Matthew James, DC FSBT(c)

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 demonstrating.

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.

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

review and detailed presentation of the frequency of traumatic ligament injuries in the cervical spine was outlined. Imaging modalities such as dynamic plain film radiographs and MRI were discussed with emphasis on stability and presence of acute injuries. Threshold for medical specialty referral was presented within the context of conservative vs surgical management. Outline of patient presentation, physical examination findings including orthopedic and neurological findings was presented. Application of AMA Guidelines to the rating of injury severity using both the 5th and 6th edition of the Guides to the Evaluation of Permanent Impairment was reviewed.

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

Review and outline of building blocks of ligaments and tendons was presented, specific focus on collagen, elastin, ligamentocytes/tenocytes, and proteoglycans. Outline of changes to ligament histology due to pathological mechanical stress was presented in detail. Phases of ligament repair were discussed including inflammatory, remodeling and proliferation. Ligamentous scaring was presented with specific focus on inflammatory cytokines and inability of injured ligaments to resemble pre-injury histological structure was applied.

detailed review of the important components of causal relationship in a medical legal case including pre-existing conditions, the difference between aggravation and exacerbation, correlation of bodily injury and property damage as well as acute and chronic features on advanced imaging scans. Specific outline of different body tissue types and the mechanism of injury that produces objective traumatic evidence and functional loss was presented and reviewed. Tissue type in relation to history of litigation was presented with focus on litigation pathways related to bone and disc trauma. Outlined an overview of an organized legal report presented at maximum medical improvement was presented including medical chronology, progression of patient care, functional limitations, and statutory language.

Overall description and organization of the five main types of collagen in the human body was presented. Specific genetic defects resulting in collagen deficiency specifically manifested as Ehlers-Danlos Syndrome and Marfans Syndrome was presented. Detailed overview of Osteogenesis Imperfecta was presented and discussed. Specific details of Ehlers-Danlos Vascular Syndrome were outlined. Focus on collagen disorders was targeting vascular frailty and relative vs absolute contraindications to chiropractic care.

a look at the evidence – overview and discussion of the role of chiropractic management in the spine pain patient. Literature review of the last twenty-one years was presented with a focus on research trends. Systematic review of modulation of pain in the central nervous system post chiropractic adjustment was presented. Additional literature was reviewed demonstrating reduction in opioid prescription utilization in acute and chronic spine pain. Review of future trends such as chiropractic influence on brain metabolism was presented. Interprofessional co-management was emphasized and reviewed.

detailed review of upper cervical anatomy and spinal biomechanics was reviewed. Specific attention to upper cervical ligamentous attachments and histological descriptions was given. Review of clinical indicators for upper cervical spine fusion and predominant patient population was outlined. Emphasis was placed on concomitant diagnosis of structural and biomechanical sources of spine pain. Interprofessional communication pathways were reviewed. Evidence based approach to post-surgical care was presented focused on physician experience, published literature and patient response. Outline of a systemized approach to the diagnosis and management of the patient with post-surgical upper cervical fusion was presented and discussed.

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

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

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

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

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

Ethics and risk management as it applies to patient encounters, documentation, treatment, billing and coding practices, the workplace environment, and administration. Detailed review of current rules, laws and guidelines for documentation of all patient encounters as required by the Texas Chiropractic Board of Examiners, Centers for Medicare and Medicaid, HIPAA and insurance carriers.

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

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

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

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

detailed review of upper cervical anatomy and spinal biomechanics was reviewed. Specific attention to upper cervical ligamentous attachments and histological descriptions was given. Review of clinical indicators for upper cervical spine fusion and predominant patient population was outlined. Emphasis was placed on concomitant diagnosis of structural and biomechanical sources of spine pain. Interprofessional communication pathways were reviewed. Evidence based approach to post-surgical care was presented focused on physician experience, published literature and patient response. Outline of a systemized approach to the diagnosis and management of the patient with post-surgical upper cervical fusion was presented and discussed.

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

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

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

Detailed discussion of the “gold standard” tests that objectify injury in the human spine. Assessment of muscle, tendon/ligament, intervertebral disc, spinal nerve, and boney injuries was presented and correlated to imaging findings. Physical examination findings examples were correlated for the compliant need for testing orders including but not limited to plain film radiographs, MRI, CT, EMG/NCV and Bone Scan.

Detailed analysis of the 2022-2023 scientific literature supporting chiropractic management of the spine pain patient. Outline of supporting evidence in the pain management, corrective care and health maintenance phases of care was presented. Peer reviewed medically indexed papers were discussed and correlated to trends in research with emphasis on the RAND Corporation’s Center for Collaborative Research in Complementary and Integrative Health was presented.

