J. Michael Bennett, DC , FSBT

A comprehensive 8-lecture clinical and medico-legal training program addressing the full continuum of personal injury case management from initial patient encounter through litigation and expert testimony. Instruction includes tissue-based injury identification, mechanism-of-injury correlation, reproducible examination procedures, imaging integration, structured documentation, impairment considerations, and courtroom communication strategy. Emphasis is placed on defensibility under cross-examination, documentation reviewed by non-clinicians, deposition preparation, and interdisciplinary coordination with attorneys, adjusters, and primary care physicians. Participants develop systematic case frameworks that integrate clinical precision with legal awareness while maintaining evidence-based spine management principles.National Spine Management Group, Federation of Chiropractic Licensing Boards, PACE Program

Advanced clinical instruction on the identification, differentiation, and documentation of ligamentous, discal, muscular, and osseous injuries in trauma-focused environments. Emphasizes injury pattern recognition, acceleration–deceleration biomechanics, rotational and shear stress mechanisms, compression versus distraction forces, and expected tissue-specific healing timelines. Covers acute versus delayed presentation patterns, instability indicators, fracture identification, annular disruption patterns, and structural compromise. Clinical reporting strategies are aligned with medico-legal scrutiny, focusing on causation analysis, objective reproducibility, and defensible narrative development consistent with high-liability case environments.National Spine Management Group, Federation of Chiropractic Licensing Boards, PACE Program

In-depth analysis of intervertebral disc morphology, displacement patterns, and degenerative grading systems with emphasis on differentiating traumatic herniation from degenerative bulge. Detailed instruction on Modic endplate changes (Types 0–III), Pfirrmann disc grading (I–V), disc desiccation, loss of disc height, vacuum phenomenon, intradiscal fluid, signal intensity interpretation, and migration patterns including protrusion, extrusion, and sequestration. Integrates sagittal and axial plane analysis, zone classification, annular fissure recognition, and correlation of imaging findings with symptom patterns and EMG data. Emphasis on timing of imaging relative to causative event and 2structured reporting language to support causation analysis in medico-legal review.National Spine Management Group, Federation of Chiropractic Licensing Boards, PACE Program

Comprehensive review of American College of Radiology (ACR) Practice Parameters and Technical Standards for cervical, thoracic, and lumbar MRI. Covers slice thickness requirements, interslice gap limitations, STIR sequence utilization, sagittal and axial planning through superior endplate, mid-disc, and inferior endplate levels, and sequence optimization for annular and endplate evaluation. Emphasis on reproducibility, artifact minimization, patient positioning standards, and imaging consistency necessary for medico-legal defensibility. Instruction highlights the role of proper technical acquisition in preventing misinterpretation, under-reporting, and credibility challenges in litigation environments.National Spine Management Group, Federation of Chiropractic Licensing Boards, PACE Program

Advanced instruction in the biomechanical and radiographic evaluation of motion segment instability in both the cervical and lumbar spine utilizing AMA Guides (5th and 6th Editions) criteria. Comprehensive coverage includes translational and angular measurement thresholds for the cervical spine (>3.5 mm anterior-posterior translation; >11° segmental angular differential compared to the adjacent inferior segment) and lumbar spine motion integrity assessment through flexion-extension radiography, segmental translation analysis, and angular displacement evaluation. Emphasis is placed on proper imaging acquisition protocols, neutral-flexion-extension positioning, full patient effort validation, elimination of motion artifact, magnification correction, and standardized measurement methodology to ensure reproducibility.Instruction correlates abnormal motion findings with ligamentous injury patterns involving the anterior longitudinal ligament (ALL), posterior longitudinal ligament (PLL), interspinous and supraspinous ligaments, facet capsule disruption, and posterior tension band compromise. Participants analyze instability patterns in acute trauma versus degenerative spondylotic motion changes, differentiating structural incompetence from adaptive hypermobility. Impairment rating implications are reviewed with structuredintegration into medico-legal reporting, including causation analysis, permanency considerations, and courtroom defensibility strategy.The program further incorporates advanced discussion of inter-rater reliability (IRR) and quantitative agreement standards in motion measurement systems. Detailed review of Cohen’s Kappa (κ) interpretation thresholds for categorical agreement and Intraclass Correlation Coefficient (ICC) benchmarks for continuous measurement reliability is applied directly to translational and angular motion analysis. The curriculum underscores structured, reproducible measurement systems, inter-reader comparison methodology, and objective documentation strategies that enhance defensibility under deposition and cross-examination while promoting interdisciplinary consistency in spine trauma evaluation.National Spine Management Group, Federation of Chiropractic Licensing Boards, PACE Program

Advanced discussion of inter-rater reliability metrics including Cohen’s Kappa (κ), Intraclass Correlation Coefficient (ICC), and percent agreement standards as applied to segmental motion analysis, disc grading systems, translational and angular measurements, and AOMSI evaluation. Interpretation scales and clinical benchmarks are reviewed with emphasis on thresholds appropriate for clinical use, research integrity, and high-stakes medico-legal environments. Instruction focuses on minimizing provider-dependent variability, enhancing interdisciplinary consistency, and strengthening objective defensibility under deposition and cross-examination.National Spine Management Group, Federation of Chiropractic Licensing Boards, PACE Program

Comprehensive review of FDA medical device regulatory pathways including 510(k) clearance and De Novo classification processes, predicate device requirements, risk classification levels, and submission timelines. Examines professional, civil, and criminal consequences of utilizing non-FDA-approved technologies, including malpractice exposure, insurance reimbursement denial, regulatory enforcement actions, and institutional disciplinary measures. Provides mitigation strategies including verification of clearance status, risk assessment protocols, IRB consultation when appropriate, and structured regulatory strategy planning for innovative or AI-based technologies within chiropractic and interdisciplinary spine practices.National Spine Management Group, Federation of Chiropractic Licensing Boards, PACE Program

– 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. National Spine Management Group, Expert Review Alliance,

– 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. National Spine Management Group, Expert Review Alliance,

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. National Spine Management Group, Expert Review Alliance

Review of diagnostic complexities in identifying non- 3 union and failed fusion. Covered micro-motion thresholds, structural bone-integrity assessment, hardware load signatures, functional variability vs true non-union, and implications for revision surgery. Integrated dynamic studies with CT and MRI analysis to improve diagnostic resolution and patient-specific treatment planning. National Spine Management Group, Medical Metrics Inc, Federation of Chiropractic Licensing Boards, PACE Program

Expanded lecture on ligament visualization advancements in MRI, CT osseous integrity assessment, dynamic imaging innovations, and computational interpretation tools. Reviewed multi-modality integration, pattern recognition, and challenges in characterizing ligament injury with conventional static imaging alone. National Spine Management Group, Medical Metrics Inc, Federation of Chiropractic Licensing Boards, PACE Program

Comprehensive scientific review of diffusion-based imaging, tract integrity quantification, microstructural signal deviations, and their relevance in traumatic, inflammatory, and metabolic brain injuries. Discussed scanner-variability constraints, white-matter susceptibility to shear injury, and correlations with cognitive and vestibular deficits. National Spine Management Group, Medical Metrics Inc, Federation of Chiropractic Licensing Boards, PACE Program

Expanded coverage of GFAP, UCH-L1, neurofilament light chain, tau isoforms, and S-100 proteins. Included diagnostic windows, decay kinetics, assay variability, pathophysiology of biomarker release, and combined multi-marker approaches that enhance differentiation of acute vs residual injury states. National Spine Management Group, Medical Metrics Inc, Federation of Chiropractic Licensing Boards, PACE Program

Detailed review of calibration science, geometric distortion modeling, magnification correction, parallax reduction, and calibration-marker methodology. Discussed measurement accuracy, reproducibility standards, cross-facility consistency, and calibration’s role in biomechanical interpretation and research validity. National Spine Management Group, Medical Metrics Inc, Federation of Chiropractic Licensing Boards, PACE Program

Multidisciplinary analysis of supervised/unsupervised learning models, predictive analytics, feature extraction, pattern recognition, dataset bias, and validation requirements. Reviewed clinical applications in triage, outcome prediction, and automated structural abnormality identification, along with regulatory and medico-legal considerations. National Spine Management Group, Medical Metrics Inc, Federation of Chiropractic Licensing Boards, PACE Program

eceivedadvanced 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.

- 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.

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. National Spine Management Group 2025, Federation of Chiropractic Licensing Boards, PACE Program

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. National Spine Management Group 2025, Federation of Chiropractic Licensing Boards, PACE Program

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. National Spine Management Group, Federation of Chiropractic Licensing Boards, PACE Program

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. National Spine Management Group, Federation of Chiropractic Licensing Boards, PACE Program,

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. National Spine Management Group, Federation of Chiropractic Licensing Boards, PACE Program

An expanded overview establishing the scientific direction and operational philosophy of the meeting, emphasizing the integration of advanced biomechanical analysis, neuro-orthopedic science, and imaging frameworks to elevate spine-care assessment. Addressed the transition from symptom-based evaluation toward measurement-driven methodologies that enhance diagnostic reproducibility and interdisciplinary communication. Reviewed unified terminology, dynamic imaging applications in motion-based pathology, and structural methods for aligning clinical workflows with emerging evidence standards. National Spine Management Group, Medical Metrics Inc, Federation of Chiropractic Licensing Boards, PACE Program

Comprehensive review of technological and scientific advancements transforming quantitative spine imaging, including the maturation of translational and angular displacement metrics, reduction of examiner variability, and development of computational image-processing systems. Discussed reproducibility research, multi- modality dataset integration (MRI, CT, dynamic studies), and structured pathways that enhance surgical planning, objectivity, and medico-legal defensibility through measurable biomechanical data. National Spine Management Group, Medical Metrics Inc, Federation of Chiropractic Licensing Boards, PACE Program

Detailed analysis of segmental biomechanics including multi-planar motion, viscoelastic ligament behavior, facet-mediated load distribution, and stiffness gradients. Examined translational shear forces, rotational coupling, posterior ligament complex interactions, and collagen microstructure contributions to mechanical signatures. Linked foundational biomechanics to diagnostic interpretation, early instability detection, micro-failure identification, and aberrant movement analysis in traumatic and degenerative states. National Spine Management Group, Medical Metrics Inc, Federation of Chiropractic Licensing Boards, PACE Program

