Entitlement Eligibility Guideline Cervical Spine Conditions
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An Audit of Bone Mineral Density and Associated Factors in Patients With
Review Article Clinician’s corner Images in Medicine Experimental Research Case Report Miscellaneous Letter to Editor DOI: 10.7860/JCDR/2019/39690.12544 Original Article Postgraduate Education An Audit of Bone Mineral Density and Case Series Associated Factors in Patients with Orthopaedics Section Lumbar Spinal Stenosis Short Communication ARASH RAHBAR1, RAHMATOLLAH JOKAR2, SEYED MOKHTAR ESMAEILNEJAD-GANJI3 ABSTRACT Results: Overall, 146 patients with lumbar stenosis were Introduction: Osteoporosis is a major global health problem enrolled. Based on bone densitometry of spine and femur, and is commonly observed with lumbar stenosis in older 35 (24%) and 36 (24.7%) of the patients had osteoporosis. people. It is stated that osteoporosis may cause progressive According to femoral densitometry, age (OR=1.311, 95% CI: spinal deformities and stenosis in elderly patients. 1.167-1.473), being a female (OR=3.391, 95% CI: 1.391-8.420) and being a homemaker (OR=3.675, 95% CI: 1.476-9.146) Aim: To audit prevalence of low bone mineral density and were found as risk factors for osteoporosis. Based on spinal associated factors in patients with lumbar spinal stenosis. densitometry, age (OR=1.283, 95% CI: 1.154-1.427) and being Materials and Methods: Patients with symptomatic lumbar a female (OR=2.786, 95% CI: 1.106-7.019) were associated with spinal stenosis were recruited in this cross-sectional study, osteoporosis. Significant correlations were observed between who had been referred to Shahid Beheshti hospital in Babol, bone mineral density and red blood cell counts (r=+0.168, Northern Iran, between 2016 and 2017. -
Facet Joint Pathology
CLINICAL Facet Joint Pathology REVIEW Indexing Metadata/Description › Title/condition: Facet Joint Pathology › Synonyms: Facet joint syndrome; zygapophyseal joint pathology; facet joint arthropathy › Anatomical location/body part affected: Spine, specifically facet joint/s › Area(s) of specialty: Orthopedic rehabilitation › Description • Facet joints(1) –Fall under the category of synovial joints –Also called zygapophyseal joints • Types of facet joint pathology(1) –Sprain –Trauma to the capsule –Degenerative joint disease/osteoarthritis –Rheumatoid arthritis –Impingement - Pain and spasm result upon injury to the meniscoid - Generally occurs when the individual completes a quick or atypical movement - The movement typically entails spinal flexion and rotation –Prevalence of facet joint pathology has been estimated to be between 15% and 45% in patients with chronic low back pain(29) › ICD-9 codes • 724.8 other symptoms referable to back [facet syndrome] › ICD-10 codes • M24.8 other specific joint derangements, not elsewhere classified • M53.8 other specified dorsopathies • M54.5 low back pain Authors • M54.8 other dorsalgia Amy Lombara, PT, DPT • optional subclassification to indicate site of involvement for M53 and M54 Ellenore Palmer, BScPT, MSc –0 multiple sites in spine Cinahl Information Systems, Glendale, CA –5 thoracolumbar region Reviewers –6 lumbar region Rudy Dressendorfer, BScPT, PhD –7 lumbosacral region Cinahl Information Systems, Glendale, CA –8 sacral and sacrococcygeal region Lynn Watkins, BS, PT, OCS –9 site unspecified -
Nonoperative Treatment of Lumbar Spinal Stenosis with Neurogenic Claudication a Systematic Review
SPINE Volume 37, Number 10, pp E609–E616 ©2012, Lippincott Williams & Wilkins LITERATURE REVIEW Nonoperative Treatment of Lumbar Spinal Stenosis With Neurogenic Claudication A Systematic Review Carlo Ammendolia , DC, PhD, *†‡ Kent Stuber, DC, MSc , § Linda K. de Bruin , MSc , ‡ Andrea D. Furlan, MD, PhD , ||‡¶ Carol A. Kennedy, BScPT, MSc , ‡#** Yoga Raja Rampersaud, MD , †† Ivan A. Steenstra , PhD , ‡ and Victoria Pennick, RN, BScN, MHSc ‡‡ or methylcobalamin, improve walking distance. There is very low- Study Design. Systematic review. quality evidence from a single trial that epidural steroid injections Objective. To systematically review the evidence for the improve pain, function, and quality of life up to 2 weeks