Anatomy of the healthy intervertebral disc and its nerve supply was reviewed. An overview of the histological structure of the intervertebral disc was presented. Discussion of the chemical and histological make-up of the intervertebral disc including vascular, proteoglycan and extracellular matrix composition was outlined and presented. Specific innervation and vascularization patterns and their relation to pain generating injuries was explained.

Anatomy of the degenerative intervertebral disc and its nerve supply will be reviewed. An overview of the histological structure of the degenerating intervertebral disc was presented. Discussion of the chemical and histological make-up of the degenerative intervertebral disc including vascular, proteoglycan and extracellular matrix composition will be presented. Key differences between the healthy and degenerative disc will be outlined including neovascularization and the ingrowth of free nerve endings.

Detailed presentation of intervertebral disc nomenclature as outlined by the combined task forces of the North American Spine Society, the American Society of Spine Radiology, and the American Society of Neuroradiology. Specific classification parameters and descriptions of intervertebral disc bulge, protrusion, herniation, extrusion, sequestration, and traumatic disc bulge will be presented and reviewed. Differences in morphological description were presented with sagittal and axial MRI examples. Review of clinical correlation to etiology was discussed.

Presentation of the ligamentous structures of the human spine including but not limited to the anterior longitudinal, posterior longitudinal, intertransverse, facet capsular, ligamentum flavum, interspinous and supraspinous ligaments was outlined. Histological presentation will be provided with focus on regional adaptation to ligamentous microscopic structure with details presented on intracellular matrix and cytokine activity following traumatic events. Emphasis was placed on injury thresholds using the stress/strain curve as a guide.

Biomechanical alterations and their effect on spinal ligaments will be presented including isotropic and anisotropic changes in ligament function. Clinical correlation will be provided based on radiographic findings, traumatic events, and chronic compensatory pain patterns. Emphasis was placed on recent peer- reviewed evidence showing transection of one ligament in the spine has an influence on all others. Correlation to chiropractic care was emphasized.

Detailed overview of sagittal balance in both a whole spine and regional perspective will be presented. Correlation to segmental changes will be reviewed. Interprofessional communication with primary care and medical specialists will be outlined with focus on kyphotic, lordotic and pelvic parameters. Emphasis was placed on pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis, thoracic kyphosis, T1 angle and cervical lordosis. Discussion of these biomechanical parameters within the corrective phase of chiropractic and communication with the spine surgeon was emphasized.

Overview and specific examples of interprofessional communication with the medical community were discussed. Common mistakes relating to speaking with primary care, interventional pain management and spine surgeons will be presented and reviewed. Emphasis will be placed on diagnosis and management of the spine pain patients within the pain management, corrective, and health maintenance phases of chiropractic care. Presentation was supported by examples published in the peer reviewed medically indexed scientific literature.

Presentation on the anatomy of medical-legal reporting and connective tissue diagnosis was provided. Overview of the care paradigm was presented including causal relationship, bodily injury, and persistent functional loss. Objectification of spinal injury and delineation between new and pre-existing conditions was outlined. Specific case reporting and timelines for accurate explanation of bodily injury was detailed.

Modernization of documentation workflows were presented with focus on E/M evaluations and care schedules. Medical necessity and clinical timing were outlined and addressed relating to diagnostic testing and specialist referral. The benefits of using case findings to reach out to the medical community was addressed and compared to outreach processes.

Common pitfalls and risk factors related to professional liability will be reviewed including physical examination and diagnostic duties. Review of professional boundaries will be presented. Proper patient intake, examination and clinical behavior will be presented. Emphasis will be placed on adverse events risk factors such as hypertension and genetic connective tissue disorders including Marfans and Ehlers-Danlos Syndrome were outlined.

Overview of professional reporting systems in the modern area including completion of clinical reporting timely, outline of clinical information to include in specialist referral and imaging orders will be presented. Details of interprofessional communication to the primary care physician, spine surgeon and interventional pain management provider was detailed and explained.

An in-depth review of basic neuroanatomy and physiology dermatomes and myotomes to both the upper and lower extremities and the neurophysiology of axons and dendrites along with the myelin and function of saltatory for conduction the sodium and potassium pump’s function in action potentials

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 were provided in group discussion

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

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

An 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

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

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

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

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

This 4-hour course will break down the need for exceptional chiropractic documentation, which is for more than insurance reimbursement, and illustrate how this can be accomplished in very little time. By documenting properly, chiropractors can show the world who we are and what we do, and how effective chiropractic treatment is.

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

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

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

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 front-line 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 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

review of objectification of neurological deficits including loss of sensation, aberrant deep tendon reflexes, loss of strength and the presence of pathological reflexes was presented and discussed. Criteria for co-management in the presence of neurological deficits with the pain management physician and the spine surgeon was outlined. Detailed presentation on CPT coding and E/M documentation requires was discussed and reviewed. Absolute and relative contraindications to chiropractic care was demonstrated and outlined.