Multidisciplinary panel evaluating classic and modern frameworks of spinal instability including displacement thresholds, ligament elongation mechanics, capsular insufficiency, and load-dependent failure patterns. Discussed diagnostic limitations of static imaging and demonstrated how dynamic measurement clarifies ambiguous presentations. Integrated predictive validity, treatment stratification, progression risk, and biomechanical interpretation for both conservative and surgical pathways. National Spine Management Group, Medical Metrics Inc, Federation of Chiropractic Licensing Boards, PACE Program

Exploration of functional imaging modalities—kinematic radiography, motion-sensitive MRI, quantitative movement studies—as unified frameworks across disciplines. Included motion-pattern recognition, segmental stiffness abnormalities, recruitment sequencing, and translation of mechanical findings into conservative, interventional, and surgical decisions. Highlighted structured reporting systems that enhance communication and support defensible documentation. National Spine Management Group, Medical Metrics Inc, Federation of Chiropractic Licensing Boards, PACE Program

Case-based review of integrated workflows across chiropractic, physical therapy, orthopedics, neurosurgery, and pain management. Demonstrated functional imaging correlations with MRI findings, diagnostic synchronization, reduction of redundancy, and timing optimization for interventions. Highlighted standardized mechanical thresholds as tools for escalation decisions and improved continuity in complex case management. National Spine Management Group, Medical Metrics Inc, Federation of Chiropractic Licensing Boards, PACE Program

Scientific analysis of how objective diagnostic data strengthens referral pathways between conservative providers and surgical or interventional specialists. Covered evidence-based justification, documentation standards, predictive indicators, and communication models that enhance interdisciplinary acceptance. Reviewed common hurdles and data-driven solutions that improve referral efficiency and treatment continuity. National Spine Management Group, Medical Metrics Inc, Federation of Chiropractic Licensing Boards, PACE Program

Detailed discussion of capsular ligament neurophysiology, mechanoreception, nociception, and proprioceptive control. Reviewed elongation injury mechanics, rotational and shear vulnerability, inflammatory cascades, and chronic capsular laxity leading to segmental instability. Correlated imaging markers such as capsular hypertrophy, fibrosis, and facet spacing alterations with mechanical failure states. National Spine Management Group, Medical Metrics Inc, Federation of Chiropractic Licensing Boards, PACE Program

In-depth analysis of vertical shear instability, altered axial load transfer, annular deformation patterns, endplate mechanics, and multi-level ligamentous compromise. Demonstrated complex motion signatures—segmental recruitment delay, aberrant stiffness ratios, directional preference abnormalities—and integrated findings with neuromusculoskeletal examination, imaging, and treatment pathway determination. National Spine Management Group, Medical Metrics Inc, Federation of Chiropractic Licensing Boards, PACE Program

Scientific review of Alteration of Motion Segment Integrity criteria, including tensile failure physics, viscoelastic tissue deformation, and posterior ligament complex compromise. Expanded discussion on radiographic variability, gray-zone cases, and advanced imaging correlations that improve repeatability and medico-legal defensibility in ligament-injury assessment. National Spine Management Group, Medical Metrics Inc, Federation of Chiropractic Licensing Boards, PACE Program

Comprehensive review contrasting subjective symptom- driven assessments with objective mechanical and imaging-derived biomarkers. Discussed recall bias, examiner variability, and the superiority of quantifiable intersegmental motion data, correlated structural findings, and reproducible functional deviations. Highlighted applications for impairment rating, prognosis modeling, and legal defensibility. National Spine Management Group, Medical Metrics Inc, Federation of Chiropractic Licensing Boards, PACE Program

Exploration of overt and subtle ligamentous microfailure, segmental coordination abnormalities, compensatory recruitment, and sensitization phenomena. Addressed challenges in correlating symptoms with imaging, detection of hidden dysfunctions, and communication of complex mechanical findings to adjusters, attorneys, and courts. National Spine Management Group, Medical Metrics Inc, Federation of Chiropractic Licensing Boards, PACE Program

Expanded lecture on advanced imaging correlation, mechanical threshold interpretation, surgical readiness assessment, preauthorization optimization, payer justification frameworks, and structured reporting that improves clarity and reduces denial rates. Highlighted medico-legal defensibility in surgical determinations. National Spine Management Group, Medical Metrics Inc, Federation of Chiropractic Licensing Boards, PACE Program

Detailed exploration of consulting value for conservative providers, including diagnostic enhancement, documentation precision, deposition preparation, trial communication, impairment rating methodology, and bridging the clinical-legal divide through objective biomechanical analysis. National Spine Management Group, Medical Metrics Inc, Federation of Chiropractic Licensing Boards, PACE Program

Highly detailed session on ICD/CPT precision, AMA impairment thresholds, anatomical correlation, and high-fidelity documentation structures. Reviewed the impact of incomplete documentation on payer disputes, legal outcomes, and clinical clarity, and provided best-practice strategies for defensible reporting. National Spine Management Group, Medical Metrics Inc, Federation of Chiropractic Licensing Boards, PACE Program

Structured overview of personal injury legal frameworks including No-Fault versus Tort systems, serious injury thresholds, Personal Injury Protection (PIP) requirements, subrogation principles, pre-litigation negotiation processes, and formal litigation procedures. Detailed discussion of depositions, direct examination, contingency fee structures, defense counsel roles, and the strategic importance of early documentation. Emphasis on clinician awareness of how medical records are interpreted by non-clinicians, how inconsistencies weaken credibility, and how structured documentation shapes case boundaries and settlement outcomes.National Spine Management Group, Federation of Chiropractic Licensing Boards, PACE Program

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. National Spine Management Group, Federation of Chiropractic Licensing Boards, PACE Program,

Translation of microstructural imaging findings into functional neurological interpretations. Reviewed region-specific tract disruption, network dysregulation (default-mode, salience, frontoparietal), and integration of neurocognitive testing. Discussed implications for prognosis, treatment selection, and legal documentation. National Spine Management Group, Medical Metrics Inc, Federation of Chiropractic Licensing Boards, PACE Program

Discussion of modern software-enabled documentation, diagnostic templating, automated annotation, dataset integration, and error-reduction strategies. Reviewed clinical workflow optimization, multi-modal information harmonization, and medico-legal implications of precision documentation. National Spine Management Group, Medical Metrics Inc, Federation of Chiropractic Licensing Boards, PACE Program

Outline and overview of what a Spine Management Physician is, and the present day need in healthcare. Details relating to the Doctor of Chiropractic filling that role with specific discussion related to WHY physical therapy, nurse practitioners or physician assistants are unable to fill this position. Overview of a spine manager’s role in the evaluation and triage of non-operative spine patients was presented. Introduction to the diagnosis of non-specific spine pain was outlined with focus on the needs of primary care, pain management and spinal surgeons. National Spine Management Group, LLC, Parker University, Alabama State Board of Chiropractic Examiners, Kentucky Board of Chiropractic, Louisiana State Board of Chiropractic Examiners, Texas Board of Chiropractic Examiners, Florida Board of Chiropractic Medicine, Arizona Board of Chiropractic Examiners, Federation of Chiropractic Licensing Boards – PACE,

A comprehensive look at the history of spinal care, degenerative changes and both regional and global spinal compensation. Outline the spine as a whole organ system that must be monitored in relation to physical activity, lifestyle, and traumatic patient history was discussed and presented. Application of spine management principles mirroring internal medicine disorders was presented and reviewed. Specific peer reviewed medically index research was presented outlining initial criteria for determining medical necessity of supportive spine care. National Spine Management Group, LLC, Parker University, Alabama State Board of Chiropractic Examiners, Kentucky Board of Chiropractic, Louisiana State Board of Chiropractic Examiners, Texas Board of Chiropractic Examiners, Florida Board of Chiropractic Medicine, Arizona Board of Chiropractic Examiners, Federation of Chiropractic Licensing Boards – PACE,

Research trends and working with primary care physicians was outlined. Focus on the conservative management of spinal conditions, aiding the primary care clinic and working to prevent unnecessary escalation of care. Reduction in opioid utilization and reduced surgery trends will be discussed. Research documenting modulation of pain at the central nervous system level with the chiropractic adjustment was presented. Application to real world scenarios including evaluation and management documentation was reviewed. Details of effective communication were presented including phone call, email, fax, and text messaging within the HIPAA compliance environment was discussed. National Spine Management Group, LLC, Parker University, Alabama State Board of Chiropractic Examiners, Kentucky Board of Chiropractic, Louisiana State Board of Chiropractic Examiners, Texas Board of Chiropractic Examiners, Florida Board of Chiropractic Medicine, Arizona Board of Chiropractic Examiners, Federation of Chiropractic Licensing Boards – PACE,

Chiropractic diagnosis of spinal ligament pathology will be discussed in the context of co-management with pain management specialists. Specific review of the role of a fellowship trained interventional pain management physician in your community will be presented. Review of epidural steroid injection, medial branch block and spinal ablation will be presented in the context of when and how to refer. National Spine Management Group, LLC, Parker University, Alabama State Board of Chiropractic Examiners, Kentucky Board of Chiropractic, Louisiana State Board of Chiropractic Examiners, Texas Board of Chiropractic Examiners, Florida Board of Chiropractic Medicine, Arizona Board of Chiropractic Examiners, Federation of Chiropractic Licensing Boards – PACE,

Spinal sagittal balance and spine surgery research trends will be reviewed. Chiropractic’s role in the conservative management of spinal biomechanics pre-surgery and post-surgery will be outlined. Terminology and documentation requirements will be presented. National Spine Management Group, LLC, Parker University, Alabama State Board of Chiropractic Examiners, Kentucky Board of Chiropractic, Louisiana State Board of Chiropractic Examiners, Texas Board of Chiropractic Examiners, Florida Board of Chiropractic Medicine, Arizona Board of Chiropractic Examiners, Federation of Chiropractic Licensing Boards – PACE,

Anatomy of the healthy intervertebral disc and its nerve supply will be reviewed. A brief overview of the biochemical structure of the intervertebral disc will be presented. The role of the intervertebral disc as a spinal stabilizer and its influence on facet joint function will be outlined. Specific attention will be given to radiologic vocabulary such as intervertebral disc herniation, extrusion, sequestration, and traumatic annular tears. National Spine Management Group, LLC, Parker University, Alabama State Board of Chiropractic Examiners, Kentucky Board of Chiropractic, Louisiana State Board of Chiropractic Examiners, Texas Board of Chiropractic Examiners, Florida Board of Chiropractic Medicine, Arizona Board of Chiropractic Examiners, Federation of Chiropractic Licensing Boards – PACE,

