literature review of cadaveric biomechanical studies by Yoganandan, Ivancic, and Chazal, and use of AOMSI findings in permanent impairment documentation, clinical triage, and medico-legal reporting.

Advanced application of axial and sagittal MRI imaging protocols specifically aligned to the true disc plane for identification of alteration of motion segment integrity (AOMSI) in patients with degenerative disc disease. This course reviews ACR-compliant imaging sequences and emphasizes quantitative biomechanical analysis through measurements of intervertebral angular motion, anterior-posterior translation, and disc height variation across cervical, thoracic, and lumbar segments. Instruction includes threshold values for segmental translation (::::3.5 mm lumbar, ::::2.5 mm cervical), angular rotation parameters, and their legal-medical relevance. Integration with motion segment evaluation enhances diagnostic accuracy in trauma, degenerative pathology, and medicolegal casework.

In-depth analysis of vertebral end plate signal alterations (Modic Types 1-3) and their clinical significance in evaluating segmental instability, axial low back pain, and surgical outcomes. Participants study the transformation of marrow composition from inflammatory edema (Type 1) to fatty degeneration (Type 2), and ultimately subchondral sclerosis (Type 3), with correspondingT1/T2 signal changes on MRI. Emphasis is placed on how Modic changes correlate with vertebral motion abnormalities, including sagittal translation, abnormal disc angulation, and spondylolisthesis patterns. The course provides evidence-based criteria for incorporating end plate pathology into differential diagnosis, surgical planning, and long-term spine stability assessment.

Structured instruction on application of the Pfirrmann grading system for lumbar disc degeneration using T2-weighted sagittal MRI. The grading system is contextualized within a framework of clinical radiology that includes assessment of disc hydration, nucleus­annulus distinction, and progressive disc space collapse. Curriculum expands to include analysis of vertebral alignment using Meyerding classification for spondylolisthesis, measurement of intersegmental disc angles, and detection of segmental kyphosis or hyperlordosis. Instruction also includes correlation with adjacent Modic changes, facet tropism, and ligamentous laxity, supporting a comprehensive biomechanical and diagnostic approach to spine pain evaluation.

Comprehensive review of static and dynamic imaging protocols used to evaluate global and regional spinal biomechanics. Participants are trained in measuring cervical and lumbar lordosis using Cobb angle techniques, identifying segmental wedging through disc angle calculations, and recognizing early translational and rotational instability. MRI and radiographic criteria for evaluating vertebral endplate integrity, subchondral marrow changes, and osteophytosis are presented in the context of sagittal balance and degenerative cascade theory. Instruction emphasizes the clinical implications of these measurements in guiding treatment strategy, identifying surgical candidates, and establishing objective documentation in personal injury and chronic pain populations.

Three cases involving challenging diagnostic presentations, including myelopathy, lumbar spine tumor, and late-stage spontaneous abortion, were presented. MRI and plain film imaging studies and the role of the diagnostic workup as well as spinal biomechanics were discussed, including the clinical presentation and symptomatology. The importance of an accurate diagnostic workup, including studies for patient presentation and ligament laxity with past medical history records, was also discussed.

This comprehensive course provided an in-depth examination of the interprofessional management of Ankylosing Spondylitis (AS), focusing on both diagnostic and therapeutic strategies. The course was structured around a detailed case study of a patient presenting with low back pain (LBP) flare-ups, with radiation, offering practical insights into the complexities of managing AS in a clinical setting. Key components of the course included the interpretation of clinical presentations, such as LBP associated with radiating pain, and the use of specific lab tests to confirm the diagnosis of AS, notably the HLA-B27 test. Participants reviewed the initial treatment plans, which included pharmacological interventions and the timing of advanced imaging modalities like MRI to assess disease progression. The course also covered the importance of early referral to rheumatology for comprehensive management, particularly in cases where standard chiropractic care may need to be supplemented with specialized medical intervention. The course also provided an in-depth review of radiographic findings, specifically the identification of mild bone spurring and narrowed sacroiliac joints on lumbar spine X-rays, which are indicative of AS. Orthopedic evaluations, including the interpretation of positive Straight Leg Raise and FABER tests, were emphasized to correlate clinical findings with radiographic evidence. Emphasis was placed on the ability to work within an interprofessional team to develop and implement evidence-based treatment strategies for patients with AS. This included understanding the nuances of when to transition from conservative care to specialized medical treatment, thereby improving patient outcomes.

This course provided an extensive exploration of ligament laxity following traumatic injury, with a focus on objectifying these findings through advanced imaging and clinical evaluation. Through a detailed case study of a 25-year-old female patient involved in a motor vehicle collision (MVC), the course delved into the complexities of diagnosing and managing ligamentous injuries in the cervical and lumbar spine. Participants were guided through the initial diagnostic process, which included assessing cervical and lumbar spine integrity through MRI and Clinical Radiographic Measurement Analysis (CRMA). The cervical MRI revealed small disc herniations at multiple levels (C3-C4, C4-C5, and C6-C7), while the lumbar MRI highlighted an often-overlooked finding: prominent fluid at the L4-L5 interspinous region, suggestive of an interspinous ligament tear. The course emphasized the importance of CRMA in detecting significant translational and angular motions in the cervical spine, particularly at C2-C3, and discussed the implications of these findings for diagnosing Alteration of Motion Segment Integrity (AOMSI). The lumbar spine was also evaluated using CRMA, which identified significant translational motion at certain levels that did not meet the thresholds for AOMSI. The focus was on understanding of the biomechanical implications of ligament laxity and the critical role of imaging in objectifying these injuries. The course also reinforced the importance of integrating clinical findings with imaging results to develop comprehensive, evidence-based treatment plans for patients with traumatic spine injuries.

review of a patient presenting with clinical symptoms suggestive of cervical myelopathy, a condition that often manifests with neurological deficits due to spinal cord compression. Physical examination was notable for the absence of pathological reflexes, which typically serve as key indicators of myelopathy, adding a layer of complexity to the diagnosis. MRI imaging, including T1, T2, and STIR sequences, revealed significant cervical cord compression. The compression was primarily due to disc protrusion at specific vertebral levels, leading to central spinal canal stenosis. Discussion of signal changes appearing as areas of hyperintensity within the spinal cord, reflecting the presence of edema or myelomalacia—both of which suggest ongoing spinal cord injury. The T1-weighted images provided further detail on the structural integrity of the spinal cord and the surrounding vertebrae, while the STIR sequences, known for their sensitivity to fluid, highlighted areas of inflammation and edema within the spinal cord and adjacent soft tissues. Despite these significant imaging findings, the lack of pathological reflexes such as Babinski or Hoffman’s signs posed a diagnostic challenge. Pathological reflexes are often considered hallmark signs of upper motor neuron lesions, and their absence can complicate the clinical picture, potentially leading to underestimation of the severity of the cord involvement. This case underscores the critical importance of integrating both clinical findings and detailed imaging studies in the assessment of cervical myelopathy. The discordance between the imaging evidence of significant spinal cord compression and the absence of expected reflex abnormalities highlights the need for a comprehensive and nuanced approach to diagnosis and management. The course emphasized that the absence of pathological reflexes should not discount the diagnosis of cervical myelopathy, especially when imaging findings clearly demonstrate cord compression and signal changes. Clinicians must remain vigilant and consider the full spectrum of clinical and imaging data to accurately assess the severity of cervical cord involvement and to formulate an appropriate management strategy, which may include conservative treatment, surgical intervention, or a combination of both, depending on the overall clinical context.

a comprehensive review of a complex clinical case involving Modic changes in a 28-year-old female patient, who presented with significant spinal symptoms. Modic changes refer to pathological changes in the vertebral endplates and adjacent bone marrow, which can be detected on MRI and are classified into three types, each with distinct imaging characteristics and clinical implications. The course covered advanced diagnostic approaches, emphasizing the interpretation of x-rays and MRIs to identify and differentiate between Modic Type 1, Type 2, and Type 3 changes. Modic Type 1 is characterized by bone marrow edema and inflammation. It appears as low signal intensity on T1-weighted images and high signal intensity on T2-weighted images. On STIR (Short Tau Inversion Recovery) sequences, Modic Type 1 changes are typically hyperintense, indicating active inflammation. Clinically, this type is often associated with pain and may represent an acute or active degenerative process. Modic Type 2 represents fatty degeneration of the bone marrow. On MRI, Modic Type 2 changes appear as high signal intensity on both T1 and T2-weighted images. These changes suggest a chronic, stable process, where inflammation has subsided, and fat has replaced the bone marrow. Modic Type 3 is characterized by sclerosis or hardening of the bone. It appears as low signal intensity on both T1 and T2-weighted images. Modic Type 3 changes are indicative of an advanced, chronic stage of degeneration and are often associated with less pain, but more structural rigidity. The course explored various therapeutic interventions tailored to the patient's specific Modic changes, including chiropractic adjustments and ancillary therapies like physical therapy and anti-inflammatory treatments. The therapeutic approach was adapted as the patient's condition evolved, reflecting the importance of ongoing assessment and flexibility in treatment planning. A critical evaluation of the clinical outcomes was conducted, analyzing the patient’s progress and setbacks over the course of treatment. This evaluation provided valuable insights into the effectiveness of different treatment strategies and highlighted the importance of adapting care plans based on patient response to optimize long-term outcomes. Content provided a deeper understanding of Modic changes and their impact on spinal health, enhancing their expertise in managing challenging spine cases within an interprofessional healthcare framework. The course emphasized the need for precise imaging interpretation and a nuanced approach to patient care, ultimately improving the ability to achieve better clinical outcomes for patients with Modic-related spinal conditions.

his course offered an in-depth exploration of effective communication strategies and patient navigation in the management of complex spine cases, with a particular focus on surgical interventions. Through the case review of a 60-year-old female patient with chronic neck and lower back pain, the course examined the impact of her extensive medical history, including her daily medication regimen and previous spine surgeries, on her current condition. Specific spine surgical techniques, such as cervical fusion, laminectomy with fusion, and minimally invasive decompression, were critically reviewed in the context of their long-term efficacy and impact on patient outcomes. The course emphasized the importance of interprofessional collaboration in managing such complex cases, underscoring the need for seamless communication among healthcare providers to optimize patient care. By focusing on the enhancement of clinical skills, participants learned to guide patients more effectively through their treatment journeys, ensuring that care plans are tailored to individual needs and that all aspects of the patient's condition are considered. In addition to surgical technique review, the course highlighted strategies for improving patient-centered care, particularly in the post-operative period, where coordination between surgeons, chiropractors, physical therapists, and other healthcare professionals is crucial for improving functional outcomes. This comprehensive approach ensured that participants were well-equipped to manage the intricacies of spine care, from pre-operative planning through to post-operative recovery, enhancing their ability to deliver high-quality, coordinated care.

A comprehensive review of a clinical case involving a patient with acute lower back pain was conducted. The discussion included an in-depth analysis of T1, T2, and STIR MRI sequences of the lumbar spine. Detailed findings from the imaging studies were presented, highlighting the presence of a hemangioma and a Tarlov cyst. Additionally, Modic type 1 and type 2 changes at the intervertebral endplate were noted, along with intervertebral disc extrusion. The case discussion emphasized the importance of accurately diagnosing and managing the condition, particularly focusing on identifying the pain-generating structures. This approach ensures a targeted and effective treatment plan. Furthermore, the presentation outlined the significant benefits of clinical care coordination with community medical providers, underscoring the importance of a multidisciplinary approach in managing complex cases of lower back pain. The integration of various healthcare professionals is essential for optimizing patient outcomes and providing comprehensive care.

