Dennis Mutell, DC

This qualification includes graduate chiropractic education in healthy and traumatically altered spinal morphology inclusive of osseous, connective tissue and neurological structure, function and pathology. This certifies you are qualified in assessing predictive models in spinal biomechanics and devising engineering paradigms for treatment plans to maximize spinal homeostasis in an evidenced based conclusion. In addition, this qualification acknowledges your expertise in triaging the injured and coordinating collaborative care from the trauma through conclusion of rehabilitation

Credentialed in hospital protocols, emergency room protocols, acute and chronic patient triage inclusive of MRI spine interpretation, spinal biomechanical engineering, head trauma, concussion, mild traumatic and traumatic brain injuries.

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

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

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.

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

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.

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. MRI samples will be provided

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

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

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

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.

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

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

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.

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

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

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

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

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

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

– 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

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

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

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

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

detailed overview of medial legal communication in relation to patient subjective and objective clinical findings. Outline of direct and cross-examination techniques were presented. Overview of Voir Dire and Daubert hearings were outlined. Discussion of examination of proof in relation to causality, bodily injury, and persistent functional losses was reviewed. Court testimony flow, professional expectations, and court room etiquette was presented and emphasized

discussion and outline of case management workflows related to the management of acute and chronic spine pain with a particular focus on pain of traumatic origin. Evidence-Based communication and Electronic Health Record processes were emphasized and presented. Patient management and triage based on patient history, physical examination and imaging findings was outlined. Overview of interprofessional referral options including physical therapy, interventional pain management and spine surgery was discussed in detail. Spine Management as concept was discussed by Dr. John Edwards, neurosurgeon in relation to reducing escalation of non-urgent cases as well as creating space for patients with urgent need.

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.

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

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

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.

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

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

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

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

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

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.

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.

– 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.

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

– 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

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

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

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

Volume RF, surface, quadrature and phase array coils and other hardware necessary for the generation of MRI imaging

magnetization, excitation, relaxion, acquisition, computing and display. T1 relaxion and relaxation curves, T2 relaxation, phase and phase coherence, T2 relaxion curves

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.

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.

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

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

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

– 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

– 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

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.

– 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.

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

– 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

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

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.

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

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

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 highresolution surface models, measures of bone volume and shape, and the 3-D kinematics of each segmented bone

normal motion of the shoulder joint compared with clinical implications of 6 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

- 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.

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.

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.

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

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

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

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

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

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.

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

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

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.

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

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.

– 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

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.

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

– 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

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

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.

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

– 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

– 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

– 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 11 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

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

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

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

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

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

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

– 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

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

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 13 in the ED

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

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

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

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

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

traumatic brain injury, short and long term adverse clinical outcomes, death and disability reviewed and compared 14 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

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

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

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

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 metaanalysis 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.

– 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 15 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

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

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 model

– 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 muscuoloskeletal 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

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.16 Shared electronic health records, face-to-face informal consultations methods for interprofessional communication

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 nonpharmacologic 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

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

Detailed review of the scientific literature supporting interprofessional collaboration between the spine surgeon and the Doctor of Chiropractic was presented. Emphasis on updated needs of the spine surgeon with focus on the understanding of pre and post-surgical chiropractic care. Literature updates and documentation requirements were discussed. Specific talking points are provided for telecommunication with the spine surgeon

Review of the scientific literature supporting interprofessional collaboration with the interventional pain management physician was outlined. Updates and review of the chiropractic scientific literature in relation to pain management mechanisms of the chiropractic adjustment were presented. Documentation and interprofessional referral, communication and telecommunication talking points for daily practice was outlined

Review of literature supporting interprofessional communication at the primary care level was presented. Literature outlining interprofessional communication and the needs of the primary care physician was discussed. Efficient reporting and communication points were reviewed. Chiropractic interaction with primary care physicians from a clinical perspective were outlined with an emphasis on supportive relationships.

Discussion on developing a collaborative relationship with physical therapy and its effect on outcomes and community-based care was outlined. Supportive scientific literature presenting the interaction between spinal biomechanics and supervised rehabilitative techniques was reviewed. Outcomes and interprofessional communication techniques were discussed with an emphasis on interprofessional referral and support of both professions

- Review and outline of complete workflows for patient evaluation, documentation and triage when clinically indicated were detailed. Efficiency and accuracy of interprofessional communication was presented in terms of the needs of the patient, pain management physician, spine surgeon, physical therapist, and primary care physician. Evidence based triage workflows were discussed and detailed with emphasis on preventing unnecessary escalation of care in spine pain patients was presented.