Anatomy of the degenerative intervertebral disc and its nerve supply will be reviewed. An overview of the biochemical process of intervertebral disc degeneration will be outlined. Specific attention will be given to the Pfirrmann Scale and radiographic terms such as desiccation, intervertebral disc bulge and degenerative annular tears. National Spine Management Group, LLC, Parker University, Alabama State Board of Chiropractic Examiners, Kentucky Board of Chiropractic, Louisiana State Board of Chiropractic Examiners, Texas Board of Chiropractic Examiners, Florida Board of Chiropractic Medicine, Arizona Board of Chiropractic Examiners, Federation of Chiropractic Licensing Boards – PACE,

Basic spinal biomechanical principles will be reviewed including sagittal spinal alignment and coronal positioning in relation to the spinal facet joints. Research trends including symptomatic vs asymptomatic spinal parameters will be presented in the context of the Doctor of Chiropractic as the portal of entry spine care provider. National Spine Management Group, LLC, Parker University, Alabama State Board of Chiropractic Examiners, Kentucky Board of Chiropractic, Louisiana State Board of Chiropractic Examiners, Texas Board of Chiropractic Examiners, Florida Board of Chiropractic Medicine, Arizona Board of Chiropractic Examiners, Federation of Chiropractic Licensing Boards – PACE,

Histology of ligament structure and function will be presented. Microanatomy and the wound repair process will be discussed. Structural deficits post ligament injury will be presented and reviewed. Anatomical positioning of ligamentous structures will be outlined with specific attention to the spinal enthesis and the difference between an enthesophyte and osteophyte in spinal degeneration. National Spine Management Group, LLC, Parker University, Alabama State Board of Chiropractic Examiners, Kentucky Board of Chiropractic, Louisiana State Board of Chiropractic Examiners, Texas Board of Chiropractic Examiners, Florida Board of Chiropractic Medicine, Arizona Board of Chiropractic Examiners, Federation of Chiropractic Licensing Boards – PACE,

Ligament pathology as a source of persistent spinal pain and dysfunction will be outlined and reviewed. Objectifying ligament injury will be presented, and context will be provided using plain film radiographs and MRI examples. Focus on facet capsules and interspinous ligament will be central to the discussion. National Spine Management Group, LLC, Parker University, Alabama State Board of Chiropractic Examiners, Kentucky Board of Chiropractic, Louisiana State Board of Chiropractic Examiners, Texas Board of Chiropractic Examiners, Florida Board of Chiropractic Medicine, Arizona Board of Chiropractic Examiners, Federation of Chiropractic Licensing Boards – PACE,

Review of federal documentation guidelines with specific focus on CPT coding for initial and re-evaluation visits. Detailed outcomes of documentation audits by insurance carriers, regulator and special investigators will be presented in a case study format. Emphasis will be placed interprofessional communication and compliance. National Spine Management Group, LLC, Parker University, Alabama State Board of Chiropractic Examiners, Kentucky Board of Chiropractic, Louisiana State Board of Chiropractic Examiners, Texas Board of Chiropractic Examiners, Florida Board of Chiropractic Medicine, Arizona Board of Chiropractic Examiners, Federation of Chiropractic Licensing Boards – PACE,

Review and discussion of 2022/2023 research supporting the chiropractic profession and the doctor of chiropractor as a spine care manager. Specific papers will be presented related to the pain management, corrective, and health maintenance phases of chiropractic care. Overview of current and future research trends will be demonstrated. National Spine Management Group, LLC, Parker University, Alabama State Board of Chiropractic Examiners, Kentucky Board of Chiropractic, Louisiana State Board of Chiropractic Examiners, Texas Board of Chiropractic Examiners, Florida Board of Chiropractic Medicine, Arizona Board of Chiropractic Examiners, Federation of Chiropractic Licensing Boards – PACE,

- 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. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards – PACE, State University of New York at Buffalo Jacobs School of Medicine, and Biomedical Sciences –

– 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. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards - PACE. State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences –

– 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. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards – PACE, State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences

Trauma – 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. Spine Management Group, LLC, Federation of Chiropractic Licensing Boards – PACE, State University of New York at Buffalo Jacobs School of Medicine, and Biomedical Sciences

– 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. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards - PACE. State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences

– 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. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards - PACE. State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences –

– review and presentation of updated peer-reviewed medically indexed research supporting chiropractic management of spine pain was detailed. Timeline of publication was emphasized with three years being the maximum timeframe for up-to-date data. Comprehensive review of evidence supporting chiropractic management of the spine pain patient in the Pain Management, Corrective, and the Health Maintenance Phases of care. Methods to communicate this evidence to the medical and legal communities was presented in the context of compliant patient centered clinical documentation. Efficiency of a Spine Management Physician versus conventional primary care was presented. Emphasis on the hierarchy of published evidence starting with Foundational Evidence up to Level 1 evidence was presented. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, Cleveland University Kansas City, College of Chiropractic – Ft. Lauderdale, Florida

Management – presentation of compliant healthcare documentation including E/M initial and re-evaluations, daily progress notes and medical-legal narrative reports was provided. Workflows detailing interprofessional referral language, advanced imaging requests and patient communication were detailed. Streamlined processes for creating and maintaining compliant, evidence based, patient centered clinical reporting was given. Emphasis was placed on the role of a Spine Management Physician in the processes of interprofessional communication and case management. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, Cleveland University Kansas City, College of Chiropractic – Ft. Lauderdale, Florida

– presentation of the histological structural organization of spinal ligaments including analysis of tropocollagen as the basis for anatomical structure. Review of the structural hierarchy of the spinal ligament from microscopic to macroscopic was included. Anisotropic properties of spinal ligaments were defined, and examples presented. Detailed review of spinal entheses was presented with emphasis on advanced imaging and chronic enthesopathy. New insights into the pathogenesis, diagnostic modalities, and treatment of spinal enthesitis was outlined and presented. Specific focus was on traumatic injury to the spinal entheses and the difference in formation of spinal osteophytes and enthesophytes. Biomechanics of the degenerative spine was detailed and reviewed in terms of clinical spine management. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, Cleveland University Kansas City, College of Chiropractic – Ft. Lauderdale, Florida

– Crash dynamics and basic physics formulas were presented and detailed. Review of biomechanical expert reports and included mathematics was discussed with context given to data collection and accuracy. Spinal injury thresholds were reviewed as well as the Law of Conservation of Energy and its relationship to crash dynamics. Specific mathematical examples were presented including workflows to review the accuracy of biomechanical expert reporting and mathematical formulas. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, Cleveland University Kansas City, College of Chiropractic – Ft. Lauderdale, Florida

– an updated scientifically validated grading system for the identification of degeneration of the intervertebral disc and motion segment was presented. Details such as radiographic signs of disc degeneration including loss of disc height, osteophyte formation and diffuse sclerosis were provided. Grading examples were provided in radiographic and gross specimen form starting with Grade 0 (no degeneration) to Grade 3 (severe degeneration). Outline of the validity and interobserver agreement of this grading system was shown for both the cervical and the lumbar spine. Review and emphasis on the difference between osteophyte formation and enthesophytes was again outlined. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, Cleveland University Kansas City, College of Chiropractic – Ft. Lauderdale, Florida

– review of objectification of neurological deficits including loss of sensation, aberrant deep tendon reflexes, loss of strength and the presence of pathological reflexes was presented and discussed. Criteria for co-management in the presence of neurological deficits with the pain management physician and the spine surgeon was outlined. Detailed presentation on CPT coding and E/M documentation requires was discussed and reviewed. Absolute and relative contraindications to chiropractic care was demonstrated and outlined. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards – PACE, State University of New York at Buffalo Jacobs School of Medicine, and Biomedical Sciences –

Patient – 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. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards – PACE, State University of New York at Buffalo Jacobs School of Medicine, and Biomedical Sciences –

– 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. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards – PACE, State University of New York at Buffalo Jacobs School of Medicine, and Biomedical Sciences –

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. ACCME Joint Providership with the State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences, Academy of Chiropractic Post-Doctoral Division, Buffalo, NY,

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.

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. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences –

– 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. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences –

– review of specific cervical anatomy in the spine pain patient. Clinical correlation between plain film radiographs and MRI studies was reviewed including radiographic motion studies. Computerized Mensuration Analysis was outlined and discussed with findings correlating with normative translation and angular motion data. Review of the AMA Guides to the Evaluation of Permanent Impairment 5th and 6th Editions was presented. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences –

– 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. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences –

– 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. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences –

– in-depth review and discussion of the Doctor of Chiropractic as a Spine Management Physician with specific focus on the diagnosis and management of spine pain of mechanical origin. Details were outlined in relation to triage of anatomical causes of spine pain such as fracture, tumor, infection. National Spine Management Group, Cleveland University Kansas City, Chiropractic and Health Sciences, Federation of Chiropractic Licensing Boards, Buffalo, NY, Lehi, UT

– Current peer reviewed indexed research demonstrating the chiropractic adjustment’s effect on the central nervous system and pain threshold was outlined and reviewed. Anatomical review and contemporary supportive research were discussed. Details of central nervous system response to the chiropractic adjustment was reviewed and demonstrated. National Spine Management Group, Cleveland University Kansas City, Chiropractic and Health Sciences, Federation of Chiropractic Licensing Boards, Buffalo, NY, Lehi, UT

- Current peer reviewed indexed research demonstrating the chiropractic adjustment’s effect on the biomechanical structure of the human spine during the corrective/rehabilitative phase of care. Basic outline of biomechanical parameters in symptomatic and asymptomatic patients was reviewed with particular focus on pathobiomechanics in chiropractic practice. National Spine Management Group, Cleveland University Kansas City, Chiropractic and Health Sciences, Federation of Chiropractic Licensing Boards, Buffalo, NY, Lehi, UT

- Current peer reviewed indexed research demonstrating the chiropractic adjustment’s effect on the maintenance of the human spine. Details of indexed research reviewing Chiropractic’s role in the reduction of narcotic utilization and decreased absenteeism from work due to disability. Communicating Health Maintenance Care to the medical profession and the public was emphasized. National Spine Management Group, Cleveland University Kansas City, Chiropractic and Health Sciences, Federation of Chiropractic Licensing Boards, Buffalo, NY, Lehi, UT

– overview of current CPT and ICD-10 coding guidelines pertaining to the evaluation and management of spine pain patients was presented. Timed codes, relevant diagnosis related to injured tissue was presented. Specific discussion of proper format of the Assessment portion of clinical documentation was presented. Review of the difference between daily progress notes and Evaluation and Management [E/M] reporting was provided. National Spine Management Group, Cleveland University Kansas City, Chiropractic and Health Sciences, Federation of Chiropractic Licensing Boards, Buffalo, NY, Lehi, UT