A comprehensive review was conducted on a case involving a patient who experienced a motor vehicle crash, presenting with headache, neck pain, and left wrist pain. The overview included plain film radiographs of the cervical spine, with a specific emphasis on intersegmental motion and alterations in motion segment integrity. Detailed biomechanical analysis was also discussed. The review extended to coronal view MRI utilizing T1 and T2 sequences, with particular focus on the upper cervical region, specifically the alar ligaments. A hyperintense signal was noted laterally and correlated clinically with the patient's presenting symptoms. The discussion included proper diagnosis and management of upper cervical grade 2 ligament injuries, providing a detailed and comprehensive presentation.

the transformative role of AI in modernizing patient care, clinical decision-making, and healthcare administration was explored. An in-depth look at how AI enhances operational efficiencies, alleviates the administrative load on healthcare practitioners, and provides critical analysis of vast data streams for improved diagnostic and management outcomes was presented. Implications of rapid growth in life science research and the integration of these findings into practice was outlined. Critical discussions included navigating the challenges of data privacy and the ethical deployment of AI technologies, aiming to equip healthcare professionals with the skills needed to lead in a progressively AI-driven healthcare environment.

participants were provided with comprehensive insights into the utilization of AI for the transformation of patient-provider conversations into accurate medical records. Attendees gained proficiency in advanced documentation tools that leverage AI to streamline the data capture process, enhance record accuracy, and improve overall clinical efficiency. The course emphasized practical applications, ensuring participants understand the processes of integrating these AI solutions into their clinical practice, thereby elevating the standard of patient care, and safeguarding meticulous medical record-keeping.

participants were equipped with the skills to understand how big data will be harnessed in the medical field. Participants delved into methodologies for collecting, analyzing, and interpreting large datasets to drive innovation and enhance value in healthcare services. They emerged with a proficiency in the basic understanding of big data to inform clinical decision-making, improve patient outcomes, and streamline operational efficiencies. The curriculum also covered ethical considerations and compliance with basic healthcare data regulations, ensuring that attendees have a basic understanding of the complexities of data privacy and security within a professional practice.

detailed necessity of creating a differential diagnosis was presented and emphasized. Review of the gold standard in imaging avascular necrosis of the hip was presented with focus on delineation between intervertebral disc, spinal facet joint, sacroiliac joint and hip was presented. Overlapping referral patterns was shown and reviewed in detail. Diagnosis and causation of avascular necrosis in the hip was presented with emphasis on non-traumatic etiology. Surgical vs nonsurgical management was discussed.

– analysis and review of T1, T2 and STIR MRI images with specific discussion on the presence of inflammatory fluid and migration of intervertebral disc material. Communication with spine surgeon was emphasized with particular focus on verbal reporting and clinical documentation. Interprofessional communication pitfalls were outlined and presented. Medical necessity of advanced imaging was presented with clinical correlation of orthopedic and neurological examination findings was detailed.

eview of field doctor response statistics regarding utilization of x-ray in clinical practice was presented. Guest author was interviewed outlining the basis and rationale for the academic paper reviewed. Discussion surrounding the use of x-ray for both anatomical contraindications to care (red flags) and assessment of biomechanical parameters was presented. Literature supporting the conservative co-management of spinal biomechanical abnormalities within the greater healthcare system was emphasized. Evidence based practice was outlined with particular focus on the utilization of x-ray in the management of the chiropractic patient.

outline of a patient presenting with hip pain to a chiropractic clinic was presented. A complete history of non-response to conservative interventions was detailed. Failure of non-steroidal anti-inflammatory medication, physiotherapy and acupuncture was discussed. Further workup including the ordering of plain film radiography and advanced imaging was presented with detailed clinic and scientific rationale. Emphasis was placed on nine other similar cases published in the literature with the patient having no prior history of cancer or boney metastasis prior to evaluation in the chiropractic office. Review of processes pertaining to patient history taking, physical examination, response to past care and utilization of imaging modalities to arrive at an accurate diagnosis was underscored.

Mechanical movement and restrictions were discussed and correlated to the surrounding anatomy. Review of causes of the sacroiliac joint as a source of pain was outlined. Differences in boney structure including cortical bone thickness and muscular overlay were detailed. Differentiation of different ligaments supporting the sacroiliac joint and the primary restraint of anatomical movement was presented including the posterior, sacrotuberous, sacrospinous, anterior, interosseus and iliolumbar ligaments.

analysis of patients presenting with multiple spinal injuries post trauma was presented. Overview of ligamentous, intervertebral disc and cartilage injuries was reviewed. Discussion of clinical symptoms and correlation to objectified injury was discussed. Interprofessional collaboration with emphasis on clinical indications for the chiropractic adjustment, need for medical specialist referral, necessity of advanced imaging modalities such as MRI/CT and course of care was outlined and reviewed. Hallmark signs of ligamentous injury such as mid-line tenderness was detailed.

discussion and review of the RAND Corporation’s Center for Collaborative Research in Complementary and Integrative Health (CIH), established in 2020. Outline of the responsibilities of a profession were presented including development of continued knowledge related to the profession that has an influence on the lives of the public. Details of the collaboration and sharing of financial, epidemiological, statistical, and public health professionals within a consortium of academic institutions. Presentation of objectives of CIH including maintaining guidance and support to chiropractic college institutions, training for investigators and the improvement of funding competitiveness through increased scale and reduced transaction costs of research was reviewed

review of MRI as the gold standard for the diagnosis of lumbar stenosis (LSS) with emphasis on plain film radiograph’s historical limited role in 3-D diagnosis. Analysis of a convolutional neural network (CNN) for the diagnosis of severe lumbar stenosis using radiography was presented. Discussion of gradient weighted class activation mapping (Grand-CAM) was reviewed. Overview of the algorithm trained by a CNN to identify LSS on radiographs which showed high diagnostic accuracy and its application as a possible triage tool was presented.

review of the clinical diagnosis of seronegative spondyloarthropathy was presented with attention paid to the two most common types, ankylosis spondylitis and psoriatic arthritis. Details regarding a complete physical examination assessing for swelling, redness and reduced range of motion were presented along with focus on enthesitis and spinal mobility. Overview of the HBLA-27 allele and generic risk association was presented. Details associated with radiographic evidence of seronegative spondyloarthropathies were discussed including sacroiliac joint sclerosis and vertebral hyperostosis. Interprofessional management with rheumatology was emphasized.

detailed review of the anatomical structure and layers of the arterial wall was presented including the tunica externa, intima, and adventitia. Discussion of intimal tearing and thrombus formation was provided focused on hypoxic clinical patient presentations. Diagnostic angiography as the gold standard was presented. Clinical presentation of craniocervical arterial dissection was reviewed with past medical history such as genitive connective tissue disorders such as fibromuscular dysplasia, Ehlers-Danlos, Marfan, and Loeys-Dietz syndromes. Delineation between musculoskeletal and vascular manifestations of head/neck pain was presented and outlined with particular attention being given to hypoxic clinical presentations.

Spinal Biomechanics in Clinical Practice, The utilization of X-Ray digitization to diagnose spinal biomechanical pathology and analyzing trends in healthcare when triaging mechanical spine pain. The role of credentials in interprofessional collaboration.

MRI Spine Sequence Acquisition and Interpretation, The understanding and utilization of T1, T2, STIR, Proton Density, FSE, GRE imagine sequencing for conclusive diagnosing of fracture, tumor, infection, and disc pathology. Identifying herniation, protrusion, bulge, extrusion-migrated, and extrusion-fragments on MRI images.

Spinal Disc Microanatomy, The understanding of the human spinal discal elements; annulus, nucleus pulposis, cartilaginous end plates inclusive of the neurology, visualization, differentiation from the neonate to adults. The understanding of the etiology of Modic changes on MRI and how spinal biomechanics are altered

Triaging neurologically compromised cases in conjunction with positive MRI images, and collaboratively managing cases with neurosurgeons in clinical practice. Post-operative management of spinal cases through full recovery

The analytics of spinal biomechanical engineering utilizing X-Ray digitizing for Alteration of Motion Segment Integrity and biomechanical pathology. Determining laxity of ligaments in connective tissue pathology and the long-term negative sequels of the pathology

The diagnosis, and reporting of spinal disc bulges, herniations, protrusions, extrusions, and fragments. Reporting varices, Modic 1, 2, and 3, posterior longitudinal, interspinous, and intertransverse ligament. Reporting the ligamentum Flavum and epidural fat as a space-occupying lesion

discussion of Intermedullary Spinal Cord Tumors (IMSCT) was presented with details regarding astrocytoma, hemangioblastoma and ependymomas. Review of specific characteristics of each of and their visualization on T1, T2 and STIR MRI images was presented. Clinical manifestations were emphasized including neck and back pain with details surrounding interprofessional communication with the neurosurgeon presented. Emphasis was additionally placed on early diagnosis and aggressive management with the spine surgeon. Intermedullary spinal cord metastasis was detailed and presented in the context of the neck and back pain patient

review of interprofessional communication with the neurosurgeon and primary care physician in patients with IMSCT was presented. Intraoperative ultrasonography as a surgical adjunct to assist in the location and measurement of IMSCT was outlined. Importance of delineation of tumor versus normal tissue was described and emphasized. Surgical considerations for removal were outlined and correlated to operative outcomes. Specific surgical technique was presented and outlined in an evidenced based systematic review.

common intradural extramedullary tumors were reviewed including meningioma, schwannoma and their association with neurofibromatosis. Specific characteristics, locations and symptomatic pain patterns were presented. Correlation of symptom manifestation with imaging characteristics was detailed and emphasized. MRI findings reviewed included T1 and T2 weighted images. Interprofessional communication was emphasized particularly with the primary care physician and spine surgeon. Emphasis was placed on schwannoma and radiculopathic symptoms due to dorsal sensory nerve involvement. Additional tumor types such as myxopapillary ependymoma and paraganglioma were outlined with specific attention paid to their involvement with the Caudia equina.

review of the ligament, biomechanical and neurologic implications of a chronic cervical spine conditions, age dating cervical spine pathology and acute cervical spine injury including cervical spinal cord edema. The methods to determine stability and co-management with medical specialists was reviewed. Identification of the biomechanical ligament injury associated with the structural compromise, disc herniation with traumatic annular fissures and triage for neurosurgical consultation was reviewed

detailed review of the most common demyelinating diseases including multiple sclerosis, neuromyelitis optica spectrum disorder (NMOSD), acute disseminated encephalomyelitis (ADEM) and myelin oligodendrocyte glycoprotein (MOG) encephalomyelitis was presented. Specific findings on advanced imaging such as MRI were presented to ensure a timely and accurate diagnosis. MRI roles including diagnosis, imaging biomarkers and the monitoring of pharmacological side-effects were listed and discussed. Characteristic lesions of demyelinating disease were presented and listed in detail with a specific focus on the T1, T2 weighted images and sagittal FLAIR was presented.

a comprehensive review of the risk factors associated with intervertebral disc pathology. Detailed focus on acute versus chronic injury as well as genetic and environmental factors on intervertebral disc pathology was presented. Review of the classical theory of aging and progressive wear and tear was outlined and contrasted to acute traumatic injury. Intervertebral disc anatomy was reviewed and correlated to MRI based grading systems for degenerative intervertebral disc disease. Proper interprofessional communication to both the medical and legal professions was emphasized with a focus on known scientific analysis

a comprehensive review of the common histological characteristics in the temporomandibular disc, meniscus and intervertebral disc was presented. A particular perspective on tissue engineering was provided with emphasis on biomechanical properties. Overview of cell sources, scaffolding and stimuli was presented in the context of tissue engineering and therapeutic approaches to degeneration in those particular tissues. Focus was on similarity and differences between these fibrocartilage discs in terms of their similarities and their differences.