compared effectiveness of nonoperative treatment of lumbar spinal stenosis with home exercise or inpatient physical therapy. There is low- with neurogenic claudication. quality evidence from a single trial that exercise is of short-term Summary of Background Data. Neurogenic claudication benefi t for leg pain and function compared with no treatment. There can signifi cantly impact functional ability, quality of life, and is low- and very low-quality evidence from 6 trials that multimodal independence in the elderly. nonoperative treatment is less effective than indirect or direct Methods. We searched CENTRAL, MEDLINE, EMBASE, CINAHL, surgical decompression with or without fusion. and ICL databases up to January 2011 for randomized controlled Conclusion. Moderate- and high-GRADE evidence for nonopera- trials published in English, in which at least 1 arm provided tive treatment is lacking and thus prohibiting recommendations to data on nonoperative treatments. Risk of bias in each study was guide clinical practice. Given the expected exponential rise in the independently assessed by 2 reviewers using 12 criteria. -
Double Spinal Cord Injury in a Patient with Ankylosing Spondylitis
Spinal Cord (1999) 37, 305 ± 307 ã 1999 International Medical Society of Paraplegia All rights reserved 1362 ± 4393/99 $12.00 http://www.stockton-press.co.uk/sc Case Report Double spinal cord injury in a patient with ankylosing spondylitis MN Akman*,1 M KaratasÎ1, SÎ KilincË 1 and M AgÏ ildere1 1Department of Physical Medicine and Rehabilitation and Radiology, BahcË elievler, Ankara, Turkey Ankylosing spondylitis patients are more prone to spinal fractures and these fractures commonly result in mobile nonunion. We report a patient with a 30-year history of ankylosing spondylitis who sustained double spinal cord injuries following minor trauma. The ®rst injury occurred at the lumbar level due to pseudoarthrosis of an old fracture, and the second at the thoracic level following cardiopulmonary arrest and an episode of hypotension. The possible mechanisms of the injuries are discussed and maintaining normal blood pressure in these patients is emphasized. Keywords: spinal cord injury; ankylosing spondylitis; spinal cord infarction; spinal fractures Introduction Ankylosing spondylitis (AS) has a prevalance of 1 per diagnostic workup. His arterial blood pressure stayed 1000 in the general population and primarily involves below normal and his central venous pressure remained 1 the vertebral column. Spinal rigidity due to long- below 5 cmH2O for about 12 h. ECG, chest X-Ray standing AS renders the patient susceptible to vertebral and cranial computed tomography (CT) were normal. trauma, so that even minor trauma may cause When the patient awoke and was in a stable condition, fractures.2±9 There are only a few reports in the he could not feel or move his legs. -
Self-Help for Spinal Stenosis Information for Patients
Self-help for Spinal Stenosis Information for patients What is spinal stenosis? Spinal stenosis is a common condition affecting the lower back. It affects people over the age of 60 years. Spinal stenosis can result in symptoms including back pain, buttock pain and leg pain. Other symptoms include pins and needles, numbness and sometimes weakness in the legs or feet. If you have spinal stenosis you will likely experience a combination of these symptoms. What causes spinal stenosis? The spinal cord runs through a tunnel made from the bones in your back called vertebrae. This is because the bones are strong and act to protect the spinal cord. The nerves then branch out from the spinal cord and pass through smaller tunnels at the side of your spine. Sometimes the aging process leads to narrowing in parts of the lower back. This usually occurs gradually over time. The nerves and spinal cord may become tightened or squeezed as a result of this narrowing. Stenosis is the medical term for narrowing. Narrowing in the spine is very common but not everyone who has it will develop symptoms. Spinal stenosis can also occur at different levels in the spine. It is possible to get similar symptoms in your legs and feet that are not caused by spinal stenosis. Will spinal stenosis get better? It is not possible to reverse any age-related changes in the back; however it is possible to manage and improve your symptoms. Many people will experience “flare-ups” so it is important that you are confident in ways to manage your symptoms. -