– detailed review of workflows of a thorough patient history and identification of clinical red flags related to relative and absolute contraindications to chiropractic care was presented. Outline of neurological examination including pathological reflexes present during spinal cord compression, cervical stenosis and cervical myelomalacia was discussed. Normal vs abnormal measurement of range of motion objectifying spinal dysfunction was presented. Specific orthopedic testing related to specific muscle, nerve or intervertebral disc injury was discussed. Review of interprofessional triage and imaging decision tree was outlined with specific focus on the pain management physician and spinal surgeon. National Spine Management Group, Cleveland University Kansas City, Chiropractic and Health Sciences, Federation of Chiropractic Licensing Boards, Buffalo, NY, Lehi, UT

– 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. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences –

Chiropractic and the Spine Surgeon – 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. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences –

– 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. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards - PACE. State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences

– 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. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences

– 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. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences

– 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. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences –

– 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. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, Cleveland University of Health Sciences, College of Chiropractic, Kansas City

– 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. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, Cleveland University of Health Sciences, College of Chiropractic, Kansas City

– 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. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, Cleveland University of Health Sciences, College of Chiropractic, Kansas City

– 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. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, Cleveland University of Health Sciences, College of Chiropractic, Kansas City

– 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. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, Cleveland University of Health Sciences, College of Chiropractic, Kansas City

– 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. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, Cleveland University of Health Sciences, College of Chiropractic, Kansas City

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. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, Cleveland University of Health Sciences, College of Chiropractic, Kansas City

– 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. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, Cleveland University of Health Sciences, College of Chiropractic, Kansas City

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. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, Cleveland University of Health Sciences, College of Chiropractic, Kansas City

- 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. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, Cleveland University of Health Sciences, College of Chiropractic, Kansas City

– 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. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, Cleveland University of Health Sciences, College of Chiropractic, Kansas City

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. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, Cleveland University of Health Sciences, College of Chiropractic, Kansas City

–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 end- stage 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. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences –

– Discussion of the history of interprofessional healthcare and the acknowledgement by the World Health Organization was presented. Specific detail on chiropractic academia and student perception of its importance was outlined. The growth and importance of both interprofessional education and communication was stressed and reviewed. Need for a clear professional identity to facilitate interprofessional education and communication was presented. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences –

– 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. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences –

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. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences –

– 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. . National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards - PACE. State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences –

Laxity – 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. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards - PACE. State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences –

– 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. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards - PACE. State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences –

- 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. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards - PACE. State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences –

– 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. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards - PACE. State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences –

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

Presentation and discussion of the clinical diagnosis of fracture of the pars interarticular, detailed review of patient history, presenting symptomology, physical examination and imaging review. Detailed analysis of radiographic evaluation using dynamic radiographs and advanced imaging of the lumbar spine. Differential diagnosis of pain patterns and neurological findings were presented and clinically correlated to anatomical findings. State University of New York at Buffalo, Jacobs School of Medicine, Buffalo NY 2020 Interprofessional Communication in Fracture of Pars Interarticularis – analysis and discussion of the interprofessional communication and triage of pars interarticularis fracture. Documentation processes and referral to medical specialty was reviewed with detailed analysis of communicating spinal biomechanical pathology in conjunction with anatomical findings. Co-management processes was reviewed and discussed. Clinical correlation to case documentation was presented.

analysis and discussion of the interprofessional communication and triage of pars interarticularis fracture. Documentation processes and referral to medical specialty was reviewed with detailed analysis of communicating spinal biomechanical pathology in conjunction with anatomical findings. Co-management processes was reviewed and discussed. Clinical correlation to case documentation was presented.

clinical case management including both anatomical and mechanical featured of fracture of pars interarticularis was presented and discussed. Surgical parameters were demonstrated and clinically correlated to physical examination and imaging findings. Roles of surgeon, pain management, chiropractic and physical therapy were reviewed and presented. Group consensus on the proper pre-surgical, surgical and post-surgical of the patient were presented. Timeline on recovery and relevant future assessment was reviewed and its clinical correlation to both the acute and chronic pars interarticularis fracture.

diagnosis of cervical acute and chronic cervical radiculopathy was reviewed and discussed. Emphasis on patient history, symptoms, physical examination and clinical correlation to imaging and electrodiagnostic testing was presented. Clinical correlation to electrodiagnostic findings, advanced imaging and neurological examination was reviewed. Details regarding traumatic vs degenerative cervical radiculopathy etiology was presented as well as the difference between radiculopathy and radiculitis was discussed.

review of interprofessional management of the cervical radiculopathy patient. Considerations for triage and referral were correlated to physical examination findings, severity of the complaint and findings on electrodiagnostic testing. Interventional pain management including epidural injections was outlined. Biomechanical analysis and chiropractic management was reviewed including short and long term management of the cervical radiculopathy patient.

evidence based interventions related to cervical radiculopathy were outlined including surgical intervention, interventional pain management, chiropractic and supervised rehabilitation. Acute, subacute and chronic stages of clinical intervention and case management were reviewed and presented. Functional assessment and activity modification were presented and correlated to clinical findings and stage of the diagnosis.

ESI comparison to gabapentin in lumbosacral radicular pain – current trends and future progress of pain management interventions. Mode of action, required dosage, advantages and side effects profiles of currently available pharmacological approaches. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine

- Facet, medial branch blocks, prolotherapy and epidural interventions utilization within the Medicare population, effectiveness on lumbar central canal stenosis with and without steroids and effect on prevention of spinal surgery, herniated disc, fibromyalgia and chronic musculoskeletal pain. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– Transforaminal and interlaminar epidural steroid injections, anesthesia technical considerations, effects on cervical radiculopathy midline versus paramedian approaches and perineurial injection of autologous conditioned serum. Review of FDA risk assessment. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine

- MODIC Changes on MRI and effectiveness of facet injection, facet joint signal change on MRI with fat suppression comparison with SPECT/CT. Discussion of Modic 1, 2 and 3 with correlation of clinical outcomes and patient selection criteria. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– cost effectiveness, patient response and triage of therapeutic interventions. Physiological review of trigger point etiology and clinical presentation of acute and chronic pain. Functional response of intervention including relief and recurrence. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

Chemical blockage of cervical nerve roots, review of anatomical structures and correlation with MRI imaging. Blockage effects on the respiratory, circulatory and neurological systems. Review of cervical epidural space (CES) borders and variants in patient population. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– Emergency visitation in pediatric injury, pain management and adoption of best practices. Trends in use of prescription opioid medication using RADARS (Research Abuse, Diversion and Addiction Related Surveillance System), comparison between legitimate pharmacy channels and diversion and abuse. Opioid use prevalence and incidents in Veteran Affairs, new prescriptions or long-term conversion and relationship to persistent growth in opioid use. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine

– Needle EMG, active versus chronic denervation in lumbar, cervical spinal pathologies and differential diagnosis of spinal stenosis and intervertebral disc herniation. Systematic review of facet joint injections, clinical trials and conservative therapy in lower back pain. Results of spinal manipulation post-epidural injection in the cervical spine. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

Medial Branch Block as prognostic tool prior to lumbar facet radiofrequency denervation. Clinical comparison disc herniation, disc bulge, cervical and lumbar radiculopathy. Diagnosis and patient triage correlation to anatomical spine structures. Long, short term risk factors and outcomes in radiofrequency ablation. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– Review of pharmacological, botanical or synthetic origins of cannabinoids. Mechanism of action in alleviation of pain including analgesic, anti-inflammatory effects, modular actions on neurotransmitters and interactions with prescribed or endogenous opioids. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

- Volume RF, surface, quadrature and phase array coils and other hardware necessary for the generation of MRI imaging. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– magnetization, excitation, relaxion, acquisition, computing and display. T1 relaxion and relaxation curves, T2 relaxation, phase and phase coherence, T2 relaxion curves. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– gradient coils, signal coding including slice encoding gradient, phase encoding gradient, Frequency encoding gradient. Gradient specifications and slice thickness. Filling k-space, k-space symmetry and k-space filling technique. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– pulse sequences, spine echo sequences including multi-slicing and multi-echo sequencing. T1, T2, proton density contrast and their applications. Turbo spine echo, fast advanced spine echo (HASTE) sequence and gradient echo sequence. Inversion recovery sequence including STIR and FLAIR sequence. Choosing the right sequence pros and cons, T1, T2 and PD parameters. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– repetition time, echo time, flip angle, inversion time, number of acquisitions, matric and field of view. Slice thickness, slice gap, phase encoding direction 1 and direction 2 and relation to bandwidth. Motion artifact, para-magnetic artifact, phase wrap artifact, susceptibility artifact, clipping artifact, spine and zebra artifacts. Effects on image quality and acquisition. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– acute Schmorl’s node and progression to chronic stage comparison to serial MRI. Endplate fracture and acute presentation and correlation to clinical findings and pain patterns. Presentation in plain film radiograph and MRI images were compared and contrasted in both acute and chronic stages. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– scoliosis curve patters and syrinx characteristics versus Chiari I malformation. Normal MRI appearance and motion artifacts related to cerebral spinal fluid motion related phenomena and common appearances on MRI imaging. Syrinx wall and fluid motion and correlation to cardiac cycle with comparison between systolic and diastolic presentations. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– full spine analysis, adjacent spinal biomechanics and its impact on surgical outcomes. Sagittal alignment pelvis to cervical spine and association with kyphosis and lordosis mechanical positioning. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– lumbar spine pathology and age in relation to paraspinal muscle size and fatty infiltration. Fatty degeneration of paraspinal muscle in degenerative lumbar kyphosis and CT versus MRI digital analysis. Positive correlations with edema on MRI and fibrillations, positive sharp waves, denervation and the level of reduced recruitment pattern. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– high intensity zone (HIZ) in lumbar disc and association to annular fissure on MRI. Identification of duel HIZ and its relationship to acute inflammation and calcified tissue and its association with discogenic pain patterns. Influence of phenotype, population size and inclusion sequence. T1, T2 and STIR imaging comparison and correlation. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– paraspinal muscle morphology, clinical symptoms and functional status. Review of fatty infiltration, asymmetry findings and correlation with clinical symptoms and functional scores. Review of complex anatomical arrangement of superficial and deep muscle layers in the cervical spine, correlation to MRI findings. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– diagnostic accuracy and fiber tracking in spinal cord compression. Review of spinal cord structural integrity, peripheral neuropathy and correlation to diffuse tensor imaging findings. Comparison in combining DTI with T2 and T2 alone and its value in magnetic resonance neurography. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– modified Pfirrmann grading system and lumbar disc degeneration. Consensus driven description of intervertebral disc nomenclature including intervertebral disc bulge, herniation, protrusion, broad based disc herniation, extrusion and sequestration. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– neuroimaging of spinal tumors and correlation to histological study. Determining method of choice for evaluation, review of numerous types of intradural-extramedullary masses including meningioma and schwannoma. Signal intensities, contrast enhancement patterns, presence of cysts and other key differentiation findings of spinal cord tumors. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