- Discussion of the medical-legal implications of injuries to the intervertebral disc was presented. Clinical correlation to mechanism of injury, objective physical examination findings, results of advanced imaging and persistent functional loss were reviewed. Medical legal discussion of anatomy of intervertebral disc herniation, degenerative bulge, annular tear, and their relationship to nerve supply in terms the legal community can understand was detailed

Discussion of the medical-legal implications of injuries to the ligaments of the human spine was presented. Clinical correlation to mechanism of injury, objective physical examination findings, results of advanced imaging and persistent functional loss were reviewed. Medical legal discussion of the anatomy of spinal ligaments in the normal, degenerative, and traumatically injured spine was presented. Details of nerve supply to ligaments and the mechanism of scar tissue formation through the wound repair process was provided

Discussion of the medical-legal implications of injuries sustained as a result of a low speed/impact collision resulting in minimal property damage was outlined. Clinical correlation to the low-speed mechanism of injury, objective physical examination findings, results of advanced imaging and persistent functional loss was reviewed. Medical legal discussion related to the correlation between impact forces and human spinal tolerance with particular attention being given to pre-existing degenerative spinal conditions was presented

Presentation on the flow of clinical information into the medical legal format used by adjusters, attorneys, judges, jurors, and law clerks was provided. Key indicators of persistent functional loss such as physical examination findings, global and segmental range of motion, advanced imaging findings and results of electrodiagnostic testing were outlined. Direct discussion on where in a narrative report these findings are to be written with an emphasis on patient assessment and expert opinion

Detailed review of common MRI sequences for spine imaging will be presented including T1, T2 and STIR in the sagittal and axial planes was presented. Additional sequences such as Proton Density, Diffusion Weighted and Dixon was detailed and reviewed. Particular attention were given to ordering contrast medium in a spine care practice

Overview of spine care leadership and the processes of creating an Evidence-Based, Patient Centered reputation in your community was discussed. Focus on structuring a medical community outreach program, what topics to include and the process of building support was detailed. This section outlined the differences between the various stakeholders in the medical community including nurses, physician assistants, physicians, and administrative support staff was discussed

- Overview of spine leadership and the process of creating a positive medical-legal provider reputation in your community was presented. Focus on structuring a legal community outreach program, what topics to include and the process of building support was detailed. This section outlined the differences between the various stakeholders in the legal community including adjusters, paralegals, lawyers, law clerks and judges was detailed

Detailed review of compliance parameters within clinical documentation with emphasis on detailed efficient processes was presented. Pitfalls common to clinical practice was demonstrated with practical, office ready solutions to ensure proper workflows, compliance, and efficiency were outlined. Whole practice documentation modeling was discussed including the use of a scribe

Review and discussion of 2021/2022 research supporting the chiropractic profession and the doctor of chiropractor as a spine care manager was outlined. Specific papers were presented related to the pain management, corrective, and health maintenance phases of chiropractic care. Overview of current and future research trends were demonstrated in relation to the pain management phase, corrective care phase and health maintenance phase of chiropractic management

outline of updated compliant reporting of the patient encounter within E/M evaluations, daily progress notes, goal setting and interprofessional management/referral was presented. Medical legal hurdles were explained and the impact of documentation on court room presentations was demonstrated. Overview of objective evidence in the diagnosis and management of traumatically injured patients was presented

discussion and review of litigation award Anchors and their influence on the chiropractic practice and documentation of functional losses due to spinal injury was outlined. Courtroom processes and review of testimony was presented. Consensus driven diagnosis and case management was emphasized. Objectification of bodily injury and its relation to short and long-term functional losses was presented

Review of essential biomechanical parameters in the human spine was presented. Emphasis was placed on their clinical application, patient outcomes and communication with the spine surgeon when applicable. Pre and post-surgical case management was reviewed in the context of peer-reviewed medically indexed literature. A look to the future of interprofessional spine care between the chiropractor and the surgeon was presented