The long-term clinical outcomes of chronic LBP with hypermobility due to ligament laxity was reviewed with evidenced based literature. Potential interventions and their expected outcomes were presented

a detailed review of the process to effectively render a medical legal opinion on the causality, bodily injury and persistent functional loss of a traumatically injured spine patient. Focus was on clinical correlation of the mechanism of action, patient history, physical examination, imaging films/studies and persistent functional loss. Emphasis was placed on interprofessional communication and differentially diagnosis pre-existing conditions versus those that are acutely present post injury. Segmental spinal analysis of intervertebral disc and arthritic pathology was presented.

detailed presentation on the biomechanical effects of intervertebral disc degeneration on the human cervical spine. Review of relevant anatomy including vertebral bodies, healthy intervertebral disc, degenerative intervertebral disc, spinal nerves, spinal cord, spinal ligaments, and facet joints was outlined. Structural changes were correlated to biomechanical alterations with a detailed focus on the C5-6 segment of the spine. Aberrant facet joint loading was discussed and correlated to intervertebral disc disease and alternations in normal motion and acceleration of spinal arthritis.

The utilization of the AMA Guides to Permanent Impairment and how to accurately determine the appropriate percentage as also reviewed. A comparison of the 5th and 6th edition of the AMA guides was reviewed.

Description of the function of the enthesis ranges of ligaments and tendons and the lack of conventional MRI protocols to properly visualize them was presented. Review of tissues that are MRI visible and those that are MRI invisible was outlined. Parameters of MRI visible tissue that have short T2s and rapid MR signal decay were detailed. Tendons and ligaments with T2s of 4-10 ms were outlined as being able to be distinguished only with short TE gradient echo sequences and the requirement of tissues with T2s of .5-2ms and less than 100us requiring UTE sequences.

Creating care paths using clinical examination and advanced diagnostics to formulate care paths including collaborative care. Documenting and diagnosing spinal biomechanical lesions, disc pathology from MRI including, but limited to herniations, bulges, extrusions, sequestrations and non-disc spinal lesions from varices and neoplastic space occupying lesions.

The diagnosis of acute spinal ligament injury and the resulting segmental hypermobility was discussed and reviewed. The chronic sequela of untreated biomechanical pathology was also reviewed.

in-depth review of the anatomical course of the vertebral artery in the cervical spine with specific emphasis on the V1, V2, V3 and V4 segments and their anatomic boundaries. Specific epidemiology of Cervical Artery Dissection (CAD) was presented and outlined. Risk factors for CAD such as atherosclerosis, inflammation, and genetic tissue disorders such as Marfans and Ehlers-Danlos Syndromes were detailed. Clinical symptoms of CAD were presented such as Horner’s Syndrome, cerebral ischemia, vertigo, and nausea were presented. Detailed review of hemodynamic versus thromboembolic causes of ischemia post CAD were reviewed.

detailed overview of the anatomy of the lumbar spine and surrounding neurological systems was presented and outlined. Clinical symptoms and risks of clinical progress where discussed. Upper vs lower motor neuron lesions were reviewed and correlated to cauda equina syndrome. The difference between suspected and confirmed cauda equina syndrome was detailed and explained. Emphasis was placed on early intervention and emergency surgical referral in patients with cauda equina syndrome.

detailed overview of the needs of the primary care physician and the diagnosis and management of mechanical spine pain. Discussion of peer-reviewed medically indexed research studies supporting chiropractic in the pain management phase of care is presented. Specific statistics in the reduction of opioid prescription refills particularly in older and injured patients were presented. Complaint reporting and consistent communication was outlined and reviewed with particularly emphasis on clinical workflows within the practice environment.

detailed review of a case of impaired spinal biomechanics post lumbar fusion. Discussion related to a multi-level lumbar spina fusion in a 65-year-old female patient and residual lower extremity radiculopathy was presented. Analysis of influence of right sided knee replacement and subsequent right sided neuropathy post-surgery was outlined. Progression of spinal symptoms cranially to include neck pain and bilateral hand paresthesia was discussed. Detailed review of upper and lower extremity EMG/NCV findings, lumbar MRI, cervical MRI and plain film radiographs were presented. Clinical correlation to anatomical versus biomechanical causes of extremity paresthesia was discussed with detailed analysis of lumbar neuroforamen and pelvic incidence. Spinal compensation in the cervical spine related to lumbar biomechanical pathology was presented.

The diagnosis of acute and chronic spinal ligament laxity and spinal joint instability was discussed along with the application to spine surgical planning and pain management procedures.

Medical-legal reporting of diagnosis of acute versus chronic disc and ligament injury and the tools necessary for accurate diagnosis, prognosis, exacerbation, or aggravation. How to build a reputation for ethical and accurate medical legal reporting was also reviewed.

Detailed review of the tenants of degenerative disc disease in the human spine. A review of metabolic factors including bone and cartilage remodeling, lipid metabolism and oxidative stress within the disc was presented. Outline of adverse biomechanical factors including levels of modic changes, reaction to microtrauma and responses to increased mechanical stresses due to loss of sagittal and coronal spinal balance. Discussion reviewing biochemical factors such as innate and adaptive immunity, inflammation and low-grade discitis were presented. Emphasis was placed on individual risk factors such as smoking and weight gain. Genetic factors were discussed and correlated to environmental risk factors for degenerative disc disease.

Interpreting and utilizing X-ray and MRI findings in creating demonstrative documentation. Advanced identification of spinal disc lesions, herniations, bulges, protrusion, extrusion, and fragmentations through computer graphics. Identification and demonstrative documentation of vertebral motor unit pathology and reporting demonstratively using computer graphics.

Utilization of thin slice acquisitions with T2 Fat suppressed, STIR, proton density, T1 and T2 sequencing for advanced identification of spinal disc lesions, herniations, bulges, protrusion, extrusion, and fragmentations. Better visualization of intradural and extradural lesions, neoplasms, and infections.

Ethical, collaborative relationships with medical PCPs and specialists using advanced documentation and accurate reporting of imaging and advanced imaging. Creating a collegial relationship when conflicts arise in concluding accurate diagnosis to allow consensus and the evidence to determine final diagnosis.

Correlating MRI to CAT Scan when either creates an unclear conclusion to render a complete image of the morphology of the indeterminate pathology. Understanding the physics of CAT Scan and the radiation levels with different types of CAT Scan technology.

Understanding the morphology and physiology of connective tissue at the cellular and extra-cellular levels in building a foundation to understanding the function and interaction of ligaments, tendons, muscles, and bones, Identifying connective tissue pathology and the repair process with a foundation of r permanent aberrant sequella.

Understanding the concepts of normal vs. pathological movement of vertebral motor units in accurately concluding diagnosis on biomechanical pathology when considering excessive motion. An evidence-based approach to determining translation, angular deviation and rotations beyond pathobiomechanical limitations in the spine

An evidence-based approach to concluding accurate diagnosis, prognosis, and treatment plan, Eradicating the non-specific back pain dogma utilizing X-ray digitizing based on literature standards, Creating treatment plans with identifying the primary spinal lesions using evidence-based tools.

Understanding and including all historical elements; current history, past history, family history, and social history when documenting a 99201, 99202, 99203, 99204, and 99205. The application of time as the prime element as per Medicode in coding examinations and re-examination with face to face, review of records and the time necessary to document in an electronic health record.

review of the causes of vertebral osteomyelitis was presented including findings on patient subjective complaint and objective findings on physical examination. Differentiation between plain film radiographs, T1, T2, Flair and STIR weighted imaging was presented and discussed. Associated clinical findings including infections in adjacent areas including intervertebral discitis areas was presented. Causes of osteomyelitis including past surgical procedure, frequent injections, infection in an adjacent tissue, IV drug use and long-term corticosteroid use were presented. Anterior elements of the functional motor unit were outlined as the primary location of osteomyelitis. Correlation clinically to difficulties in identifying this clinical entity in its early stages was reviewed.

outline of the causes of arachnoiditis in the human spine was presented. Specific focus was on a case of lumbar arachnoiditis involving the cauda equina evidenced on T1, T2 sagittal and axial MRI. Treatment options and lack of curative interventions was presented. Relevant anatomy of the lumbar spine including cauda equina, conus medullaris, filum terminale, dura mater, pia mater and arachnoid mater were reviewed in detail. Review of arachnoiditis and chiropractic adjustment were discussed as well as interprofessional coordination of care with interventional pain management and surgical consultation.

case review of traumatically induced 10mm L5-S1 intervertebral disc extrusion was presented. Correlation of neurological examination including testing of myotomes, dermatomes and deep tendon reflexes was presented. Detailed review of sagittal T1, sagittal T2, axial T1, axial T2 as well as STIR images were presented. Clinical referral for surgical consultation was outlined and clinical rationale was presented. Review of the different between anatomical and functional sources of pain were outlined with a focus on biomechanical parameters such as pelvic incidence.

overview and discussion of contusion of the anterior sacral ala in an elite college cross-country runner. Physical examination outlining range of motion, neurological and orthopedic examination was reviewed and correlated to the subjective complaint of right sided lower back pain. Misdiagnosis was presented and long-standing symptoms resulting in possible cessation of play for this athlete. Discussion of interprofessional communication with the neuroradiologist and subsequent MRI order with slices through the anterior sacrum was reviewed and presented.

Correlating clinical findings with x-ray and advanced imaging to conclude and accurate diagnosis, prognosis and treatment plan. The utilization of demonstrative documentation in diagnostic testing to visualize pathology in the trauma and non-trauma case.

overview and discussion of spinal anatomy including intervertebral discs, ligaments, spinal nerves, spinal cord, and facet capsule was presented. Emphasis was placed on differential diagnosis, physical examination and clinical correlation of injury mechanism and patient complaint. Specific outline of facet joint injury and joint effusion was demonstrated and discussed using T1, T2 and STIR weighted MRI scans of the lumbar spine with specific attention paid to the right L3 facet joint. Interprofessional communication in documentation and referral for interventional pain management consulting was presented with emphasis on facet or medial branch block injections.

discussion of spine care in terms of engineering principles was presented. Biomechanical parameters such as pelvic incidence, sacral slope, pelvic tilt, and sagittal balance were outlined and presented. Spinal curvature and load distribution was presented mathematically and outlined using full spine plain film radiography. Comparative anatomy between primates and humans as well as humans of different ages was presented as examples of spinal compensation. Spinal rehabilitative principles was provided in group discussion

review and outline of the diagnosis and management of a spinal synovial cyst was presented. Discussion surrounding patient history, physical examination and advanced imaging findings was outlined. Structure and appearance of synovial cyst on T1 and T2 weighted MRI was presented, and the benign nature of these lesions was reviewed. Indications for specialist referral and patient centered management raging from watchful waiting to surgical intervention due to neurologic compromise was reviewed. Advanced imaging differences between plain film radiographs, CT and MRI was outlined and discussed. MRI signal on T2 weighted image in relation to cerebral spinal fluid was highlighted

discussion of a case pertaining to traumatically induced pathology to the spine of a 59-year-old female. Outline of pathological reflexes and detailed physical examination best practices. Review of important imaging included CT axial, CT sagittal and CT coronal views as well as T2 FSE sagittal, T2 FSE axial and STIR Sagittal MRI studies were reviewed and clinically correlated. Relevant cervical and lumbar spinal anatomy in in the sagittal, axial and coronal planes was detailed on MRI and CT studies. Interprofessional communication with the spine surgeon was presented and review of surgical intervention including ACDF (anterior cervical discectomy and fusion) procedure to the patient’s cervical spine.