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.

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

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

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.

Differential diagnosis of facet syndrome thoracic radiculopathy and discogenic pain including structural innervation of surrounding tissues and intervertebral discs with referral pattern was reviewed and discussed Subsequent failure of chiropractic care and rehabilitation leading to multilevel thoracic spinal fusion was demonstrated and reviewed Plain film radiographs and MRI evaluation of the thoracic spine sagittal and axial images in T1 T2 and STIR was demonstrated and clinically correlated to objective findings and subjective complaints Interprofessional referral and documentation were outlined and discussed

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

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

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

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

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

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

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

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

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

The credentials and knowledge based on an academia perspective when cooperatively treating in a collaborative environment inclusive of understanding pathology and mechanical spine issues

Integrating Spinal Biomechanical Engineering and MRI Spine Interpretation into a primary spine care model inclusive of necessity and acquisition protocols A comprehensive review the latest evidence in documenting mechanical issues

Understanding hospital and medical specialist’s care paths for mechanical spine pathology and integrating the Doctor of Chiropractic in the hospital and allopathic treatment protocols

Documentation Central nervous system connection and the thalamus hypothalamus connection in both ascending and descending central pathways with neuro-endocrine implications that have the mechanisms to be a component of Schizophrenia Dementia and Alzheimer & with a linear relationship to the chiropractic spinal adjustment and chronic pain

Detailed analysis of the historical publication of Pelvic Incidence as an 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

Ethics and risk management as it applies to patient encounters treatment billing and coding practices the workplace environment and administration Detailed review of the new 2021 E/M reporting and in-depth review of current rules laws and guidelines for documentation of all patient encounters as required by the Texas Chiropractic Board of Examiners Centers for Medicare and Medicaid HIPAA and insurance carriers

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

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

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

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

Herniated, bulged, protruded and extruded discs etiology and morphology Age-dating disc pathology inclusive of Modic changes piezoelectric effect Wolff’s Law and radicular clinical presentation

Utilization in spinal models considering the opioid abuse and various spinal models in contemporary healthcare Care paths for mechanical spine pain and the evidence for conservative chiropractic care

Mechanoreceptor proprioceptor nociceptor innervation and control of the spinal system with central nervous system action and interaction the integration of the pain processing network and the HPA Axis hypothalamus adrenal and pituitary with the chiropractic spinal adjustment

Maintaining ethical Interprofessional relationships based upon an evidenced based practice inclusive of triage diagnostics and reporting Creating thorough documentation that reflects your complete findings encompassing descriptive ICD-10 codes and concludes the presence or absence of pathology

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

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 and bulges

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

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

A 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 were included and correlated to chiropractic care and impairment rating using the AMA Guides to the Evaluation and Management 5th and 6th editions

An 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

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

Outline and 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

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

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

Integrating documentation procedures from intake through diagnosis with evidence-based standards of care and proving medical necessity Identifying risk issues and management in staffing, administration documentation and patient care/management with mitigation strategies

The evaluation, interpretation and reporting of collaborative medical specialist’s 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

A Documentation Relationship Between the Doctor and Lawyer, 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

Correlating history 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

Code of ethics Texas Chiropractic Board of Examiners rules and proposed changes Ethics as applied to administration staffing and clinical practice

Analyzing spinal healthcare trends in both utilization and necessity and understanding the marketplace and how a level of clinical excellence is reflected in a doctor's documentation and credentials Treatment pathways in triaging spinal path biomechanics

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

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

Clinical Grand Rounds of herniated protruded extruded sequestered and bulging disc Differentially diagnosing vascular vs mechanical spinal lesions and the necessity for urgent vascular neurological intervention collaborating in a team environment utilizing a neuroradiologist electrophysiologist and neurosurgeon with the chiropractor as the primary spine care provider

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

A case review of traumatically induced multi-level cervical disc herniation with associated Grade 2 Ligament Injury rated as sub-threshold Review of case history physical examination findings plain film radiographs cervical spine MRI and bone scan

The clinical correlation of clinical evaluation, advanced imaging and necessary electro diagnostics in concluding an accurate diagnosis prognosis and treatment plan and indications for collaborative care

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

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

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

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

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

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

Understanding the algorithmic interpretation of spinal biomechanical pathology in a 3-D model and creating treatment plans impairment ratings and teaching models based upon the vertebral motor unit angles Determining sagittal and axial alignments in creating a normative baseline for treatment goals and outcomes

Creating ethical relationships based upon accurate documentation reflective of the casually related condition of the injured. Ensuring accepted credentials of the doctor based upon Voir Dire standards reflected in an admissible curriculum vitae. How to present demonstrative documentation in the courts reflective of the patient’s pathology.