Correlation – positional cervical spinal cord compression and fibromyalgia. T1 and T2 weighted images, comparison of hypo and hyperintense signals and extent of intramedullary changes on MRI. Review of MRI findings associated with myelomalacia and discussion of correlation with clinical findings. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– formation characteristics of synovial cyst, relation to degenerative changes in spinal facet joints as demonstrated on MRI. Pre and post-surgical procedural MRI were reviewed and compared. Surgical management and subsequent resection were demonstrated. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– in depth review of quality of MRI imaging and comparison to consistent MRI diagnosis between facilities. Errors of interpretation in the study examinations were considered and presented. Impact of radiological diagnosis, location of MRI study and reading radiologist and impact on treatment choice and clinical outcomes. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– normal kinematics using biplanar radiographic model were reviewed. Discussion of extensive database of carpal bone anatomy and kinematics from a large number of healthy subjects. 3-D motion of each bone was calculated for each wrist position and discussed. Database constructed including high-resolution surface models, measures of bone volume and shape, and the 3-D kinematics of each segmented bone. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– normal motion of the shoulder joint compared with clinical implications of glenohumeral joint instability including surgical recommendations. Review and overview of the anatomy of the glenohumeral joint, emphasis on instability based on the current literature. Description of detailed anatomy and anatomical variants of the glenohumeral joint associated with anterior and posterior shoulder instability. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

- use of orthopedic special tests (OSTs) to diagnose shoulder pathology and clinical examination. Review OST clusters, examination of methodology and illustration of their use in arriving at a pathology-based diagnosis. Discussion of examination of the biceps tendon and clinical relevance. Review of SLAP lesion and shoulder impingement syndrome were reviewed. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– Review of the most common mononeuropathy in the human body. Relationship between clinical findings, neurological examination and electrodiagnostic testing in the diagnosis of carpal tunnel syndrome. Acute and chronic symptoms including progression of the disorder were reviewed. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– Detailed anatomy of osseus, ligamentous and muscular structure of the elbow was reviewed. Common disease of elbow disorders and their treatment was discussed. Lateral epicondylitis and medial collateral ligament injury of the elbow were outlined. Rheumatoid arthritis, posttraumatic osteoarthritis, and elderly patients with comminuted distal humeral fractures. Surgical design and technique were outlined. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– anatomical review of cervical spine and glenohumeral joint focus on similarities and differences. Cervical disorders masking shoulder pain, cervical radiculopathy, cervical spondylotic myelopathy, facet and discogenic pain patterns were outlined. Details of shoulder pathology parsonage-tuner syndrome, subscapular neuropathy and thoracic outlet were presented. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

- review of MRI analysis of scapular fracture. Detailed review of scapular function rehabilitation and training on chronic pain syndromes. Reliability of magnetic resonance imaging versus arthroscopy for the diagnosis and classification of superior glenoid labrum anterior to posterior lesions. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

- Review Standardization and Terminology Committee (STC) of the International Society of Biomechanics (ISB) and classification of joint kinematics. Standard for the local axis system in each articulating bone is generated and presented. Rationale for international standards among researchers was presented. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

- Review Standardization and Terminology Committee (STC) of the International Society of Biomechanics (ISB) and classification of joint kinematics. Standard for the local axis system in each articulating bone is generated and presented. Rationale for international standards among researchers was presented. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– normal and abnormal shoulder anatomy as viewed on MRI was presented. Review and presentation of MRI in the diagnosis and treatment of brachial plexus injury. Discussion of preganglionic avulsions and muscular denervation. Comparison of CT myelography to MRI myelography were outlined. Enhanced three dimensional T1 high-resolution isotropic volume excitation MR in the evaluation of shoulder pathology. Comparison with two-dimensional enhanced T1 fat saturation MRI were discussed. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– review of relevant anatomy in shoulder, elbow, wrist, hip, knee and ankle was presented. Physical examination including orthopedic, neurological and range of motion testing was presented and compared with findings on MRI results. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– efficacy of fusion and decompression surgery in patients with lumbar spinal stenosis. Review of degenerative spondylolisthesis and patient selection criteria. Discussion of correlation of MRI, CT findings and clinical evaluation. Review of sedimentation sign on MRI and indications of prognostic factors. Surgery versus nonsurgical treatment outlined and outcomes discussed. Compensation for lumbar spinal stenosis and clinical sagittal plane deformity was presented. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– adjacent segment degeneration as major consequence of spinal fusion. Review of occurrence and location with correlation between surgical outcomes were discussed. Discussion of age, BMI and pre-existing stenosis in cranial adjacent segment as risk factors. ASD prevalence in radiographic evidence between cranial and caudal segments were reviewed. Presentation of risk factors and pre-operative radiological features. Facet sagittalization and tropism were discussed. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– Review of the Charlson Comorbidity Index (CCI) and the American Society of Anesthesiologist (ASA) Physical Status Classification System. Review of index outcomes and relation to costs of care. Discussion of index rating and likelihood of complications. Review of classification system in cerebral spinal fluid (CSF) leaks. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

- classification system that considers disc space height, sagittal alignment and translation, and the absence or presence of unilateral or bilateral leg pain was discussed. Detailed review of spondylolisthesis etiology, clinical presentation and imaging findings was reviewed. Review of inter and interobserver reliabilities of radiographic and clinical criteria. Review of consensus driven treatment options for degenerative spondylolisthesis presented. Transforaminal Lumbar Interbody Fusion (TLIF) in degenerative disc disease with associated spondylolisthesis grade I was reviewed and correlated. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– discussion of outcomes and sagittal alignment in single unilateral transforaminal lumbar interbody fusion (TLIF). Detailed review of surgical TLIF procedure and associated mid and long-term clinical outcomes. Discussion and presentation of influence of pelvic incidents and lumbar lordosis mismatch and post-operative residual symptoms. Analysis of adjacent segment disease following fusion. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– review of surgical approaches and complications in correction of adult spinal deformity. Relevance of age, comorbidities, blood loss, osteoporosis and smoking were discussed. Discussion of Cobb Angle, Sagittal Vertical Axis, Pelvic Tilt, Thoracic Kyphosis were reviewed and examined in relation to transpsoas lateral interbody fusion (LIF), percutaneous pedicle screw (PPS), transforaminal lumbar interbody fusion (TLIF). Comparison between minimally invasive and traditionally open procedures was provided and reviewed. Discussion of minimally invasive surgery options were emphasized and outcomes reviewed with correlation to diagnosis and procedural coding. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– review of differences in surgical treatment of recurrent lumbar disc herniation. Clinical correlation between plain film radiography, MRI studies and clinical presentation were reviewed. Data on frequency in management of recurrent lumbar intervertebral disc herniations presented. Duration of symptoms and influence of patient outcomes in sciatica patients undergoing micro-discectomy and decompressions. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– discussion on epidemiology of lumbar surgery outcomes and hospital stay. Correlation to clinical presentation and comorbidities were reviewed. Outline of decompression and instrumental fusion in the lumbar spine. Review of costs of lumbar surgery, trends in hospital stay and costs both on a cumulative and daily basis. Comparison of the nationwide inpatient sample and national surgical quality improvement program databases for lumbar spine fusion procedures was reviewed and presented. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– 3-D printing and surgical planning discussion a variety of historical materials in the creation of patient specific implants based on unique individual anatomy. Historical trends in the creation of prosthetics with 3-D modeling software using neuroimaging data. Review of treatment complex spinal pathologies and surgical planning was discussed. Outline of current and future barriers to global implementation and commercialization was reviewed. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– discussion of current spine surgery training including fellowship programming in the United States. Accreditation Council for Graduate Medical Education (ACGME) cases logs were reviewed and discussed. Variability of procedures within programs and between medical specialty programs were outlined. Differential utilization between orthopedic and neurosurgical fellows was reviewed. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– pathophysiology and various craniospinal disorders. Directional phase contrast MRI (4D Flow) was reviewed along with the anatomical and physiological properties of cerebral spinal fluid. Specific disorders such as Alzheimer’s disease, hydrocephalus, Chiari Malformation and syringomyelia. Clinical correlation of CSF dynamics to understanding disease process was reviewed including normal and abnormal flow patterns. Recent advancements in fluid flow studies were outlined and presented. Signal intensity changes on MRI study in cervical spondylotic myelopathy was discussed and compared to normal parameters. Fluid dynamics patterns within syringomyelia and Chiari malformation was discussed and correlated to MRI findings and clinical presentations. Spinal microsurgical exploration surgery and resultant CSF leak and spontaneous intractable intracranial hypotension was reviewed and its pathoanatomical presentation outlined. Review of the natural and surgical history of Chiari malformation Type I in pediatric population and clinical correlation with MRI studies. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– Review of consequences of alterations in homeostatic control of the neuronal environment. Discussion of blood flow alterations and altered vessel permeability as determinants in the pathophysiology of brain injury. Review present day literature on the anatomy, development and physiological mechanisms of the blood–brain barrier. The blood brain barrier’s role in the maintenance of the extracellular environment. Vascular anatomy of the spinal cord was review in relation to the physiology of the neural environment. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– detailed review of the blood supply of the spinal cord, anatomy of the vascular system and physiology of blood flow. Pathophysiology of various conditions including Thoracic Aortic Occlusion and Spinal Cord Injury were discussed with specific relation to risk of neurological deficit. Severity and duration as an effect was reviewed and correlated clinically. Cerebral circulation and aging, discussion of effects on cognitive functioning and cerebrovascular disease in aging. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– MRI flow imaging and computational fluid dynamics in healthy patients with Chiari Malformations. Review of abnormal cerebral spinal fluid flow oscillations and their effects on healthy patients. Discussion of nonlaminar complex spatial and temporal variations with associated pressure waves and pressure gradients causing syringomyelia, headaches and other clinical manifestations in Chiari I malformation. Microsurgical anatomy and internal architecture of brainstem in 3D images and surgical considerations. CSF hydrodynamic changes, spinal cord injury and development of post traumatic syringomyelia (PTSM). Impact of spinal cord nerve roots and denticulate ligaments on cerebral fluid dynamics in the cervical spine was reviewed and discussed. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– differentiation between peripheral nerves and spinal nerve roots and effects of electrostimulation. Discussion of various stimulating or recording neurosurgical implants and success vs failure rates. Review of the nerve root compression and its relation to consequences of disc herniation and acute compression during surgery. Maximum pressure level a spinal nerve root can sustain is reviewed. Discussion of microsurgical anatomy of lumbosacral nerve rootlets, Rhizotomy and chronic spinal cord injury. Review of qualitative grading of severity of lumbar spinal stenosis on morphology of dural sac on MRI studies, review of classification systems and the consideration of impingement of neural tissue. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– discussion of stroke by embolism, source and cause in diagnosis and long-term treatment. Review of complex nature of embolus transport and its relation to etiology. Image based hemodynamics with discrete particle dynamics in relation to the distribution of emboli across the various cerebral arteries. Detailed anatomy of Circle of Willis reviewed and discussed with particular focus on size/inertia dependent trends in embolus distribution to the brain, distribution of cardiogenic versus aortogenic emboli among anterior, middle and posterior cerebral arteries, left versus right brain preference in cardio-embolus and aortic emboli transport and source-destination relationship for embolisms affecting the brain. Detailed review of the microsurgical anatomy of the posterior cerebral artery in three dimensional images. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– review of endovascular therapy in addition to standard care in acute ischemic vessel occlusion stroke. Comparison in National Institutes of Health Stroke Score (NIHSS) score, symptom onset, Alberta Stroke Program Early CT Score (ASPECTS) and occlusion location. Considerations in acute management and revascularization of tandem occlusions in acute ischemic stroke with literature review. Discussion of Transcirculation Pipeline embolization device deployment as a rescue technique. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– review of historical interventions, multilevel decompression and instrumented fusion in reduction of neural compression and spinal column stabilization. Discussion of morbidity and mortality in relation to surgical procedures. The use of the modified fragility index to predict 30-day morbidity and mortality from spine surgery. Differences in patient selection for minimally invasive versus open surgical procedures, and review of post-surgical outcomes. Morbidity, mortality and health care costs for patients undergoing spine surgery following ACGME resident duty-reform. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