Review of the aortic arch, brachiocephalic trunk, common carotid, carotid bifurcation, internal carotid, external carotid, Circle of Willis, and vertebral artery pathways was demonstrated. Review of correlation of patient history, physical examination and findings on advanced imaging was presented. Clinical review of dysphagia and odynophagia were presented and discussed clinically in the context of the physical examination and patient pain patterns. Vascular anomalies and their general asymptomatic presentation were emphasized. Etiology of arterial dissections was outlined with emphasis on differentiating spontaneous versus traumatic characterization. Advanced imaging of carotid space pathology was presented with catheter angiography demonstrated as the gold standard.

eview of the ligament injury thresholds, methods of diagnosis utilization of SITR pulse Sequence MRI as the gold standard for evaluating the age of and pathophysiology was discussed and presented. Biomechanical assessment of hypermobility associated with ligament laxity was presented along with the specific ligament involved in the clinical picture. When and how to triage to medical specialist was reviewed. Review of the four columns of vertebral architecture was detailed.

review of published categorization of pain generation by the International Association for the Study of Pain including nociceptive, neuropathic and nociplastic sources. Discussion on the history and relevance of the Delphi process of conducting consensus-based research was presented. Origins of nociceptive, neuropathy and nociplastic sources of pain was outlined including non-neural tissue, the somatosensory nervous system as well as the categorization of pain syndromes with non-specific findings on physical examination and imaging studies. Review of the importance of quantitative testing, clinical examination and clinical correlation was presented and related to the academic approach to the categorization of pain. Spine Management Group, LLC, Federation of Chiropractic Licensing Boards

detailed overview of the anatomy and mechanics of the Atlanto-axial space in both diagrams and MRI studies. Overview of the clinical and laboratory diagnosis of rheumatoid arthritis and MRI as the imaging modality of choice for pannus formation in the upper cervical spine. Discussion on pannus formation being more common in non-rheumatoid arthritis patients. Overview of theories relating pannus formation to spinal instability at the C1-2 joint and identification of pannus as a common trait in the elderly.

overview of Lumbar Interbody Fusion (LIF) as an established treatment for a range of spinal disorders such as degenerative pathologies, trauma, infection, and neoplasm was presented. Mechanical techniques and implant processes were discussed. Rage of LIF approaches was outlined including posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF or MI-TLIF), oblique lumbar interbody fusion/anterior to psoas (OLIF/ATP), anterior lumbar interbody fusion (ALIF), lateral lumbar interbody fusion (LLIF). Review of Minimally Invasive Surgery (MIS) was discussed and detailed.

review of types of tissue injured in head and neck trauma including muscle, nerve, intervertebral disc, ligament, spinal cord, vertebral body, artery, or vein was presented. Clinical correlation of mechanism of injury, patient history, subjective complaint, physical examination, advanced imaging findings and electrodiagnostic testing was emphasized. Interprofessional communication and review of any diagnostic dilemmas was reviewed. Spinal compressive radiculopathy versus acute nerve injury without prolonged compression was presented. Differential diagnosis between ligament, intervertebral disc and nerve pathology was outlined in depth and presented. Emphasis was presented on spinal nerve manifestations of ligament injury in the cervical spine.

review of prodromal symptoms relating to the typical presentation of the multiple sclerosis patient as a novel update in clinical diagnosis. Recognition of subtle symptoms was emphasized. Multiple sclerosis as the leading cause of neurological disability in young adults was outlined and the importance of early recognition and prompt intervention. Overview of prodromal symptom trends occurring years before full symptoms appear and emphasis was placed on the Doctor of Chiropractic as a front- line provider it their recognition, clinical referral pathways were discussed.

detailed discussion of MRI physics and imaging acquisition sequences in clinical practice. Thorough review of image intensity definitions and the correlation to tissue type including nerve, cerebral spinal fluid, muscle, bone, ligament, and tendon. Overview of fat suppression techniques including STIR and FLARE utilization and clinical necessity. Discussion of sequence categories including Proton Density, T1, T2 and Diffusion Weighted was presented. Overview of Flow Sensitive sequences was briefly presented. Spine Echo (SE), Gradient Echo (GE), Inversion Recovery (IR) and Echoplanar Imaging (EPI) were outlined and contrasted in clinical context. Requirements for MRI examination were reviewed. Updated information was presented on MERGE imaging in the cervical spine.

Review and discussion of objective data derived from ordering diagnostic spinal injections. Patient triage in relation to facet joint injury, ligament laxity, radiculopathy, herniation of the intervertebral disc and sacroiliitis was outlined. Patient injury data from physical examination, provocative testing and diagnostic imaging was correlated clinically with response to diagnostic block after appropriate referral to medical specialty. The sacroiliac joint as an underdiagnosed source of chronic lower back pain was outlined. Review of gold standard for diagnosis of sacroiliitis, fluoroscopy-guided block was presented.

review of objective muscle weakness as the primary indication for surgical interventions in patients with intervertebral disc herniations and extrusions was presented. Discussion of parameters for physical examination findings to warrant ordering advanced imaging and surgical consultation. Overview of rationale for evaluation of spinal central canal in patients with abnormal neurological findings was reviewed. Duties of a Spine Management PhysicianTM in the diagnosis and co-management of patients with intervertebral disc extrusions was outlined. Clinical correlation and coordination of care was detailed including timing of advanced imaging order and surgical referrals.

A review of the ligament, biomechanical and neurologic implications of a degenerative lumbar spondylolisthesis was presented. The methods to determine stability and co-management with medical specialists was reviewed. Identification of the biomechanical compensations associated with the structural compromise was reviewed

review of the scientific and validated process for evaluating degenerative disc disease in the human spine was reviewed. Detailed analysis of differentiating between acute and chronic changes was emphasized. Overview and discussion of advanced imaging as well as plain film radiographs with dynamic views was presented. Review in detail of the Pfirrmann scale and it’s association with intravertebral disc degeneration was presented including all Pfirrmann grades with illustrative reference.

discussion and presentation of the trial process and requirements of both the treating physician and expert physician was outlined. Emphasis was placed on detailed preparation of case flow and objective demonstrable findings. Review of courtroom proceedings including witness and expert testimony was included. Expert versus treating physician requirements were presented. Emphasis was placed on thorough evaluation and narrative reporting processes to prepare for court room questioning. Specific review of illustration of demonstrative evidence was outlined.

discussion of intravertebral disc morphology was presented and reviewed. Correlation between morphological and ideological findings was presented. Detailed review of spondylosis deformans, intravertebral osteochondrosis, intravertebral disc herniation and bulge was outlined. Specific detail was placed on changes in disc morphology due to ligament injury in the human spine. Clinical correlation of disc herniation versus disc bulge was presented. Overview and detailed analysis of types of annular tearing in the desk was presented with an emphasis on the delineation between clinical findings and findings on advanced imaging

outline of morphological presentations of concentric, radial and transverse fissures within the annulus fibrosus of the intervertebral disc. Consensus driven definitions were presented as outlined by recommendations of the combined task forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology. Modified Dallas Classification of annular fissures was reviewed and outlined. Specific correlation to annular fissure type and intervertebral disc morphology was detailed. Specific correlative factors linking annular fissures with acute and chronic injury was presented and reviewed

The methods and tools to determine injury to the Occipital-Atlanto and Atlanto-Axial ligaments were presented. Correlation to mechanism of injury and medical legal reports were reviewed. The AO standards for spinal instability was presented

– discussion related to millisievert and cumulative effective dose was presented. Outline of the definition and research process of achieving Minimal Clinical Important Difference in spine surgery was discussed. CED levels below 100mSv was reviewed and compared to patients receiving multiple plain film radiographs. Discussion and relation of spinal biomechanics, sagittal balance, utilization of spine radiographs and MRI to working with the neurosurgeon was outlined.

review of inclusion criteria accompanying modification of chiropractic treatment plan due to an absolute or relative contraindication to chiropractic care. Examples of clinical rationale, physical examination findings and proper diagnoses were provided. Review of the definitions of both relative and absolute contraindications to chiropractic care, specific details on referral to medical specialty were provided. Analysis of regional contraindications and treatment in adjacent regions were provided and discussed. The keys to understanding indications to care were detailed including the patient interview, review of medical records, diagnosis, and spinal examination findings. Review of most common reasons for chiropractic license violations were presented including application of the chiropractic adjustment to a contraindicated condition, failing to refer in the presence of a contraindication, failure to properly evaluate the patient to determine if a contraindication is present and failing to properly document the patient encounter.

review and discussion on the beginning of patient triage at phone intake was presented and related to the physical examination, review of diagnostic imaging and diagnosis. Detailed discussion of proper triage protocols including physical examination findings, plain film radiographs, MRI, diagnosis, and response to care was presented. Evidence based utilization of advanced imaging protocols was detailed including presence of neurological deficit non-response to care, increase in radicular symptoms and spinal instability on plain film imaging. Overview of interprofessional communication during triage including last E/M report, imaging reports, specialist referral, and demographic sheet was presented.

detailed review of anatomical structures on the axial slices of lumbar spine MRI were presented. Musculature presented included gluteus medius, psoas major, multifidus, iliacus, lumbar paraspinals and quadratus lumborum in both the T1 and T2 axial sequences. Traversing vs exiting spinal nerves were contrasted and compared to cervical spine. Neurological structures such as conus medullaris, caudia equina, filum terminale, ventral and dorsal nerve roots were identified. Visualization and discussion of benefit of T2 axial sequences in the identification of facet joint pathology was presented. Emphasis was placed on the structure and morphology of the intervertebral disc and spinal ligaments including anterior longitudinal ligament, posterior longitudinal ligament, facet capsule, interspinous, supraspinous, intertransverse and iliolumbar were detailed. Location and anatomical structure of the sacroiliac joint was presented and discussed.

detailed review of anatomical structures in the axial, sagittal and coronal planes of CT of the lumbar spine. Musculature presented included gluteus medius, psoas major, multifidus, iliacus, lumbar paraspinals and quadratus lumborum in both the T1 and T2 axial sequences. Emphasis was placed on the structure and morphology of the hard tissues of the spine with particular focus on the facet joints and pars interarticularis. Location and anatomical structure of the sacroiliac joint was presented and discussed.

Analyzing the requirements in anatomical diagnostic imagery to communicate spinal pathology. Integrating technology, clinical findings, and advanced graphic tools to communicate a diagnostic conclusion

Clinical case review of MRI including intra and extra-dural findings inclusive of the disc and vascular anatomical lesions. Differentially diagnosing central cord lesions, and spinal cord vascular lesions in both acute trauma and degenerative presentations

Analyzing neuro-biomechanical pathological lesions defines primary spinal lesions and removes the dogma of non-specific back pain. Creating evidence-based demonstrative documentation in the creation of treatment plans

Diagnosing and documenting: Ependymoma, Astrocytoma, Hemangioblastoma, Lipoma, Meningioma, Neurofibroma, Schwannoma, Myxopapillary Ependymoma.

Clinical record-keeping, why write clinical notes, the importance of context, what to include in a clinical note, tips for better clinical documentation, basic legal considerations, open clinical notes, how to keep documentation efficient.