Cervical Spondylosis
Page 1 of 6 Cervical Spondylosis This leaflet is aimed at people who have been told they have cervical spondylosis as a cause of their neck symptoms. Cervical spondylosis is a 'wear and tear' of the vertebrae and discs in the neck. It is a normal part of ageing and does not cause symptoms in many people. However, it is sometimes a cause of neck pain. Symptoms tend to come and go. Treatments include keeping the neck moving, neck exercises and painkillers. In severe cases, the degeneration may cause irritation or pressure on the spinal nerve roots or spinal cord. This can cause arm or leg symptoms (detailed below). In these severe cases, surgery may be an option. Understanding the neck The back of the neck includes the cervical spine and the muscles and ligaments that surround and support it. The cervical spine is made up of seven bones called vertebrae. The first two are slightly different to the rest, as they attach the spine to the skull and allow the head to turn from side to side. The lower five cervical vertebrae are roughly cylindrical in shape - a bit like small tin cans - with bony projections. The sides of the vertebrae are linked by small facet joints. Between each of the vertebrae is a 'disc'. The discs are made of a tough fibrous outer layer and a softer gel-like inner part. The discs act like 'shock absorbers' and allow the spine to be flexible. Strong ligaments attach to adjacent vertebrae to give extra support and strength. Various muscles attached to the spine enable the spine to bend and move in various ways. -
Chapter 4: Massage and Sciatica: an In-Depth Study 2 CE Hours
Chapter 4: Massage and Sciatica: An In-Depth Study 2 CE Hours By: Kerry Davis, LMT, CIMT, CPT Learning objectives Define the characteristics of sciatica. Discuss how to construct a treatment plan. Recognize the causes of sciatica. Discuss how to assess the client’s posture and gait. Compare sciatica with other conditions of the low back. Describe the evaluation of the client’s pain patterns and symptoms. Distinguish the muscle imbalance patterns attributing to sciatica. Demonstrate practice of test assessments to rule out other Understand the pattern of referred pain resulting from sciatica. conditions of the low back. Illustrate application of massage techniques to treat the client. Overview Low back pain affects more than three million people in the United encounter multiple cases during the course of their practice due to the States each year (Werner, 2002). According to a 2010 survey, low back impact that low back pain has on society. This course will educate the pain was listed as the third most oppressive condition afflicting people. massage therapist about how to identify sciatica. It will also familiarize Low back pain does not discriminate between men and women and the therapist with the most common causes of sciatica, discuss usually presents as early as the age of thirty; in fact, the prevalence differences between sciatica from piriformis syndrome and sacroiliac increases in correlation with age (National Institute of Neurological joint dysfunctions, examine the proper evaluation of the condition, as Disorders and Stroke, 2015). It is likely that massage therapists will well as develop the treatment protocols for sciatica. UNDERSTANDING SCIATICA Sciatica, or lumbar radiculopathy, is characterized as an inflammation in the feet and toes. -
Cervical Fusion