-Predisposing factors for dural tears in lumbar spine surgery including degenerative conditions, prior surgery and age related indicators were reviewed. Discussion and review of re-admission rages in spine surgery through metanalysis and systematic review. Bibliometric study of the most important minimally invasive (MIS) spine surgery papers including Level III and IV studies with focus on moving toward Level I and Level II. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– review of lack of guidelines for the management of lower back pain in the ED. Frequency of lower back pain visitation in the emergency department including environmental/sociocultural dimensions and physical/psychospiritual dimensions were reviewed. Discussion of utilization of significant healthcare resources with complete description of lower back pain characteristics, health services use in non-urgent lower back pain patients presenting to the ED. Managing spine pain in the ED using usual and customary medical intervention. Extent of appropriate CT and MRI scans in the hospital setting, accessibility reviewed in conjunction with presented national data. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– review of ADHD medication utilization and motor vehicle accident data and frequency of motor vehicle accident sin this specific patient population. Review of the prevalent and preventable cause of morbidity and mortality among patients and concepts of restricting based on prognostic factors. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– review of imaging protocols among a spectrum of clinical indications, perspective on aging populations and clinical complexity. Review of CT, MRI, plain film imaging and ultrasound and their relationships to internal medicine and musculoskeletal disorders examined on an emergency basis through patient generated national survey data. Details of specific contexts in which imaging has become concentrated and targeted efforts for optimization of utilization. considerations of utilization of CT in the emergency department and evaluation to increasing trends. Review of quality improvements in imaging utilization. Comparison between pediatric and adult imaging protocols and trends. Discussion and analysis of “Choose Wisely” recommendations and creating of guideline/policy/clinical pathways in New England EDs. MRI utilization in pediatric ED reviewed and analyzed. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– traumatic injuries to the thoracolumbar spine and overall impact on emergency services. Discussion of exact definitions of Conus Medullaris Syndrome (CMS) and Cauda Equina Syndrome (CES). Diagnosis in acute phase and radiological findings clinically correlating with physical examination findings. Parameters for spinal regions of traumatic injury were presented and reviewed. Case presentations for neck and spine were included and reviewed with particular focus on differential diagnosis and case uniqueness. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– review of Ohio State University Emergency Medicine Residency Program Musculoskeletal Emergencies Curriculum. Outline of the significant nature of musculoskeletal emergency presentations to ED. Details in the training required to master clinical experience, self-directed learning and small group didactics. Case study reviews and discussion was presented with particular focus on infection vs non-infections and traumatic vs non-traumatic presentations in ED. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– discussion of limited evidence of long-term outcomes of opioids with non-opioid medication for chronic pain. Literature review on effectiveness for opioid interventions. Discussion of alternative recommendations, evidence demonstrating lack of benefit and poor long term outcomes. Variation in physician opioid prescriptions discussed. Patterns of opioid initiation at first visits for pain in the ED in the United States including frequency and dosage. Emergency Department data concerning the persistent pain after motor vehicle accidents and comparison between opioid and NSAID prescribed in the ED. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– review of patients presenting to ED with concussion with re-visitation within 72 hours. Mechanism of injury including closed head injury, assault, fall and motor vehicle accidents discussed. Epidemiological evidence presented regarding number of visitations, characteristics and care paths reviewed. Discussion of adoption of a more comprehensive discharge plan to further prevent repeat visits was outlined. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– Evaluation of data from the National Hospital Ambulatory Medical Care Survey and frequency of ED visitation. Percentage of visits requiring hospital admission was reviewed along with patterns of need for critical care. Review of imaging ordering statistics and clinical diagnosis was discussed. Details of primary and secondary ED diagnosis presented in relation to sprain/strain, contusion and spinal pathology including herniated intervertebral disc, facture and spinal cord compression. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– a review of the current representative data on ambulatory care visits to hospital emergency departments in the United States. Demographics, residence, insurance class, chief complaint with focus on traumatic injury, diseases of the nervous and musculoskeletal systems were outlined. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– detailed analysis of impact of lower back pain on ED globally. First systematic review of the trends in the literature including lower back pain as significant complaint and the variables in its definition. Discussion of the proper diagnosis and triage of lower back pain and its current impact on ED management was reviewed. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– case reports – detailed review of Spinal Cord Injury without Radiographic Abnormality was presented. Syndrome of post traumatic myelopathy demonstrable on MRI with no evidence of osseous injury on plain film or CT scan. Reporting of incidence was included with detailed discussion of case presentations, accurate diagnoses and triage was reviewed. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– traumatic brain injury, short and long term adverse clinical outcomes, death and disability reviewed and compared based on CDC data over a 7 year period. Mechanism of causation including motor vehicle accidents, falls and assault. Public health recommendations and interpretation of data was presented. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– CDC Data, Trends in Emergency Department Visits for Ischemic Stroke and Transient Ischemic Attack – relationship between stroke and statistical cause of death, type of stroke and prognosis related to recurrence was discussed. Specific definitions of ischemic stroke, transient ischemic attack with etiology and relationship to emergency visits were outlined and presented. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– pediatric utilization of emergency medicine resources, description of trends on a national basis. Detailed analysis of specific demographics including race and resident status were reported and reviewed. Discussion in allocation of resources including insurance class and coverage were reviewed. Anticipated expansion of Medicaid was considered and reviewed. Estimates of nonurgent ED visits by children were presented and discussed. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– discussion of primary care visits and lower back pain. Expenditures and contributions to disability data. Discussion of supply of chiropractic care in context of visits for lower back pain and primary care physicians. Estimated national impact of primary care visits and expenditures was outlined with a focus on chiropractic’s assistance in managing lower back pain. Defining an “episode” of lower back pain and relationship to collection of epidemiological data. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– review of adverse events associated with chiropractic care in the treatment of migraine. Outline of a prospective 3-armed, single-blinded, placebo RCT. Discussion of transient and mild events following chiropractic intervention. Randomized clinical trials and meta-analysis reviewed and discussed relating to the diagnosis and management of lower back pain including adverse event reporting. Risk of injury to the head, neck or trunk following an office visit for chiropractic spinal manipulation, as compared to office visit for evaluation by primary care physician. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– evaluation of the analgesic effects of spinal manipulation on both healthy and pain inflicted patients. Discussion of evidence of increased in pressure pain thresholds in musculoskeletal pain at both local and remote sites. Detailed knowledge of patient population regarding demographics and socioeconomic factors as well as disease-specific characteristics. Suggestion that lower back pain should not be seen as benign and self-limiting with focus on management. Describe the communication system surrounding the management of chronic pain from the perspectives of allopathic providers, acupuncture and chiropractor providers, and chronic musculoskeletal pain patients. Chiropractic manipulative treatment (CMT) association with lower healthcare costs among multiply-comorbid Medicare beneficiaries with an episode of chronic low back pain was reviewed. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– demographic review of data on the perceptions of chiropractic care. Review of patient interest, trustworthiness, costs and frequency of visits was discussed. Nationally representative survey to compare characteristics and use of survey respondents with positive and negative perceptions of DCs and chiropractic care. Positive perceptions of DCs were more common than those for chiropractic care. US adults generally perceive DCs in a positive manner. Describe the preferences of older adults for low back pain co-management by MDs and DCs and identify their concerns for receiving care under such a treatment model. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

- Discussion and development of an integrated care pathway for doctors of chiropractic, primary care providers, and mental health professionals who manage veterans with low back pain, with or without mental health comorbidity, within Department of Veterans Affairs health care facilities. Support for the inclusion of chiropractic care as a component of multidisciplinary health care for low back pain, as currently recommended in existing guidelines with a focus on US Service Members. Discussion of availability of chiropractic care to military healthcare systems, referral and interprofessional communication models. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– differences in outcomes, patient satisfaction, and related healthcare costs in spinal, hip, and shoulder pain patients who initiated care with medical doctors (MDs) vs those who initiated care with doctors of chiropractic (DCs). Pain of musculoskeletal origin and epidemiology of reduced productivity. Comparison of data on health outcomes, patient satisfaction, and related healthcare costs in patients consulting differing first-contact care providers for musculoskeletal pain. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– suggestion of a diverse role for chiropractors within conventional health care facilities. Discussion of chiropractic’s effectiveness for managing musculoskeletal disorders, particularly spine-related pain and disability. Descriptions of doctors of chiropractic who work in nongovernmental, private sector health care settings in the United States. Shared electronic health records, face-to-face informal consultations methods for interprofessional communication. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