Utilizing pain patterns, the high signal in the annulus, high signal outside the annulus, Modic changes, disc height, vacuum disc, sclerosis, Phirrman rating, facet edema, and previous MRIs to determine the chronicity of pathology., Master-Class in ligaments; anatomy, physiology, vascularization, neurological innervation, tissue repair, and how they all relate to clinical practice. Ligament pathology correlating to the mechanisms of patho-neuro-biomechanical lesions (vertebral subluxation complex). Also, how ligaments play a critical role in the chiropractic spinal adjustment and in defining the chiropractic spinal adjustment mechanisms

Case reviews concluding and accurate diagnosis, prognosis, and treatment plan utilizing evidence-based instrumentation and algorithms. Using demonstrative reporting of case findings to collaborate with co-treating physicians

A documentation discussion on meeting the requirements of the courts, carriers, and licensure boards in complete and accurate reporting. Ensuring the diagnosis, prognosis, and treatment plan are demonstratively documented

Documentation, and coding for x-ray and MRI reports, and patient education. Connective tissue pathology as sequella to trauma and diagnosing of ligament laxity and strain-sprain in conjunction with biomechanical lesions of the human spine. The demonstrative reporting of spinal biomechanical lesions and the subsequent creation of treatment plans

detailed review of anatomical structures on the axial slices of cervical spine MRI were presented. Musculature presented included sternocleidomastoid, splenius cervicis, splenius capitus, logus capitus, longus colli and semispinalis capitis in both the T1 and T2 axial sequences. Traversing vs exiting spinal nerves were contrasted and compared to cervical spine. Neurological structures such as the spinal cord, ventral and dorsal nerve roots were identified. Visualization and discussion of benefit of T2 axial sequences in the identification of facet joint pathology was presented. Emphasis was placed on the structure and morphology of the intervertebral disc and spinal ligaments including anterior longitudinal ligament, posterior longitudinal ligament, facet capsule, interspinous, supraspinous, intertransverse and alar ligaments were detailed.

The long-term clinical outcomes of chronic hypermobility due to ligament laxity was reviewed. Potential interventions and their expected outcomes were presented

Chiropractic diagnosis of acute disc and ligament injury and the tools necessary for accurate diagnosis, prognosis, and treatment planning. Ethical and accurate medical legal reporting was also reviewed

Interprofessional collaboration including co-management, triage, and referral to medical specialists along with record keeping and documentation sharing with pain management and surgical specialties was reviewed. Clinical indications for surgical consultations were presented

Utilizing radiographic and advanced imaging inclusive of MRI and CAT scan findings to verify tissue pathology suspected by orthopedic testing conclusions and developing a treatment plan as sequelae.

Utilizing radiographic and advanced imaging inclusive of MRI and CAT scan findings to verify tissue pathology suspected by orthopedic testing conclusions and developing a treatment plan as sequelae.

updated review and demonstration of intervertebral disc nomenclature related to intervertebral disc degeneration, trauma and other pathology. Specific attention paid to the agreed upon nomenclature between the Combined Task Forces of the North American Spine Society, American Spine Society, American Society of Spine Radiology and American Society of Neuroradiology. Details were provided in comparison to intervertebral disc herniation and intervertebral disc degeneration. Radial fissures were reviewed and outlined including circumferential, transverse and radial pathology and its anatomical relation to the intervertebral disc.

detailed review of MRI documented lumbar disc extrusion measuring 12mm including STIR, T1 and T2 sagittal and axial images. Presentation of radiographic biomechanical analysis outlining sagittal alignment and vertebral body rotations. Discussion of co-management of spinal pathology while considering both the biomechanical and anatomical components of spine pain. Radiographic review included lateral neutral, lateral flexion, lateral extension and AP views. Clinical correlation and discussion of pre and post-surgical care was outlined.

outline of spondylolisthesis clinical work up in the presence of spine pain including plain film dynamic radiographs, regional MRI study and assessment of alteration of motion segment integrity of specific spinal segments. Review of the correlation of present segmental degenerative changes such as loss of disc height, osteophyte formation, ligament ossification and facet joint hypertrophy and its association to pre-existing spondylosis was presented. Detailed discussion of past and present medical history including past traumatic events was emphasized.

review of a radiographic rating system for objective assessment of intervertebral disc degeneration in the cervical spine. The degree of degeneration was organized based on loss of disc height, formation of osteophytes and the presence of diffuse sclerosis of adjacent vertebral bodies. Specific details of assessment were outlined and presented. Comparison of plain film radiographs to cadaver specimens was demonstrated and discussed. Review of interobserver validity of the grading system between observers was presented.

discussion of the predominant mode of joint loading of the cervical facet joints during whiplash injury related to retraction tension on the facet joint capsule. Review of shear forces, translation of the inferior and superior facet joint as well as injury risk due to excessive stretching of spinal ligaments was presented. Overview and discussion of mechanical trauma to ligament tissue and subsequent microstructural damage not visibly detected was outlined. Threshold for microstructural changes during retraction, reduced ligament stiffness and unrecovered strain was discussed in detail. Individual response to facet joint capsule response supported in the medical literature was presented.

Discussion and review of ligament injury in the upper cervical spine. Focus was on missed diagnosis due to a lack of imaging and interprofessional communication. Discussion of upper cervical anatomy including occipital condyles, C1/C2 articulation in both MRI, plain film and CT scanning was presented using imaging slides. Clinical documentation was reviewed with particular attention paid to clinical documentation errors form other providers. Discussion on case management and interprofessional communication to correct documentation errors was emphasized.

Detailed review of the difference between biomechanical and biomedical analysis of injuries was presented. Outline of necessity of the use of properly credentialed biomechanical and crash investigation professionals in the diagnosis, management and reporting of crash injuries. Review of specific research related to forces during Activities of Daily Living and those sustained in a crash were presented. Details of a proper biomechanical analysis were discussed and specific review of a biomedical report omitting the mathematical calculations needed to determine force and injury potential was presented. Additional review of methods needed to determine expertise of the biomechanist or accident investigation was discussed.

Discussion of thirty years of jury verdict data was reviewed and presented. Focus was on the rationale for claims against Doctor of Chiropractic and overall decisions rendered by jury pools. Outlining the risk factors associated with overly aggressive treatment, failure to diagnose and lack of interprofessional referral when medical necessary was presented with statistics. Comparison between chiropractic management and surgical management were outlined and detailed. Detailed analysis of causality versus correlation was presented and discussed.

Analyzing spinal healthcare trends in both utilization and necessity and understanding the marketplace and how a clinical excellence level is reflected in a doctors' documentation and credentials. Treatment pathways in triaging spinal pathobiomechanics.

An evidence-based understanding of time-related etiology of disc pathology considering the American Society of Neuroradiology's designation of protrusion, extrusion, and sequestration of spinal discs, T1, T2, STIR and Proton-Density weighted evaluation to diagnose spine form MRI accurately.

Utilizing spinal mensurating algorithms to conclude a pathobiomechanical vs. normal spine in the absence of anatomical pathology. Clinically correlating a history and physical examination findings to x-ray biomechanical results in creating an accurate diagnosis, prognosis, and treatment plan.

Utilizing both MRI and x-ray to diagnose 1) Arthritis - Inflammatory and Degenerative, 2) Advanced cartilage assessment, 3) Rotator Cuff Tears, 4) Labral tears (shoulder and hip), 5) Tendon injuries and degeneration, 6) Meniscal tears, 7) Ligamentous injuries, 8) Common fractures, 9) Sports-related injury patterns, 10) Plantar fasciitis.

The narrative report. How to effectively create medical-legal documentation and what the courts look for. Making your "4-Corner" (narrative) report demonstrable and build a reputation as an evidence-based provider. The step-by-step minutiae of building a report.

Treatment modalities centered upon "best-outcomes" in an evidence-based model considering chiropractic vs. physical therapy and chiropractic vs. medicine. Considerations of disability, pain reduction, functional improvement, drugs utilized, and side-effects are all considered.

review of the outlined of the initial and re-evaluation E/M reporting in an injured patient. Discussion targeted compliant reporting and interprofessional communication with the attorney. Specific methods of ensuring compliant reporting were discussed and outlined. Statutory language, permanency determination and impairment were presented and reviewed in contact of the final narrative report. Emphasis was placed on the objectification of persistent functional loss and causal relationship in the personal injury patient. Supporting medical evidence of intervertebral disc pathology including disc herniation, disc bulge and annular tear was provided.

discussion of the clinical occurrence of spinal degenerative conditions such as Diffuse Skeletal Hyperostosis (DISH), central stenosis, foraminal stenosis, degenerative disc disease and osteoporosis was presented. Advanced imaging and plain film radiological utilization in the diagnosis of spinal degermation was outlined and reviewed. Acute versus degenerative conditions in the spine were reviewed and detailed in relation to traumatic and non-traumatic events. Consensus driven parameters in the identification and rating of degenerative change severity was discussed.

overview of the most common pain syndrome in the lumbar spine including societal burdens was presented. Discussion of facet joint arthrosis being the most frequent facet joint pathology in the human spine. Outline of level of correlation between clinical symptoms, physical examination findings and degenerative spinal conditions was discussed. Presentation of diagnostic facet block and the medical necessity of such a referral when indicated was outlined.

testing and physical examination workflows – evidence-based evaluation of the spine pain patient was outlined and presented. Thorough review of criteria for ordering plain film and advanced imaging was discussed and demonstrated. Clinical rationale for ordering electrodiagnostic testing and patient referral criteria overview was demonstrated. EMR and documentation workflows were discussed, and efficiency protocols were outlined and applied to evidence based physical examination procedures with and without a medical scribe. Details of reevaluations and clinical outcomes were reviewed and discussed.

detailed review of the structure and function of the human intervertebral disc was presented including annulus fibrosis, nucleus pulposus, cartilaginous endplate and sharpey’s fibers. Diagrams as well as MRI images were outlined and reviewed in both the cervical and the lumbar spines with particular focus on the difference between degenerative and traumatically induced changes. High intensity zone (HIZ) as a characteristic of injury to the posterior aspect of the annulus fibrosis best visualized on T1 sagittal MRI images. Detailed comparison of axial and sagittal T1, T2 and STIR images was outlined, discussed, and reviewed.

detailed analysis of the historical publication of Pelvic Incidence as a integral part of sagittal spinal balance. Inter-professional communication with the surgeon using peer reviewed medically indexed biomechanical parameters was outlined and presented. Functional interaction between the spine and pelvis was demonstrated and discussed. Components of Pelvic Incidence, sacral slope, pelvic tilt and femoral heads were reviewed and demonstrated on plain film radiographs. Specific updated research regarding spinal pelvic balance and pelvic incidence measurements was provided.

discussion of the Spine Management Physician concept utilizing supportive evidence was presented. Outline of trends in spinal pain management versus a curative model was discussed. Credentials, training, and triage methods were demonstrated for the Doctor of Chiropractic to increase proficiency in spine management. Scientific evidence supporting the need for a portal of entry physician dedicated to spine management oversight was outlined. Key differences between Spine Management Physician and Primary Spine Care were discussed.

Chiropractic Evidence – Pain Management Care – outline of neurological mechanisms of central nervous system modulation of pain in the human body was demonstrated. Specific peer-reviewed, medically indexed evidence was presented starting with 2012 Systematic Review outlining spinal manipulation’s effectiveness in pain management. Current evidence as well as future trends were discussed and presented. Neurological downregulation was discussed including afferent and efferent neurological pathways regulated by the dorsal horn of the spinal cord. Interprofessional communication and compliant documentation of the pain management phase of care was emphasized.