Medical Coverage Policy Effective Date ............................................. 6/15/2021 Next Review Date ....................................... 6/15/2022 Coverage Policy Number .................................. 0527 Cervical Fusion Table of Contents Related Coverage Resources Overview .............................................................. 1 Acupuncture Coverage Policy ................................................... 1 Bone, Cartilage and Ligament Graft Substitutes General Background ............................................ 4 Bone Growth Stimulators: Electrical (Invasive, Medicare Coverage Determinations .................... 9 Noninvasive), Ultrasound Coding/Billing Information .................................... 9 Discography Intervertebral Disc (IVD) Prostheses References ........................................................ 11 Intraoperative Monitoring Lumbar Fusion for Spinal Instability and Degenerative Disc Conditions, Including Sacroiliac Fusion Minimally Invasive Intradiscal/Annular Procedures and Trigger Point Injections INSTRUCTIONS FOR USE The following Coverage Policy applies to health benefit plans administered by Cigna Companies. Certain Cigna Companies and/or lines of business only provide utilization review services to clients and do not make coverage determinations. References to standard benefit plan language and coverage determinations do not apply to those clients. Coverage Policies are intended to provide guidance in interpreting certain standard benefit plans administered by Cigna Companies. -
Managing Spinal Conditions in Older Persons
JAMES ZUCHERMAN, MD JUDY SILVERMAN, MD Considering the patienfs overall medical status is crucial Managing spinal conditions in older persons ABSTRACT: Older patients who present with spinal complaints do not need to accept pain and diminished functional capacity as conse quences ofaging. Spinal stenosis results from the natural progression ofdegenerative changes in the spine. Thoracolumbar compression fractures usually are caused by trauma but also are common in pa tients who have osteoporosis. Mobility testing can help identif]^ un derlying pathology and deinse an exercise program. It is important to screenfor other causes ofpain, such as hip pathology. Radiography, MRI, and CTare useful imaging studies. The presence ofcauda equina syndrome requires urgent imaging and, usually, surgery. In This is the seventh in a special se some cases, a short course ofphysical therapy can reverse symptoms. ries ofarticles on the evaluation Lumbar or thoracic osteoporoticfracture treatmentfocuses on and management ofback pain. symptom management. (J Musculoskel Med. 2005;22:214-222) The percentage of the US popula the most common severe condi healthful living habits. Judicious ' tion older than 65 years has been tions in older persons. Consider use of exercise, proper body me increasing during the past centu ing a patient's overall medical sta chanics, medications, and surgery , ry and is peaking as baby boomers tus is crucial in management of can result in improvement in func- ; reach older age, Many older per these problems, because comor- tion and quality of Hfe. In this ar- | sons have aches, pains, and dimin bidities can affect treatment op tide, we describe the diagnosis ished functional capacity but do tions and outcomes. -
Adult Spinal Deformity and Its Relationship with Height Loss
Shimizu et al. BMC Musculoskeletal Disorders (2020) 21:422 https://doi.org/10.1186/s12891-020-03464-2 RESEARCH ARTICLE Open Access Adult spinal deformity and its relationship with height loss: a 34-year longitudinal cohort study Mutsuya Shimizu1* , Tetsuya Kobayashi1, Hisashi Chiba2, Issei Senoo1, Hiroshi Ito1, Keisuke Matsukura3 and Senri Saito3 Abstract Background: Age-related height loss is a normal physical change that occurs in all individuals over 50 years of age. Although many epidemiological studies on height loss have been conducted worldwide, none have been long- term longitudinal epidemiological studies spanning over 30 years. This study was designed to investigate changes in adult spinal deformity and examine the relationship between adult spinal deformity and height loss. Methods: Fifty-three local healthy subjects (32 men, 21 women) from Furano, Hokkaido, Japan, volunteered for this longitudinal cohort study. Their heights were measured in 1983 and again in 2017. Spino-pelvic parameters were compared between measurements obtained in 1983 and 2017. Individuals with height loss were then divided into two groups, those with degenerative spondylosis and those with degenerative lumbar scoliosis, and different characteristics were compared between the two groups. Results: The mean age of the subjects was 44.4 (31–55) years at baseline and 78.6 (65–89) years at the final follow- up. The mean height was 157.4 cm at baseline and 153.6 cm at the final follow-up, with a mean height loss of 3.8 cm over 34.2 years. All parameters except for thoracic kyphosis were significantly different between measurements taken in 1983 and 2017 (p < 0.05). -