Discussion of the role of a spine manager in the daily treatment of spine patients was presented. Emphasis was placed on the understanding of the roles of other providers in the care paradigm including interventional pain management, spine surgery and rehabilitation professionals. Interprofessional communication techniques were presented with a focus on diagnosis and management in a patient centered environment

- Overview of current literature-based examples of the evolution of chiropractic graduate education was presented. The need for clinical rotations, interprofessional communication and patient advocacy was detailed. Future training modules including learner outcome assessments and educational pathways were also outlined. Detailed review of the medical model of graduate education was detailed and explained with a pathway for chiropractic academic growth outlined

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

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

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

– 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 parsonagetuner syndrome, subscapular neuropathy and thoracic outlet were presented

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

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

discussion of the 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

– 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

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

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

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

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

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

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

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

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

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

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

Discussion of 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

– 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

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

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

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

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

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

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

review of the influence of osteoporosis on development of vertebral compression fracture was reviewed and detailed in comparison to neoplasm. Utilization of MRI as the gold standard for evaluating the age of and pathophysiology was discussed and presented. Absorptiometry was outlined and presented in relation to monitoring bone density. Interprofessional communication of absolute versus relative contraindications to conservative care and spinal manipulation was outlined and reviewed. Review of the three columns of vertebral architecture was detailed

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

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

Utilizing clinical findings in conjunction with advanced imaging and electrodiagnostic findings in managing collaborative relationships with medical specialists. Applying a literature standard to care to ensure conservative care as the first option.

Managing spinal related cases based upon MRI findings of herniations, bulges, protrusion, extrusions (comminuted and fragmented) utilizing thin-sliced acquisition protocols. When to consider ordering T1, T2, Short Tau Inversion Radiant, proton density and Dixon sequencing for spinal related pathology.

Creating literature-based documentation inclusive of history and a clinical examination that encompasses causality, diagnosis, prognosis and treatment plans. Ensuring the whole person impairment ratings are consistent with contemporary literature.

Spinal biomechanical engineering models related to pathobiomechanics and literature-based standards in creating an accurate diagnosis, prognosis, and treatment plan. Determining impairment ratings based upon alteration of motion segment integrity utilizing motion-imaging, and creating demonstrable evidence for continued treatment plans.

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

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

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

For Performance Optimization and Improving Outcomes through Clinical Analysis.

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.

Documenting electrodiagnostics, concussion and disc pathology as reflective of clinical findings when collaborating with medical specialists in private practice and hospital settings or in the medical-legal arena. Ensuring complete documentation in the evaluation and management process for both the initial and re-evaluation processes.

Concluding an E&M report in cases involving medical primary care providers of medical specialists that have complicated case histories, significant risk factors, and inconclusive findings. Triage and management of complicated cases requiring the clinical evaluation, advanced imaging and electrodiagnostics.

Contemporary acquisition protocols including slice thicknesses and sequences inclusive of the ordering process. Interpretation of axial, sagittal and coronal views in T1, T2 and stir views inclusive of the disc, spinal cord, extra-dural and intra-dural pathology.

Having referral relationships with emergency rooms, neurosurgeons, orthopedic surgeons, pain management specialists, neurologists, neuroradiologist and medical primary care providers based upon clinical dilemmas that processed after a thorough history, examination and imaging if clinically indicated to conclude diagnostic dilemmas. Utilizing evidence-based protocols and acquisition of images and treatment pathways, collaborating with medical specialists and primaries to conclude and accurate treatment plan.

Constructing and concluding an E&M (99202-99205) report that accurately reflects the history, clinical findings and management of trauma cases that concurrently meets the needs of both the carriers in the courts and ethical relationship that concurrently matches the standards of both contemporary academia requirements and a contemporary literature-based standard.

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 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.

A literature based model for collaborating with hospitals, medical primary care providers and specialists. Reviewing the documentation requirements to communicate the diagnosis, prognosis and treatment plans with medical entities and having the evidence as a basis for those recommendations.