Chiropractic Evidence – Corrective Care – specific trends in the biomechanical assessment of the human spine were provided and discussed. Emphasis was placed on the transfer of laboratory based biomechanical science and clinical utilization of biomechanical parameters in the diagnosis and correction of spinal biomechanical pathology. Peer reviewed medically indexed publications defining symptomatic vs asymptomatic were presented and discussed. Sagittal alignment and its relation to pelvic incidence was reviewed in relation to asymptomatic parameters. Interprofessional communication relating to biomechanical stabilization and spinal rehabilitation was outlined and reviewed. Review of a regional versus whole spine model of spine management was presented emphasizing the needs of the patient, primary care physician, pain management physician and spine surgeon.

Cervical Spine – detailed review of cervical spinal physical examination with emphasis on clinical triage between anatomical and biomechanical sources of spine pain. Neurological evaluation of the neck and surrounding structures was reviewed including pathological reflexes, assessment of vascular compromise and myelopathic findings. Detailed patient screening was stressed and its correlation to physical examination, red flags and relative vs absolute contraindications to chiropractic care was presented. Patient positioning and efficient processes were reviewed and demonstrated. Details relating to cervical spine and orthopedic testing was discussed.

Thoracic and Lumbar Spine and Pelvis – outlines of thoracic, lumbar and pelvis physical examination were presented. Neurological evaluation of the lumbar spine and surrounding structures was reviewed including pathological reflexes, assessment of cauda equina syndrome and triage processes for neurologically compromised patients. Detailed screening was stressed and its correlation to physical examination, red flags and relative vs absolute contraindications to chiropractic care was reviewed. Patient positioning and efficient processes was reviewed and demonstrated. Details relating to lumbar spine and pelvic orthopedic testing was discussed.

review of electronic health record workflows were presented and discussed with emphasis on CPT compliant and efficient reporting. The importance of communication with the patient’s other healthcare providers was outlined and discussed. Specific needs of the primary care physician, pain management physician and spine surgeon were outlined and reviewed. Details of simplified vocabulary and necessity of thoroughness were emphasized. Administrative workflows ensuring regular and continued communication of clinical documentation was provided.

– communication techniques were discussed with emphasis on patient comprehension to increase compliance and reduce patient anxiety. Details were presented on simplification of complex medical terminology to ensure understanding at the initial visitation as well as throughout the patient’s care plan. Conversational interaction and dissemination of health information at the appropriate comprehension level was provided. Proper reporting and interprofessional communication were emphasized in a wholistic approach to supporting the patient’s needs

detailed discussion of the morphological descriptions of intervertebral disc pathology in the cervical, thoracic, and lumbar spine was presented. Differential diagnosis of disc bulge, herniation, protrusion, extrusion, and sequestration were presented. Attention was given to the five grades of annular fissure associating circumferential, radial, and transverse morphology. High intensity zone (HIZ) was discussed in detail as well as its correlation to acute inflammatory fluid. Specific MRI images were presented and correlated to consensus driven definitions of intervertebral disc pathology. Pre-existing degenerative changes in the human spine such as disc osteophyte complex, spondylosis, increased innervation of the intervertebral disc and endplate changes were discussed and correlated to acute findings on MRI. In depth discussion of the difference between morphology and etiology of intervertebral disc pathology was outlined.

anatomical review of spinal ligaments including nerve supply and formation of scar tissue post injury was presented. Function and histological composition were detailed and clinically correlated to physiological thresholds. Injury thresholds were also outlined and compared to the AMA Guides to the Evaluation of Permanent Impairment 5th and 6th edition. Detailed review of radiographic findings in the cervical and lumbar spine in the presence of ligamentous injury was reviewed and presented. Clinical criteria supporting the diagnosis of ligament injury and ligament laxity including patient history, physical examination, radiographic findings, and advanced imaging was presented.

detailed outline of acute versus chronic spine injury findings were presented. Reliable grading systems for phases of spinal degeneration was reviewed and discussed. Scientifically validated measuring process for intervertebral disc height and the 5 Grades of spinal degeneration proposed by Kettler were outlined. Specific discussion was presented in the differential diagnosis of ligament laxity due to degenerative process and acute ligamentous injury in the functional spinal unit with specific examples of radiographic and advanced imaging findings. Clinical correlation with Modic I, Modic II and Modic III endplate changes including cadaver specimens was presented.

review of spinal tissue types and their response to physical stress and injury was presented. Prognostic factors in patient management were presented in relation to injury to spinal musculature, nerve tissue, ligamentous tissue, intervertebral disc, and bone. Tissue based triage, patient and interprofessional communication was emphasized and stressed. N

specific reviewed of the anatomical innervation of pain generating structures in the human spine was presented. Scientific chronology of nerve supply discovery was presented and discussed. Increased innervation of the degenerating interverbal disc was presented and supported with contemporary scientific evidence. Spinal ligamentous structures as pain generating entities were also reviewed including anterior longitudinal ligament, posterior longitudinal ligament, supraspinous ligament, interspinous ligament and facet capsule. Clinical correlation to patient history, physical examination and imaging findings was emphasized with specific discussion on interprofessional triage and patient management.

Discussion of chronic spine pain as a Public Health issue and Chiropractic’s role in its diagnosis and management. Epidemiological statistics of chronic pain sufferers consulting Doctors of Chiropractic in the United States was presented. Outline of a spinal function and preventative model as opposed to a curative process was presented and reviewed.

– discussion of the different types of Ossification of Anterior Longitudinal Ligament (OALL) including Segmental, Continuous and Mixed in the sagittal plane. Review of axial classification including Flat, Nodular and Globular was presented. Anatomy of spinal ligaments including the anterior and posterior longitudinal ligament and their attachments was outlined. Context of dysphagia, its progression, symptoms and need for referral was reviewed and outlined.

– research analysis of mechanic factors as etiology of intervertebral disc degeneration. Review of spinal tissue mechanics and their relation to mechanical stress was discussed and corelated to abnormal changes in the structure and composition of the intervertebral disc. Detailed discussion of ingrowth of pain transmitting nerve fibers into degenerative intervertebral discs and their relationship to acute and chronic pain was presented. Clinical correlation between congenital malformations of the spine, including scoliosis, kyphosis, spina bifida, spondylolysis and Klippel Feil syndrome), accidental back injury or ligament injury, occupational exposure and causing aberrant mechanical loading of lumbar spine, and intervertebral disc degeneration visible on T1, T2 and STIR MRI, sagittal and axial sequences was presented

Review of the most common cervical spinal sagittal alignment parameters and their relationship to interprofessional communication was presented. Discussion of rationale for knee replacement revision surgery including aseptic loosening, fracture and prosthetic joint infection was reviewed. Specific statistical review on revision surgery and effective treatment of endstage knee osteoarthritis was presented. Details of evidence-based research outlining patients with cervical degenerative disorders having a higher rate of total knee replacement revisions than those without degenerative changes. Analysis of the benefit of radiographic studies looking at the mechanical relationship between the cervical spine and knee composition was outlined and reviewed

– clinical differences between etiology and morphology were reviewed and presented. Outline of patient history, physical examination including neurological and orthopedic evaluation as well as criteria for ordering and reading advanced imaging such as MRI and CT were presented. Plain film static and dynamic radiographic studies were reviewed. Patient centered; consensus driven clinical diagnosis including interprofessional communication was presented. Specific anatomical location of cervical intervertebral disc herniation was presented and correlated to neurological findings on physical examination.

CPT Coding Guidelines for Initial and Established Patients with particular attention paid to Patient History, Review of Systems, Social and Family History, Physical Examination, and Medical Decision making. Specific differences in coding levels and required elements for a 99202-99203-99204-99205, and a 99212-99213-99214-99215.

Pathways to improve coordination of care, and interprofessional communication with collaborating physicians. Maintaining ethical relationships in the medical-legal community through documentation and communication of demonstrable diagnosis, prognosis, and treatment plans.

Clinical case review of MRI’s including sagittal, axial, T1, T2, STIR, and proton density sequences. Identified will be the vertebrate, spinal cord, discs, nerve roots, thecal sac, posterior longitudinal ligament, epidural veins, and fat saturation pulses. Pathology will include bulges, herniations, protrusions, extrusions, myelomalacia, cord edema, and schmorl’s nodes.

Case reviews utilizing E/M, MRI, and x-ray mensuration report to conclude an accurate diagnosis, prognosis, and treatment plan. Common diagnosis requiring interprofessional collaboration with a discussion of diagnostic dilemmas and proper communication methods.

review of the pathogenesis and morphological presentation of lumbar intervertebral disc herniation. Outline of patient history, physical examination including neurological and orthopedic evaluation as well as criteria for ordering and reading advanced imaging such as MRI and CT were presented. Plain film static and dynamic radiographic studies were reviewed. Patient centered; consensus driven clinical diagnosis including interprofessional communication was presented.

review of the pathogenesis and morphological presentation of cervical facet syndrome. Outline of patient history, physical examination including neurological and orthopedic evaluation as well as criteria for ordering and reading advanced imaging such as MRI and CT were presented. Discussion involving ligamentous structures such as interspinous ligament, supraspinous ligament and facet capsules was presented. Plain film static and dynamic radiographic studies were reviewed as well as specific sclerotogenous referrals patterns of facet mediated pain. Patient centered; consensus driven clinical diagnosis including interprofessional communication was presented, specific presentation relating to diagnostic medial branch blocks and pain management referral was emphasized.

characterization of cervical radiculopathy in terms of neurological dysfunction including compression and inflammation of the spinal nerves was reviewed. Cervical spondylosis and intervertebral disc herniation as causative factors were presented and discussed. Conservative care as well as surgical intervention were presented and correlated to response to care and clinical findings. Outline of patient history, physical examination including neurological and orthopedic evaluation as well as criteria for ordering and reading advanced imaging such as MRI and CT were presented. Plain film static and dynamic radiographic studies were reviewed. Patient centered; consensus driven clinical diagnosis including interprofessional communication was presented.

discussion of the clinical presentation of lumbar facet syndrome with specific attention paid to the pathogenesis and differential diagnosis of lumbar disc herniation, disc bulge and radiculopathy. Review of patient history, mechanism of injury, physical examination including neurological and orthopedic evaluation as well as criteria for ordering and reading advanced imaging such as MRI and CT were presented. Discussion involving ligamentous structures such as interspinous ligament, supraspinous ligament and facet capsules was presented. Plain film static and dynamic radiographic studies were reviewed as well as specific sclerotogenous referrals patterns of facet mediated pain. Patient centered; consensus driven clinical diagnosis including interprofessional communication was presented, specific presentation relating to diagnostic medial branch blocks and pain management referral was emphasized.

review of all relevant spinal anatomy in the cervical and lumbar spine including vertebral bodies, central canal, neuroforamen, ligamentum flavum, anterior and posterior longitudinal ligaments, facet capsule, interspinous ligament, supraspinous ligament and spinal cord anatomy. Review of spinal cord anatomy included white and gray matter, ventral and dorsal nerve roots, spinal nerve including the dura mater, arachnoid mater and pia mater. Specific review of patient history, mechanism of injury, physical examination including neurological and orthopedic evaluation as well as criteria for ordering and reading advanced imaging such as MRI and CT were presented in relation to cervical myelopathy, spinal cord compression and myelomalacia. Patient centered; consensus driven clinical diagnosis including interprofessional communication was presented, specific presentation relating to diagnostic outcomes and management. Attention was given to MRI and CT myelogram in both the uncomplicated and complicated patient

detailed outline of injury thresholds of the anterior longitudinal, posterior longitudinal and ligamentum flavum was presented. Review of structural and physiological properties relating to stress/strain curve of the above ligaments. Outline of the toe region, linear region and failure region was demonstrated. Transversely isotropic material properties of spinal ligaments was included and correlated to chiropractic care and impairment rating using the AMA Guides to the Evaluation and Management 5th and 6th editions

– a case of persistent and worsening neck and left shoulder pain post-surgical fusion was presented. Pre and post plain film and advanced imaging slides were reviewed and correlated clinically to left sided mid-scapular pain. Physical examination including orthopedic and neurological testing was discussed in correlation to presenting symptoms. Differential diagnosis of radiculopathy, radiculitis, discogenic pain, scapular myofascial syndrome and thoracic intersegmental dysfunction was presented. Cervical facet joint referral patterns were reviewed and outline of referral for diagnostic facet joint block was discussed.

outline and discussion of the mechanical origins of spine pain emphasizing common biomechanical parameters was presented. Review of chiropractic-based maintenance care in the management of patient centered spine pain was introduced. Introduction of a Spine Management Physician was presented outlining the natural history of spine pain in the human population. Interprofessional communication and case management was emphasized with focus on societal burden of mismanagement was presented

– outline and discussion of Whiplash as a mechanism of injury with particular focus on damage to underlying tissue structures. Review of anatomy, with specific focus on surrounding muscular, supraspinous ligament, interspinous ligament, spinal nerve, spinal cord, facet capsule and dorsal/ventral nerve roots was presented. Clinical correlation to imaging studies and its influence on management of the Whiplash patient was reviewed. Focused attention was paid to Whiplash as a mechanism of injury and not a complete diagnosis.