- American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations on noninvasive treatment of low back pain. Systematically review the current evidence on non-pharmacologic therapies for acute or chronic non-radicular or radicular low back pain. Comparative benefits of non-pharmacological therapies in acute/subacute low back pain including exercise, spinal manipulation, lumbar supports, acupuncture, laser, ultrasound and traction. Discussion of first and second line therapies with reduction in opioid prescription. National Spine Management Group, Federation of Chiropractic Licensing Boards, Cleveland University College of Chiropractic, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine,

– a case review of traumatically induced acute cervical intervertebral disc extrusion with superior migration resulting in severe central canal stenosis and spinal cord impingement. A detailed review of physical examination findings, neurological evaluation, MRI images and surgical triage. Interprofessional communication both verbally and through proper evidence-based documentation. Academy of Chiropractic, Post-Doctoral Division,

– Case review of traumatically induced biomechanical pathology in the cervical spine in the absence of pre-existing degenerative change and ligament laxity. Review of underlying multi-level acute intervertebral disc herniation and clinical correlation to patient presentation. T1, T2 and STIR MRI review of acute intervertebral disc herniation in both sagittal and axial planes outlining correlation to radiologist report and electrodiagnostic findings. Academy of Chiropractic Post-Doctoral Division

- Case review of traumatically induced cervical and lumbar spine. Prior cervical fusion C4-7 with review of plain film radiographs, MRI studies and neurological evaluation. Biomechanical assessment revealed significant compensation in lumbar spine secondary to cervical disc herniation and grade 2 ligament injury above the prior fusion. Modic 2 changes on lumbar spine MRI. Care plan, interprofessional documentation and patient centered education. Academy of Chiropractic Post-Doctoral Division

- Case review of traumatically induced cervical spine grade 2 ligament tear with associated underlying degenerative disc disease and traumatic brain injury. MRI review and discussion of axonal shearing findings on advanced imaging, evidenced based triage to neurology concussion clinic and documentation. Clinical correlation to pre-existing electrodiagnostic evidence. Surgical co-management of anatomical and biomechanical pathology with post-op follow up, focus on interprofessional communication. Academy of Chiropractic Post-Doctoral Division

-a case review of traumatically induced cervical spine traumatic bulge of the intervertebral disc with concomitant grade 2 ligament injury was presented. Detailed anatomy and morphological presentation of normal and degenerative intervertebral disc presentation was demonstrated and reviewed. Review of morphological differences between disc bulge, disc herniation and disc protrusion was presented. Grade 1, Grade 2 and Grade 3 ligamentous sprains were reviewed and discussed. Radiographic analysis and objectification of grade 2 sprain was presented and its correlation to the AMA Guides to the Evaluation of Permanent Impairment 5th edition was reviewed. Interprofessional communication both verbally and through proper evidence-based documentation was emphasized and discussed.

a case review of traumatically induced multi-level cervical disc herniation with associated Grade 2 Ligament Injury rated as sub-threshold. Review of case history, physical examination findings, plain film radiographs, cervical spine MRI and bone scan. Radiographic analysis and objectification of grade 2 sprain was presented and its correlation to the AMA Guides to the Evaluation of Permanent Impairment 5th edition was reviewed. Review of the purpose, function and positive findings on bone scan was reviewed and demonstrated using patient’s fractured sternum. Interprofessional communication both verbally and through proper evidence-based documentation was emphasized and discussed.

– case review of spinal biomechanical engineering study in the care plan of non-responsive lower back pain. Review of medical care plan, epidural steroid injections and past medical history. Patient centered approach to full spine assessment in non-responsive chronic lower back pain with associated primary spinal mechanical lesion identified in upper thoracic spine.

– case review of traumatic injury to the cervical spine with underlying pre-existing traumatic injuries. Physical examination, neurological and orthopedic testing was clinically correlated to mechanism of injury, plain film radiographs and MRI studies. Comparison of T1, T2 and STIR views were reviewed in relation to intervertebral disc bulge, intervertebral disc herniation, Modic 1, Modic 2 and Modic 3 changes. Comparative review of causally related versus pre-existing changes was demonstrated.

a case review of traumatically induced multi-level cervical disc herniation with below a pre-existing spinal fusion. Review of case history, physical examination findings, plain film radiographs, cervical spine MRI with particular attention paid to osteophyte and modic changes. Interprofessional communication both verbally and through proper evidence-based documentation was emphasized and discussed focusing on acute versus chronic spinal injury.

Clinical Diagnosis of Traumatically Induced Intervertebral Disc Injury versus Pre-Existing Disc Bulge in the Cervical Spine-case review of pre-existing cervical spine degenerative disc disease, myomalacia and spinal cord compression with superimposed central canal stenosis due to overlying traumatically induced cervical disc herniation. Discuss of Modic 1 changes and acute injury with associated foraminal canal stenosis and acute intervertebral disc herniation. Causality related to mechanism of injury, physical examination presentation and analysis of bodily injury was presented.

Understanding the normal of spinal biomechanics and the neurotransmitters required for homeostasis. The interconnected role of Pacinian Corpuscles, Ruffini Corpuscles, Golgi Organ Receptors, Nociceptors, Proprioceptors and Mechanoreceptors in maintaining sagittal and axial alignment in the presence of mechanical pathology.

The literature, academic and clinical standards to age-date herniated discs. The clinical correlation the pain patters with advanced imaging finings of bone edema, spurs based upon the Piezoelectric effect of remodeling, high signal on T2 weighted images, Vacuum Discs and disc heights in determining the time frames of the etiology of the spinal disc pathology.

Understanding the timely triage necessities based upon clinical and imaging outcomes and the documentation required for collaborative physicians to continue care. Ensuring that the documentation is complete, reflective of services rendered and clear for third party consideration in an admissible format to considered in a medical-legal environment.

Understanding the lateral and ventral horn’s innovations of Pacinian Corpuscles, Ruffini Corpuscles, Golgi Organ Receptors, Nociceptors, Proprioceptors and Mechanoreceptors and the pathways through the spinal thalamic tracts through the periaqueductal region, the Thalamus into the Occipital, pre-frontal, sensory and motor cortexes and the efferently back through the Thalamus to disparate regions in creating spinal homeostasis, Pacinian Corpuscles, Ruffini Corpuscles, Golgi Organ Receptors, Nociceptors, Proprioceptors and Mechanoreceptors

Utilizing T1, T2, STIR and Gradient studies in determining myelomalacia, intra and extra-dural tumors and systemic disease patterns affecting the spinal cord. When to use contrast post-operatively in identifying disc structures vs. adhesions on postoperative advanced imaging. MRI Interpretation of herniated, circumferential bulges, focal bulges, protruded, extruded, comminuted, sequestered and fragmented discs. When to consider a neurosurgical consultation based upon the correlation of imaging and clinical findings

– A detailed review of spinal cord anatomy both in sagittal and axial sections with particular attention being paid to the three covering layers. Analysis of the structure, function and sensory innervation of the dura mater [aka the thecal sac], arachnoid mater and pia mater. Discussion of the sensory innervation of health and degenerative intervertebral discs was presented and outlined. Causality related to mechanism of injury, physical examination presentation and analysis of bodily injury was presented.

a detailed review of physical examination and assessment of traumatic cervical spine injury in a patient with a pre-existing spinal fusion at C3-C5. Discussion of pre-existing disc bulges versus traumatically induced intervertebral disc herniation was reviewed. Clinical correlation to prior history, current history, physical examination findings, MRI T1, T2 and STIR images, dynamic flexion/extension radiographs were provided. Definition and discussion of Alteration of Motion Segment Integrity (AOMSI) and its correlation to mechanism of injury and sensory pain fiber test was presented.

– a detailed review of spinal cord anatomy both in sagittal and axial sections with particular attention being paid to the three covering layers. Analysis of the structure, function and sensory innervation of the dura mater [aka the thecal sac], arachnoid mater and pia mater. Discussion of the sensory innervation of health and degenerative intervertebral discs was presented and outlined. Causality related to mechanism of injury, physical examination presentation and analysis of bodily injury was presented.

– a case review of objectification of spinal biomechanical pathology utilizing a Whole Organ Model of the human spine. Discussion of adjacent region mechanical dysfunction and clinical diagnosis utilizing sagittal and coronal plan data. Interprofessional communication both verbally and through proper evidence-based documentation was emphasized and discussed focusing on acute versus chronic spinal injury.

-case review of pre-existing cervical spine degenerative disc disease, myomalacia and spinal cord compression with superimposed central canal stenosis due to overlying traumatically induced cervical disc herniation. Discuss of Modic 1 changes and acute injury with associated foraminal canal stenosis and acute intervertebral disc herniation. Causality related to mechanism of injury, physical examination presentation and analysis of bodily injury was presented.

– case review of traumatic injury to the cervical spine with underlying pre-existing traumatic injuries. Physical examination, neurological and orthopedic testing was clinically correlated to mechanism of injury, plain film radiographs and MRI studies. Comparison of T1, T2 and STIR views were reviewed in relation to intervertebral disc bulge, intervertebral disc herniation, Modic 1, Modic 2 and Modic 3 changes. Comparative review of causally related versus pre-existing changes was demonstrated.

– A detailed review of physical examination and assessment of traumatic cervical spine injury in a patient with a pre-existing spinal fusion at C3-C5. Discussion of pre-existing disc bulges versus traumatically induced intervertebral disc herniation was reviewed. Clinical correlation to prior history, current history, physical examination findings, MRI T1, T2 and STIR images, dynamic flexion/extension radiographs were provided. Definition and discussion of Alteration of Motion Segment Integrity (AOMSI) and its correlation to mechanism of injury and sensory pain fiber test was presented.

Migration of spinal care for mechanical spine issues from hospitals and medical specialists to trauma qualified chiropractors based upon published outcomes. Utilizing imaging studies in spinal biomechanics, pain models and clinical outcomes to determine a conclusive diagnosis, prognosis and treatment plan for triaging in a collaborative environment.