Ensuring the correct codes are utilized in an evaluation and management encounter the correct elements are utilized to support the level of example coded along with a self-audit program to ensure ethical billing occurs guidelines for history of present illness primary complaint review of systems family social and past histories are discussed and how to document the same

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

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

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

A detailed review of physical examination and assessment of traumatic thoracic and lumbar spine fractures using plain film radiograph and CT scans with and without contrast. Detailed review of mechanism of injury emergency department records and radiology reports were presented Errors in fracture site description and omission on plain film study by the radiologist were reviews Analysis of potential spinal instability in the cervical spine was discussed and a detailed referral for computerized mensuration analysis was demonstrated

A case study presentation outlining risk factors for increased injury susceptibility including prior surgical fusion. Comparison between MRI and plain film radiographic objective data was outlined and presented. Importance of interprofessional communication and review of prior medical records. Analysis of spinal compression fracture and surgical hardware was outlined.

Case analysis outlining morphological descriptions of the human spine including desiccation herniation extrusion and bulge Outline and presentation of annulus fibrosis nucleus pulposus and pain fiber innervation of both healthy and degenerative intervertebral discs were presented Analysis of injury causation and its relation to MRI findings were detailed.

Utilizing x-ray, MRI and other modalities of advanced imaging in conjunction with spinal biomechanical failure and clinical evaluation to collaboratively create treatment protocols for patients in both the operative and non-operative cases Determining the boundaries of scope of care for both the chiropractor and neurosurgeon based upon a definitive diagnosis of the mechanical vs. an anatomical lesion

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

A case review of traumatically induced 14 mmm acute cervical intervertebral disc extrusion with inferior migration resulting in severe right lateral canal stenosis foraminal stenosis and spinal cord impingement A detailed review of physical examination findings neurological evaluation MRI images and surgical triage was presented

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

The latest research on the 6 ways to age-date disc herniations and bulges from trauma inclusive of disc pathology nomenclature MRI ordering protocols inclusive of Dixon format and fat-suppressed images The neurology and pathology of connective tissue and the sequella of trauma at the biomechanical level leading to bio-neuro-mechanical failure Contemporary evidenced-based building blocks for triaging and in a collaborative environment

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 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

Causality and Bodily Injury 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

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

The literature-based definitions of both the mechanisms the chiropractic adjustment and how it affects the central nervous system in pain pathways and systemic issues that is the arbiter for normal vs. abnormal function. The physiological mechanisms of how the chiropractic spinal adjustment affects the peripheral and central nervous systems. Subluxation degeneration/Wolff’s Law will be detailed from a literature perspective combined with the mechanism of subluxation (bio-neuro-mechanical lesion). A literature perspective why long-term chiropractic care is clinically indicated as usual and customary to effectuate demonstrable biomechanical changes in the spine. An evidenced-based perspective of why physical therapy is a poor choice for spine as a 1st referral option for any provider inclusive of the literature.

Integrating automated mensuration into creating treatment plans and determining maximum medical improvement a literature-based study of normal vs. abnormal motor until function. Determining ligamentous laxity alteration of motion segment integrity and pathological stress units and whole person impairments based upon the literature and academic standards

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), Somatosensory Evoked Potential (SSEP), Visual Evoked Potential (VEP), Brain Stem Auditory Evoked Potential (BAER) and Visual-Electronystagmography (V-ENG) interpretation, protocols and clinical indications for the trauma patient.

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.

MRI slices, views, T1, T2, STIR Axial, FFE, FSE and sagittal images in the interpretation of degenerative spondylolisthesis, spinal canal stenosis, Modic type 3 changes, central herniations, extrusions, compressions, nerve root compressions, advanced spurring and thecal sac involvement from an orthopedic, emergency room, chiropractic, neurological, neurosurgical, physical medicine perspective.

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, 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, 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 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. Clinical indication for the utilization of MRI and pathologies of disc in both trauma and non-trauma sequelae, including bulge, herniation, protrusion, extrusion and sequestration.

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 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.

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

MRI 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.

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.

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.

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 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.

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.

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, ocular and proprioceptive neurological integration in the righting reflex as evidenced in imaging. Digital and numerical algorithm in analyzing a spine.

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

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

Digitalizing and analyzing the full spine images to diagnose pathobiomechanics as 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.

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

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

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

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

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

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

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

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 reimbursor’s requirements for complete documentation.

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 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.

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

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

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

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

An academic basis for documentation that is usual and customary across professions in collaborative care. Maintaining ethical medical-legal relationships based upon Voir Dire and Duabert standards with ensuring a 4-corner inclusive report. Ensuring Primary Care Status based upon an academic standards.