- outline and analysis of spinal biomechanical parameters in a whole spine model of care in the post-surgical analysis of the spine pain patient. Review of the details of measuring Pelvic Incidence and discussion of history of its analysis in relation to sagittal balance and vertebral body rotation was discussed. Outline of movement from a regional model of spine care to a full spine model was presented particularly in the context of pain management strategies post-surgery. Analysis of the components of the post-surgical patient including muscle movement patterns, segmental mobility, spinal curvature and rotation in the coronal, sagittal and axial planes was presented. Interprofessional communication and co-management was emphasized.

outline and analysis of spinal biomechanical parameters in a whole spine model of care. Review of the details of measuring Pelvic Incidence and discussion of history of its analysis. Outline of movement from a regional model of spine care to a full spine model was presented. Analysis of the components of the pre-surgical patient including muscle movement patterns, segmental mobility, spinal curvature and rotation in the coronal, sagittal and axial planes was presented.

detailed outline of injury thresholds of the anterior longitudinal, posterior longitudinal and ligamentum flavum was presented in the lumbar spine. Review of structural and physiological properties relating to stress/strain curve of the above ligaments. Outline of the toe region, linear region and failure region was demonstrated. Transversely isotropic material properties of spinal ligaments was included and correlated to chiropractic care and impairment rating using the AMA Guides to the Evaluation and Management 5th and 6th editions.

Utilizing radiographic and advanced imaging inclusive of MRI and CAT scan findings to verify tissue pathology suspected by orthopedic testing conclusions and developing a treatment plan as sequelae

Utilizing radiographic and advanced imaging inclusive of MRI and CAT scan findings to verify tissue pathology suspected by orthopedic testing conclusions and developing a treatment plan as sequelae

It includes potential stroke, or vertebrobasilar insufficient patients and understanding the nuances in a clinical evaluation with orthopedic testing as a critical part of the evaluation and screening process. How to integrate orthopedic testing in the clinical setting utilizing both simple and complex patient scenarios. It includes potential stroke, or vertebrobasilar insufficient patients and understanding the nuances in a clinical evaluation with orthopedic testing as a critical part of the evaluation and screening process

This section continues with multiple case studies of gross traumatic brain injuries from trauma requiring neurosurgical intervention and also discusses recovery sequela based upon the significance of brain trauma. This module also concludes with concussion protocols in traumatic brain injury short of demonstrable bleeding on advanced imaging.

This this section covers concussion etiology and cognitive sequela where gross bleeding has not been identified on advanced imaging. It discusses the significance of electroencephalogram testing in determining brain function and pathology (if present). This module also covers the understanding of waveforms in electroencephalogram testing in both normal and abnormal scenarios.

This module covers amplitude, conduction and conduction delays as sequela to traumatic brain injury to diagnose concussion and traumatic brain injury in the absence of gross bleeding and advanced imaging. This section covers electroencephalograms and event-related potentials which measures the brain response that is a direct result of specific sensory or motor events. It is a stereotype electrophysiological response to a stimulus and provides a noninvasive means of evaluating brain function. In this module multiple case studies are discussed with ensuing triage protocols pending the results.

Connective tissue morphology, embryology and wound repair as sequalae to trauma. Full components of strain-sprain models and permanency implications with wound repair and osseous aberration with aberrant structural integrity.

Spinal Biomechanics and Disc Pathology, Disc pathology as sequella to trauma; herniation, extrusion, protrusion, sequestration and how the spinal unit as one system creates homeostasis to balance the pathology.

The peripheral and central innervation of the disc and spinal ligaments of the dorsal root ganglion, spinal thalamic tracts, periaqueductal gray areas innervating the Thalamus and multiple regions of the brain. The efferent neurological distribution to disparate areas of the spine to create homeostatis until tetanus ensues creating osseous changes under the effect of Wolff's Law.

The anatomy and physiology of the brain and how blood perfusion effects brain function. A detailed analysis of the blood supply to the brain and the physiology of ischemia.

Various types of stroke identifying ischemia, hypoperfusion, infarct and penumbra zones and emboli. Cardiac etiologies and clinical features as precursor to stroke with associated paradoxical emboli and thrombotic etiologies. Historical and co-morbidities that have etiology instroke inclusive of diabetes, coagulopathy, acquired and hereditary deficiencies.

Stroke type and treatments performed by vascular specialists. The goals of treatment with the physiology of the infarct and penumbra zones and the role of immediate triage in the primary care setting. Detailing the complications of stroke and future care in the chiropractic, primary care or manual medicine clinical setting.

The neurological history and examination for identifying stroke risks with a focus on supra and infratentorial regions, upper and lower motor lesions, cranial nerve signs, spinal cord pathology, motor and sensory pathology and gait abnormalities. Examining genetic and family histories along with dissection risk factors. Stroke orthopedic testing and clinical guidelines pertaining to triage for the primary care provider.

Trends in Spinal Healthcare, Analyzing spinal healthcare trends in both utilization and necessity and understanding the marketplace and how a level of clinical excellence is reflected in a doctors' documentation and credentials. Treatment pathways in triaging spinal pathobiomechanics.

MRI Spine Interpretation, An evidence-based understanding of time-related etiology of disc pathology considering the American Society of Neuroradiology's designation of protrusion, extrusion, and sequestration of spinal discs, Considering the signal intensity of discs in age-dating pathology and acquisition protocols for advanced spinal imaging.

Spinal Biomechanics; A Literature Perspective, An evidenced-based model for spinal biomechanical engineering and pathobiomechanics considering the pathophysiological limits in translations, angular deviation, and rotational planes. Utilizing the Cartesian system in plotting vertebral points to demonstratively conclude an accurate diagnosis, prognosis and biomechanical treatment plan with the consideration of long-term care in the non-specific mechanical spine pain patient when necessary.

Case Management of Mechanical Spine Pathology, Clinical Grand Rounds of herniated, protruded, extruded, sequestered, and bulging discs. Differentially diagnosing vascular vs. mechanical spinal lesions and the necessity for urgent vascular, neurological intervention, Collaborating in a team environment utilizing a neuroradiologist, electrophysiologist, and neurosurgeon with the chiropractor as the primary spine care provider.

CPT Coding Guidelines for Initial and Established Patients with particular attention paid to Patient History, Review of Systems, Social and Family History, Physical Examination, and Medical Decision making. Specific differences in coding levels and required elements for a 99202-99203-99204-99205.

Pathways to improve coordination of care, and interprofessional communication with collaborating physicians. Maintaining ethical relationships in the medical-legal community through documentation and communication of demonstrable diagnosis, prognosis and treatment plans.

History of clinical biomechanics with an emphasis on the diagnosis and management of spine pain of mechanical/functional origin. Evidence-based symptomatic vs. asymptomatic parameters using peer-reviewed medical index literature. Computerized mensuration analysis of spinal biomechanical pathology. Comparison of demonstrable spinal biomechanical failure on imaging to clinical evaluation and physical examination.

Case reviews utilizing E/M, MRI, and x-ray mensuration report to conclude an accurate diagnosis, prognosis, and treatment plan. Common diagnosis requiring interprofessional collaboration with a discussion of diagnostic dilemmas and proper communication methods.

Differentially diagnosing mild traumatic brain injury vs. traumatic brain injury and the clinical and imaging protocols required to conclude an accurate diagnosis for head trauma.

The forces in physics that prevail in accidents to cause bodily injury. Quantifying the force coefficients of vehicle mass and force vectors that can be translated to the occupant and subsequently cause serious injury.

Magnetic fields, T1 and T2 relaxations, nuclear spins, phase encoding, spin echo, T1 and T2 contrast, magnetic properties of metals and the historical perspective of the creation of NMR and MRI.

Normal anatomy of axial and sagittal views utilizing T1, T2, 3D gradient and STIR sequences of imaging. Standardized and desired protocols in views and sequencing of MRI examination to create an accurate diagnosis in MRI.

MRI Disc Pathology and Spinal Stenosis, MRI interpretation of bulged, herniated, protruded, extruded, sequestered and fragmented disc pathologies in etiology and neurological sequelae in relationship to the spinal cord and spinal nerve roots.

MRI interpretation of bone, intradural, extradural, cord and neural sleeve lesions. Tuberculosis, drop lesions, metastasis, ependymoma, schwanoma and numerous other spinal related tumors and lesions

MRI interpretation sequencing of the cervical, thoracic and lumbar spine inclusive of T1, T2, STIR and 3D gradient studies to ensure the accurate diagnosis of the region visualized

The clinical application of the results of space occupying lesions. Disc and tumor pathologies and the clinical indications of manual and adjustive therapies in the patient with spinal nerve root and spinal cord insult as sequellae

MRI slices, views, T1, T2, STIR axial, stacking, FFE, FSE and sagittal images. Clinical indication for the utilization of MRI and pathologies of disc in both trauma and non-trauma sequellae, including bulge, herniation, protrusion, extrusion and sequestration

MRI slices, views, T1, T2, STIR Axial, FFE, FSE and sagittal images in the interpretation of lumbar herniations. With the co-morbidities and complications of stenosis, pseudo-protrusions, cantilevered vertebrate, Schmorl's nodes and herniations. morphology of lumbar disc pathologies of central and lateral herniations, protrusions, extrusions, sequestration, focal and broad based herniations are defined and illustrated. Spinal cord and canal compromise interpretation with management

MRI Interpretation of Lumbar Degeneration/Bulges, MRI slices, views, T1, T2, STIR axial, stacking, FFE, FSE and sagittal images in the interpretation of lumbar degeneration. With the co-morbidities and complications of stenosis, pseudo-protrusions, cantilevered vertebrate, Schmorl/'s nodes and herniations. Central canal and cauda equina compromise interpretation with management.

MRI Interpretation of Lumbar Herniations, MRI slices, views, T1, T2, STIR axial, stacking, FFE, FSE and sagittal images in the interpretation of lumbar herniations. With the co-morbities and complications of stenosis, pseudo-protrusions, cantilevered vertebrate, Schmorl/'s nodes and herniations. Morphology of lumbar disc pathologies of central and lateral herniations, protrusions, extrusions, sequestration, focal and broad based herniations are defined and illustrated. Central canal and cauda equina compromise interpretation with management. .