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. PACE Recognized by The Federation of Chiropractic Licensing Boards', Academy of Chiropractic Post-Doctoral Division, Long Island, NY,

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. PACE Recognized by The Federation of Chiropractic Licensing Boards', Academy of Chiropractic Post-Doctoral Division, Long Island, NY

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. PACE Recognized by The Federation of Chiropractic Licensing Boards', Academy of Chiropractic Post-Doctoral Division, Long Island, NY,

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-Electronystagmography (V-ENG) interpretation, protocols and clinical indications for the trauma patient. PACE Recognized by The Federation of Chiropractic Licensing Boards', Academy of Chiropractic Post-Doctoral Division, Long Island, NY

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. PACE Recognized by The Federation of Chiropractic Licensing Boards', Academy of Chiropractic Post-Doctoral Division, Long Island, NY,

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. PACE Recognized by The Federation of Chiropractic Licensing Boards', Academy of Chiropractic Post-Doctoral Division, Long Island, NY,

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

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 homeostasis until tetanus ensues creating osseous changes under the effect of Wolff's Law

Disc pathology as sequela to trauma; herniation, extrusion, protrusion, sequestration and how the spinal unit as one system creates homeostasis to balance the pathology

Triage, care and collaboration for herniated, bulged, protruded, extruded and fragmented spinal discs. Compliant documentation of evaluation and management of new and established patients inclusive of chief complaint, history of present illness, review of systems, past-family-social histories with case management protocols and the required elements. Clinically coordinating treatment with subjective complaints, clinical findings and diagnosis for each encounter.

MRI History and Physics, 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

MRI Spinal Anatomy and Protocols, 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 Spinal Pathology, MRI interpretation of bone, intradural, extradural, cord and neural sleeve lesions. Tuberculosis, drop lesions, metastasis, ependymoma, schwannoma and numerous other spinal related tumors and lesions

MRI Methodology of Analysis, 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 sequelae.

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 sequelae, including bulge, herniation, protrusion, extrusion and sequestration.

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 slices, views, T1, T2, STIR axial, stacking, 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. Central canal and cauda equina compromise interpretation with management.

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 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 slices, views, T1, T2, STIR Axial, FFE, FSE and sagittal images in the interpretation of degenerative spondylolisthesis, 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.

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 sequelae to pathobiomechanics from trauma. The utilization of digital motion x-ray in diagnosing 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, ocular 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 rotational 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.

Digitalizing and analyzing the full spine images to diagnose pathobiomechanics as sequelae to trauma in relation to ligamentous failure and disc and vertebral pathology as sequelae. This includes anterior and posterior vertebral body elements in rotational 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.

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 gray matter, thalamus and cortices involvement.

The biomechanics of traumatic disc bulges as sequella 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.

Orthopedic Testing: Principles, Clinical Application and Triage, Integration of orthopedic testing in the clinical setting to develop a differential diagnosis. 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.

Orthopedic Testing: Cervical Spine, Integration of cervical orthopedic testing in the clinical setting to develop a differential diagnosis. 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.

Orthopedic Testing: Cervical Spine, Integration of cervical orthopedic testing in the clinical setting to develop a differential diagnosis. 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.

Orthopedic Testing: Lumbar Spine, Integration of lumbar orthopedic testing in the clinical setting to develop a differential diagnosis. 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.

Orthopedic Testing: Clinical Grand Rounds, Integration of 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. 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.

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.

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.

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.

Delta V issues correlated to injury and mortality, side impact crashes and severity of injuries, event data recorder reports correlated to injury, frontal impact kinematics, crash injury metrics with many variables and inquiries related to head restraints.

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.

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

Trends in hospital and emergent care in the healthcare delivery system inclusive of policies, hospital staffing and current care paths for mechanical spine issues.

Accurate and compliant documentation of history and clinical findings inclusive of functional losses, loss of activities of daily living, duties under duress and permanent loss of enjoyment of life. Prognosing static vs. stable care, gaps in care both in the onset and in the middle of passive care with a focus on detailed diagnosing. The integration of chiropractic academia, the court system and the insurance reimburser’s requirements for complete documentation.

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 in stroke 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.

Utilizing peer reviewed scientific literature in creating a diagnosis, prognosis and treatment plan for the chronic and acute patient. How to implement and stay current on techniques and technology in healthcare.

Utilizing detailed history and examination findings to determine the best care path for the patient. Clinical factors in determining the timelines for advanced imaging in both the trauma and non-trauma patients.

Report writing for legal cases, the 4 corners of a narrative and documenting damages with understanding defense medical documentation and consistent reporting of bodily injuries

Understanding report writing and the types of medical reports required for court inclusive of diagnosis, prognosis and treatment plans with requirements of reporting causality and permanency

Organizing your documentation and understanding all collaborative documentation and how it fits into your diagnosis, prognosis and treatment plan, Understanding the nuances of the functional losses of your patients related to their bodily injuries

Utilizing demonstrative documentation in direct examination and communicating the results of your care concurrently with the written documentation and reporting an accurate diagnosis for all images

The evaluation, interpretation and reporting of collaborative medical specialists results and concluding an accurate diagnosis inclusive of all findings and reviewing all images to ensure an accurate diagnosis

Determining and documenting disabilities and impairments inclusive of loss of enjoyment of life and duties under duress and the evaluation and validation of pain and suffering

Reporting your documentation factually and staying within the 4 corners of your medical report and scope of practice inclusive of understanding how your credentials allow you to report your documentation

The level of organization required in a medical-legal case that accurately reflects the bodily injuries of your patients and the time constraints in rendering an accurate report

Reviewing the facts of the case inclusive of your documentation, the defense medical examiner, medical specialists and the attorney to ensure accurate and consistent reporting

Creating demonstrative evidence, visuals of your patient's bodily injuries inclusive of x-rays, MRI's, CAT Scans and electrodiagnostic findings, the spinal biomechanics of herniated disc with ipsilateral findings and contralateral symptomatology

an evidence-based approach to the trauma patient, this seminar includes current trends in spine pain management in the Primary Care setting, a detailed review of the negative impact of mechanical spine pain on current primary care offices and the management of systemic internal medicine disease. Current trends in spinal pain management in Interventional Pain Management and the specific approaches were outlined by reviewing current peer-reviewed indexed research. Discussion on collaborative patient care and expectations from patient referral and current barriers to Interprofessional communication were outlined and discussed. Contemporary trends in spinal pain management in orthopedic and neurosurgery surgery were reviewed along with the criteria for effective and necessary referral to surgical providers. New trends in collaborative care and intervention utilizing a full spine model to ensure enhanced surgical outcomes where presented and reviewed. Pain Management pathways in Spinal Manipulation, mechanism of action at the peripheral and central nervous system level were outlined. Interprofessional communication between Primary Care, Medical Specialty and Surgeons was organized and reviewed with documentation protocols to ensure Evidence Based Care paths and Patient Centered Care is at the forefront of daily patient care. Spinal Manipulation research, evidence-based reviews and discussion of proper patient selection, outcomes measurement and interprofessional communication where presented in case study format.

Triage and Management of the Trauma and Non-Trauma Patient, Differentially diagnosing spinal issues in the trauma and non-trauma patient inclusive of spinal disc pathology utilizing x-ray, MRI, CAT Scan and clinical evaluations. Collaborative triaging protocols with neurologists, neurosurgeons, orthopedic surgeons, pain management and primary medical care providers with both mechanical and anatomical spinal pathologies. Academy of Chiropractic, Cleveland University - Kansas City Chiropractic and Health Sciences, Long Island, NY,

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. PACE Recognized by The Federation of Chiropractic Licensing Boards', Academy of Chiropractic Post-Doctoral Division, Long Island, NY,

Requisite and comprehensive biomechanics knowledge for forensic experts. Whiplash and brain injuries: the real reasons they are on the rise. The minimal property damage = minimal injury risk myth exposed. In-depth analysis of brain, neck, and cervical spine trauma mechanisms. Soft tissue injuries: a comprehensive and cutting edge analysis. All clinical syndromes and conditions resulting from whiplash (WAD/CAD). What forensic experts need to know about the various pain syndromes. Risk assessment: the fundamental key to modern forensic practice.

In-depth training on all aspects of management of trauma, from beginning to end; a comprehensive primer on crash reconstruction. Auto crash reconstruction in low speed crashes: critical knowledge for today's forensic practitioners. Historical documentation in personal injury and forensic medicine applications. Comprehensive physical examination of whiplash and traumatic brain injury. Special laboratory methods, such as the S-100 protein. The latest radiographic examination methods and analysis techniques. CT examination of brain and soft tissue injuries. MRI examination of brain and soft tissue injuries; latest techniques. Special diagnostic imaging modalities (SPECT, PET, fMRI, MRA, VF, etc.); how and when to use Electrodiagnostics (EMG, sEMG, SSEP, VEP, etc…); how and when to use. Rendering a diagnosis/impression in the personal injury or forensic setting; pearls and pitfalls. Soft tissue healing times and implications for successful case management. The state of the injury and implications for case management. Designing a treatment plan and living with guidelines. Important applications of activities of daily living; optimizing outcomes. Chiropractic manipulation, deep tissue massage, and PT Modalities for best outcomes.

Critical documentation from day 1; What every personal injury and forensic expert needs to know. The fundamental of expository, scientific writing you were never taught; common dos and don'ts. The essential craft of narrative report preparation from A-Z; style, strategy, methods, organization, and common pitfalls. Incorporating outcomes assessment and disability instruments into your reports (SCL-90-R, Oswestry, Roland-Morris, Rivermead PCS, and more). The application of AMA guidelines in personal injury and forensic practice. Modern guidelines and best practices (Presley Reed, Mercy, QTF, ACOEM, Croft); How they are commonly abused and how and when to use them correctly. Critical rebuttal methods and strategies in today's modern forensic practice. Special software applications: managing data, information, graphics; saving time.

Essentials of documentation and records keeping; what you need vs. what you don't Medical photography; when and how to use it and incorporate it. Taking the pain out of depositions, arbitrations, and testifying in court. Preparing for the classic cross-examination strategies. Critical differences between chiropractic and medical approaches that literally make or break a case. Using evidence effectively; models, charts, diagrams, photos, movies, and more. Daubert and Frye rules; how they affect your testimony and how they can exclude opposing experts. Disabusing the MIST myth; Colossus. Learned treatises and reliable authorities; other federal rules of evidence experts should know.

Normal anatomy of axial and sagittal views utilizing T1, T2, gradient and STIR sequences of imaging. Degeneration and annular fissures of discs in both trauma and non-trauma patients and the biochemical properties of joints in age dating pathology. Disc bulges from degenerative and sequelae to osseous issues, herniation pathology and protrusion, extrusion, migrated and sequestered variations. Clinical scenarios as a sequelae to disc and pre-existing pathologies