Delayed Diagnosis of Tandem Spinal Stenosis: a Retrospective Institutional Review
International Journal of Spine Surgery, Vol. 13, No. 3, 2019, pp. 283–288 https://doi.org/10.14444/6038 ÓInternational Society for the Advancement of Spine Surgery Delayed Diagnosis of Tandem Spinal Stenosis: A Retrospective Institutional Review AMIT BHANDUTIA, MD, LUKE BROWN, MD, MBA, ALYSA NASH, MD, IAN BUSSEY, MD, MARK SHASTI, MD, EUGENE KOH, MD, PHD, KELLEY BANAGAN, MD, STEVEN LUDWIG, MD, DANIEL GELB, MD Department of Orthopaedics, University of Maryland Medical Center, Baltimore, Maryland ABSTRACT Background: Tandem spinal stenosis (TSS) is defined as simultaneous spinal stenosis in the cervical, thoracic, and/or lumbar regions and may present with both upper and lower motor neuron symptoms, neurogenic claudication, and gait disturbance. Current literature has focused mainly on the prevalence of TSS and treatment methods, while the incidence of delayed TSS diagnosis is not well defined. The purpose of this study was to determine the incidence of delayed TSS diagnosis at our institution and describe the clinical characteristics commonly observed in their particular presentation. Methods: Following institutional review board approval, an institutional billing database review was performed for patients who underwent a spinal decompression procedure between 2006 and 2016. Thirty-three patients who underwent decompression on 2 separate spinal regions within 1 year were included for review. Patients with delayed diagnosis of TSS following the first surgery were differentiated from those with preoperative diagnosis of TSS. Results: TSS requiring surgical decompression occurred in 33 patients, with the incidence being 2.06% in this cohort. Fifteen patients received a delayed diagnosis after the first surgical decompression (45%) and were found to have a longer interval between decompressions (7.6 6 2.1 months versus 4.01 6 3 months, P ¼ .0004). -
Protocols Full Document
STATE OF RHODE ISLAND WORKERS’ COMPENSATION COURT MEDICAL ADVISORY BOARD PROTOCOLS Approved by the Medical Advisory Board Rhode Island Workers’ Compensation Court John Parziale, MD Robert M. Ferrieri Chair Chief Judge Workers’ Compensation Court Sheila G. Mitchell, RN, BSN Medical Advisory Board Administrator Effective: 1/28/2020 1 TABLE OF CONTENTS YEAR PROTCOL WAS LAST REVIEWED . 3 PREFACE. 4 CARPAL TUNNEL SYNDROME . 5 CERVICAL MUSCULOLIGAMENTOUS INJURY (Sprain/Strain) . 8 HERNIATED CERVICAL DISC . 11 PROTOCOLS FOR INJURIES TO THE EYE . 15 PROTOCOL FOR THE EVALUATION AND MANAGEMENT OF ACUTE SHOULDER INJURIES . 26 PROTOCOL FOR THE MANAGEMENT OF ACUTE INJURIES TO THE KNEE . 29 LOW BACK MUSCULOLIGAMENTOUS INJURY (SPRAIN/STRAIN). 33 HERNIATED LUMBAR DISC. 36 LUMBAR FUSION.. 40 TRAUMATIC BRAIN INJURY.(formerly Post Traumatic Headache) . 42 CHRONIC REGIONAL PAIN SYNDROME (formerly Symp. Dyst.). 47 THORACIC OUTLET SYNDROME . 51 PROTOCOLS FOR INJURIES TO THE FOOT AND ANKLE. 54 WORKERS COMP. PROTOCOLS WHEN PRIMARY INJURY IS PSYCHIATRIC/PSYCHOLOGICAL. 69 OUTPATIENT PHYSICAL AND OCCUPATIONAL THERAPY PROTOCOL GUIDELINES. 84 ACOUSTIC TRAUMA. 91 INTERVENTIONAL PAIN MANAGEMENT TREATMENT PROTOCOL . 95 WORK HARDENING PROTOCOLS . 113 PROTOCOL FOR THE MANAGEMENT OF HERNIAS . .. 118 ACUPUNCTURE.. 123 TEMPOROMANDIBULAR JOINT DISORDERS.. 126 ACUTE HAND INJURY PROTOCOLS.. 131 PHARMACEUTICAL PROTOCOLS . 144 CONTACT DERMATITIS PROTOCOL. 145 CUBITAL TUNNEL SYNDROME.. 147 RADIAL TUNNEL SYNDROME . 150 SPINAL COLUMN STIMULATORS . 153 ANTERIOR CRUCIATE RUPTURES . 155 HEARING LOSS PROTOCOL . 157 INITIAL VOCATIONAL ASSESSMENT PROTOCOL GUIDELINES. 159 HIERARCHY OF VOCATIONAL REHABILITATION. 161 OCCUPATIONAL HEARING IMPAIRMENT TREATMENT PROTOCOL . 162 DIAGNOSIS AND INITIAL TREATMENT OF OCCUPATIONAL ASTHMA . 166 CHRONIC NONINTERVENTIONAL, NONCANCER PAIN PROTOCOL . 174 2 YEAR PROTOCOL WAS LAST REVIEWED PREFACE CARPAL TUNNEL SYNDROME .