Documentation, MRI Necessity and Trends in Spinal Treatment Protocols, Correlating history and a thorough clinical evaluation in determining the necessity for x-ray and MRI evaluations in the trauma and non-trauma patient. Considering whole spine patho-biomechanics in formulating treatment plans and long-term supportive care. Documentation requirements in transitioning from telemedicine to in-office care.

MRI Protocols Clinical Necessity, MRI slices, views, T1, T2, STIR axial, stacking, FFE, FSE and sagittal images. Clinical indication for the utilization of MRI and pathologies of disc in both trauma and non-trauma sequellae, including bulge, herniation, protrusion, extrusion and sequestration.

MRI Interpretation of Cervical Degeneration/Bulges, MRI slices, views, T1, T2, STIR axial, stacking, FFE, FSE and sagittal images in the interpretation of cervical degeneration. With the co-morbidities and complications of stenosis, pseudo-protrusions, cantilevered vertebrate, Schmorl/'s nodes and herniations. Spinal cord and canal compromise interpretation with management.

MRI Interpretation of Cervical Degeneration/Bulges, MRI slices, views, T1, T2, STIR axial, stacking, FFE, FSE and sagittal images in the interpretation of cervical degeneration. With the co-morbidities and complications of stenosis, pseudo-protrusions, cantilevered vertebrate, Schmorl/'s nodes and herniations. Spinal cord and canal compromise interpretation with management.

MRI Interpretation of Cervical Herniations, MRI slices, views, T1, T2, STIR Axial, FFE, FSE and sagittal images in the interpretation of lumbar herniations. With the co-morbidities and complications of stenosis, pseudo-protrusions, cantilevered vertebrate, Schmorl/'s nodes and herniations. morphology of lumbar disc pathologies of central and lateral herniations, protrusions, extrusions, sequestration, focal and broad based herniations are defined and illustrated. Spinal cord and canal compromise interpretation with management.

MRI Interpretation of Degenerative Spine and Disc Disease with Overlapping Traumatic Insult to Both Spine and Disc, MRI slices, views, T1, T2, STIR Axial, FFE, FSE and sagittal images in the interpretation of degenerative spondylolesthesis, spinal canal stenosis, Modic type 3 changes, central herniations, extrusions, compressions, nerve root compressions, advanced spurring and thecal sac involvement from an orthopedic, emergency room, chiropractic, neurological, neurosurgical, physical medicine perspective.

Anatomy and Physiology of Electrodiagnostics: An in-depth review of basic neuro-anatomy and physiology dermatomes and myotomes to both the upper and lower extremities and the neurophysiology of axons and dendrites along with the myelin and function of saltatory for conduction. The sodium and potassium pump’s function in action potentials.

Nerve Conduction Velocity (NCV) Part 1: Nerve conduction velocity testing, the equipment required and the specifics of motor and sensory testing. This section covers the motor and sensory NCV procedures and interpretation including latency, amplitude (CMAP) physiology and interpretation including the understanding of the various nuances of the wave forms.

Nerve Conduction Velocity (NCV) Part 2: Compound motor action potentials (CMAP) and sensory nerve action potentials (SNAP) testing and interpretation including the analysis and diagnosis of the wave forms. It also covers compressive neuropathies of the median, ulnar and posterior tibial nerves; known as carpal tunnel, cubital tunnel and tarsal tunnel syndromes. This section offers interpretation algorithms to help understand the neurodiagnostic conclusions.

The EMG process, inclusive of how the test is performed and the steps required in planning and electromyographic study. This covers the spontaneous activity of a motor unit action potential, positive sharp waves and fibrillations. The insertional activity (both normal and abnormal), recruitment activity in a broad polyphasic presentation and satellite potentials. This covers the diagnosing of patterns of motor unit abnormalities including neuropathic demyelinated neuropathies along with acute myopathic neuropathies. This section also covers the ruling out of false positive and false negative results.

Overview of EMG and NCV Procedures, Results, Diagnoses and Documentation. The clinical incorporation of electrodiagnostic studies as part of a care plan where neuropathology is suspected. It also covers how to use electrodiagnostics in a collaborative environment between the chiropractor as the primary spine care provider and the surgeon, when clinically indicated. This section covers sample cases and health conclude and accurate treatment plans based upon electro-neurodiagnostic findings when clinically indicated.

The requirements for diagnosing based upon in an initial evaluation and management encounter ranging from a 99202 – 99205 that includes comorbidities, non-musculoskeletal, and sequellae to injury diagnosis.

The requirements for diagnosing imaging inclusive of static x-rays, biomechanical x-rays, and MRI. Documenting the clinical findings of disc bulge, herniation, protrusion, extrusion, and fragmentation. Coding, diagnosing, and documenting individual treatment encounters in the clinical setting.

The Cartesian Coordinate System from the history to the application in the human body. Explanation of the x, y and z axes in both translation and rotations (thetas) and how they are applicable to human biomechanics.

Spinal biomechanical engineering of the cervical and upper thoracic spine. This includes the normal and pathobiomechanical movement of both the anterior and posterior motor units and normal function and relationship of the intrinsic musculature to those motor units. Nomenclature in reporting normal and pathobiomechanical findings of the spine.

Spinal biomechanical engineering of the lumbar spine. This includes the normal and pathobiomechanical movement of both the anterior and posterior motor units and normal function and relationship of the intrinsic musculature to those motor units. Nomenclature in reporting normal and pathobiomechanical findings of the spine.

To utilize whiplash associated disorders in various vectors of impact and whiplash mechanisms in determining pathobiomechanics. To clinically correlate annular tears, disc herniations, fractures, ligament pathology and spinal segmental instability as sequellae to pathobiomechanics from trauma. The utilization of digital motion x-ray in diagnoising normal versus abnormal facet motion along with case studies to understand the clinical application.

Integrating spinal biomechanics and pathobiomechanics through digitized analysis.The comparison of organized versus disorganized compensation with regional and global compensation. Correlation of the vestibular, occular and proprioceptive neurological integration in the righting reflex as evidenced in imaging. Digital and numerical algorithm in analyzing a spine.

Digitizing and analyzing the cervical spine in neutral, flexion and extension views to diagnose pathobiomechanics. This includes alteration of motion segment integrity (AMOSI) in both angular and translational movement. Ligament instability/failure/pathology are identified all using numerical values and models. Review of case studies to analyze pathobiomechanics using a computerized/numerical algorithm.

Digitalizing and analyzing the lumbar spine images to diagnose pathobiomechanics. This includes anterior and posterior vertebral body elements in rotatioal analysis with neutral, left and right lateral bending in conjunction with gate analysis. Ligament instability/failure/pathology is identified all using numerical values and models. Review of case studies for analysis of pathobiomechanics using a computerized/numerical algorithm along with corrective guidelines.

Neurodiagnostics, Imaging Protocols and Pathology of the Trauma Patient, An in-depth understanding of the protocols in triaging and reporting the clinical findings of the trauma patient. Maintaining ethical relationships with the medical-legal community.

Diagnostics, Risk Factors, Clinical Presentation and Triaging the Trauma Patient, An extensive understanding of the injured with clinically coordinating the history, physical findings and when to integrate neurodiagnostics. An understanding on how to utilize emergency room records in creating an accurate diagnosis and the significance of "risk factors" in spinal injury.

Crash Dynamics and Its Relationship to Causality, An extensive understanding of the physics involved in the transference of energy from the bullet car to the target car. This includes G's of force, newtons, gravity, energy, skid marks, crumple zones, spring factors, event data recorder and the graphing of the movement of the vehicle before, during and after the crash. Determining the clinical correlation of forces and bodily injury.

MRI, Bone Scan and X-Ray Protocols, Physiology and Indications for the Trauma Patient, MRI interpretation, physiology, history and clinical indications, bone scan interpretation, physiology and clinical indications, x-ray clinical indications for the trauma patient.

Neurodiagnostic Testing Protocols, Physiology and Indications for the Trauma Patient, Electromyography (EMG), Nerve Conduction Velocity (NCV), Somato Sensory Evoked Potential (SSEP), Visual Evoked Potential (VEP), Brain Stem Auditory Evoked Potential (BAER) and Visual-Electronystagmosgraphy (V-ENG) interpretation, protocols and clinical indications for the trauma patient.

Documentation and Reporting for the Trauma Victim, Understanding the necessity for accurate documentation and diagnosis utilizing the ICD-9 and the CPT to accurately describe the injury through diagnosis. Understanding and utilizing state regulations on reimbursement issues pertaining to healthcare.

The understanding and utilization of the protocols and parameters of the AMA Guide to the Evaluation of Permanent Impairment 6th Edition. Spine, neurological sequelae, migraine, sexual dysfunction, sleep and arousal disorders, station and gait disorders and consciousness are detailed for impairment rating. Herniated discs, radiculopathy, fracture, dislocation and functional loss are also detailed in relation to impairment ratings.

Documenting Clinically Correlated Bodily Injury to Causality, Understanding the necessity for accurate documentation, diagnosis and clinical correlation to the injury when reporting injuries in the medical-legal community. Documenting the kinesiopathology, myopathology, neuropathology, and pathophysiology in both a functional and structural paradigm.

Triage and Connective Tissue Injuries and Wound Repair, Triaging the injured and differentially diagnosing both the primary and secondary complaints. Connective tissue injuries and wound repair morphology focusing on the aberrant tissue replacement and permanency prognosis potential.

Spinal ligamentous anatomy and research focusing on wound repair, future negative sequelae of abnormal tissue replacement and the resultant aberrant kinematics and spinal biomechanics of the spine.

The application of spinal biomechanical engineering models in trauma and the negative sequelae it has on the central nervous system inclusive of the lateral horn, periaqueductal grey matter, thalamus and cortices involvement.

The biomechanics of traumatic disc bulges as sequelae from trauma and the comorbidity of ligamentous pathology. Age-dating spinal disc pathology in accordance with Wolff’s Law.

The review of case histories of mechanical spine pathology and biomechanical failures inclusive of case histories, clinical findings and x-ray and advanced imaging studies. Assessing comorbidities in the triage and prognosis of the injured.

The review of current literature standards in spinal trauma pathology and documentation review of biomechanical failure, ligamentous failure and age-dating disc pathology.

Crumple Zones and Critical Documentation, Factors that cause negative acceleration to zero and the subsequent forces created for the vehicle that get translated to the occupant. Understanding critical documentation of hospitals, ambulance reports, doctors and the legal profession in reconstructing an accident.

Speed Formulas and Road Surfaces, The mathematical calculations necessary utilizing time, distance, speed, coefficients of friction and acceleration in reconstructing an accident. The application of the critical documentation acquired from an accident site.

This section is an in-depth overview of traumatic brain injury in concussion. It discusses that all brain injuries are traumatic and dispels the myth of a “mild traumatic brain injury.” Also, this covers triage protocols and the potential sequela of patients with traumatic brain injuries.

This section discusses gross traumatic brain injuries from trauma and significant bleeding with both epidural and subdural hematomas. There are numerous case studies reviewed inclusive of neurosurgical intervention and postsurgical outcomes.

consists of a series of mobilization, Chiropractic manipulation, stretching, and traction procedures performed while the patient receives anesthesia (usually general anesthesia or moderate sedation). Manipulation is intended to break up fibrous and scar tissue to relieve pain and improve range of motion.