MRI Spine Interpretation of the spine. How to triage a trauma and non-trauma with advanced imaging and document the necessity. We will also cover the basics of MRI Spine Interpretation inclusive of all types of herniations, bulges,

MRI Spine The spine-brain connection in managing chronic pain patients. Understanding how chronic pain negatively effects brain morphology and potential pathology as sequella. The role of chiropractic in preventing the loss of gray matter and the most recent evidence as outlined in indexed peer reviewed literature over the last 10 years verifying chiropractic’s role,

The biological, neurological and mechanical mechanisms and pathways from the thrust to the lateral horn and brain connection and how the brain processes the chiropractic spinal adjustment based upon the literature. Care paths of chiropractic and physical therapy from an outcome basis,

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,

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

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,

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

Correlating clinical findings and the patient history in determining the correct course of care in triaging the patient utilizing orthopedic and neurological evaluations in the clinical setting. Understanding the parameters for immediate referrals vs. following the continuum of care to determine the necessity for referrals,

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

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

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

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

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

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

Correlating clinical findings and the patient history in determining the correct course of care in triaging the patient utilizing orthopedic and neurological evaluations in the clinical setting. Understanding the parameters for immediate referrals vs. following the continuum of care to determine the necessity for referrals

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 understanindg 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

Describe basic clinical anatomy and physiology of the spine using magnetic resonance imaging, Discuss the spine including its main structures and function, Locate the major structures of the cervical, thoracic and lumbar spines on an MR image, Recognize the most common pathological conditions affecting the spine, Define the role of MR paramagnetic contrast agents used to image the spine, Describe some of the routine MR protocols for the spine.

A course describing the structural and functional organization of the spinal-pelvic system. Fundamental and advanced concepts on spinal biomechanics are introduced by presenting a coherent spinal model describing normal segmental coupling, regional adaptation and global compensation. The clinical model is a structural and mechanical engineering approach based on x-ray physics, mathematics and statistical analysis. The normal movements of gait are integrated in this total biomechanical approach to explain spine distortion, predictable functional scoliosis and lumbar disc failure. Case studies are demonstrated to radiographic analyses and physical findings to determine clinical solutions and soft tissue rehabilitation.

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

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

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

The clinical application of the results of space occupying lesions. Disc and tumor pathologies and the clinical indications of manual and adjustive therapies in the patient with spinal nerve root and spinal cord insult as 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 sequellae, 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 spondylolesthesis, spinal canal stenosis, Modic type 3 changes, central herniations, extrusions, compressions, nerve root compressions, advanced spurring and thecal sac involvement from an orthopedic, emergency room, chiropractic, neurological, neurosurgical, physical medicine perspective

Spinal Trauma Pathology, Triage and Connective Tissue Injuries and Wound Repair

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

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

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

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

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

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

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

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

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

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

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

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

To utilize whiplash associated disorders in various vectors of impact and whiplash mechanisms in determining pathobiomechanics. To clinically correlate annular tears, disc herniations, fractures, ligament pathology and spinal segmental instability as sequellae to pathobiomechanics from trauma. The utilization of digital motion x-ray in 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, occular and proprioceptive neurological integration in the righting reflex as evidenced in imaging. Digital and numerical algorithm in analyzing a spine,

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

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

Interdisciplinary approaches in documentation of spinal related injuries inclusive of connective tissue disorders and biomechanical failure. Clinically correlating history, imaging, advanced imaging and clinical findings to conclude an accurate diagnosis, prognosis and treatment plan,

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,

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,

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

MRI interpretation, physiology, history and clinical indications, bone scan interpretation, physiology and clinical indications, x-ray clinical indications for the trauma patient,

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

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.

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,

Bulging, herniated, protruded and extruded disc contemporary nomenclature, analysis and differential diagnosis. Connective tissue physiology and pathology with aberrant biomechanical permanent sequalae,

Normal vs. pathological biomechanical spinal motion both in a single motor unit and coupling actions. Interdisciplinary approach to mechanical spine issues and evidenced based care paths,

The bio-neuro-mechanical scientific foundation of spinal lesion and the neurological pathways, both in the lower and upper motor neuron pathways. The autonomic sequella of the vertebral subluxation and the effects of the correction and maintenance of those lesions,

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

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

Simultaneous Optimization of Synapic Serotonin, Dopamine, Norepinephrine and Epinephrine

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,

Mastering the In-office Nutritional Exam

Functional Nutrition for the female patient

Lecture and Lab with Gross Human Dissection

Algorithms for Common Clinical Conditions