Evaluation Report From The Panel Qualified Medical Evaluator

Evaluation Report From The Panel Qualified Medical Evaluator
Please consider this letter a status update and a follow–up on your email dated May 16, 2017. As
you know, we have received the re–evaluation report from the Panel Qualified Medical Evaluator,
Dr. David Scharf, dated April 26, 2017. Summary As you indicated, Dr. Scharf did find the applicant
permanent and stationary. He noted a surgery to the applicant's neck was recommended and
authorized. However, the applicant decided not to go forward with the surgery, because he heard
from his friend who had undergone a similar surgery in the past and did not have a positive result.
Overall, Dr. Scharf's report is quite concise. He documented the applicant's current complaint as
neck pain, radiating pain to both arms, and occasional headaches, as ... Show more content on
Helpwriting.net ...
Scharf utilized Diagnosis Related Estimate cervical category II and assigned an 8% Whole Person
Impairment. Dr. Scharf noted the MRI study of the cervical spine right disc extrusion at C5–C6, but
there are no verifiable radicular symptoms in light of the result of the EMG/NCV studies, despite the
applicant's subjective complaints of radicular symptoms into the bilateral upper extremities. Since
there are no verifiable radicular symptoms, the placement into DRE category II seems appropriate.
Dr. Scharf also assigned 3% Whole Person Impairment to applicant's headache using chapter 18. As
for apportionment, Dr. Scharf did not apportion any of the impairment to any other factor except the
industrial injury of December 14, 2015. Now, in response to your email dated May 16, 2017, I
would rate Dr. Scharf's report using only a single string. Dr. Scharf's description of the 3%
impairment to the applicant's headaches appears to be a pain add on to neck injury. If you look at Dr.
Scharf's diagnostic finding, you will note that he describes the residual headaches as predominately
cervical/occipitally mediated. Therefore, I believe Dr. Scharf is under the opinion that the applicant's
headaches are stemming predominately from the neck injury. Therefore, treating a 3% Whole Person
Impairment as a pain add on seems to be more appropriate on this case. I do not see Dr. Scharf made
any reference to chapter 13. Of course, if Dr. Scharf did not make any reference to the
... Get more on HelpWriting.net ...

Tendonitis Case Studies
DOI: 08/17/2015. Patient is a 62–year–old male tie inspector who sustained injury when he slipped
and fell while straightening a cross tie on a table. Patient is diagnosed with lumbago, lumbar spine
degenerative disc disease, cervical radiculopathy, cervical spondylolisthesis, and left shoulder biceps
tendonitis. Based on the progress report dated 03/14/16 by Dr. Solomon, the patient complains of
consistent headaches and floater and a pressure sensation behind both eyes since the injury. Patient
has been referred due to possible thinning or a hole in the retina. Patient states that near visual acuity
seems narrowed. On examination, vision is 20/20 bilaterally. Intraocular pressure is 16 to the right
and 18 to the left. Dilation has been provided on this visit with tropicamide 1%/phenylephrine 2.5%.
... Show more content on Helpwriting.net ...
The lens of the right eye has 1+ nuclear sclerosis. A dilated examination of the optic disc was
performed. Ophthalmoscopic examination of optic disc of the right eye shows "CD" ratio of 0.4.
The optic disc has a peripapillary atrophy. The lens of the left eye has 1+ nuclear sclerosis. A dilated
examination of the optic disc was performed. Ophthalmoscopic examination of optic disc of the
right eye shows cup–disc (CD) ratio of 0.6. Optic disc has peripapillary atrophy. A scleral depression
and dilated fundus examination were performed. Opthalmoscopic examination of the retina and
vessels of the left eye show a vitreous detachment. The right eye periphery shows a retinal hole of
07:00 to 11:00 and

Spinal Infection: A Case Study
DIFFERENTIAL DIAGNOSIS
Most common o Spinal infection
– Presents as back pain, fever and chills, recent bacterial infection, IVDA, or immune supression
– Distinguished by pain worse at night than during the day, redness at the site of infection apparent
in the overlying skin in the area
– Differentiated by inflammation apparent on bone scan and clinical response to antibiotic therapy o
Spinal tumor
– Presents as pain in the back followed by weakness or numbness, change in the normal bowel or
bladder habits 3
– Distinguished by night and rest pain, unexplained weight loss, history of known primary cancer
elsewhere in the body, or in age 50 years
– Differentiated by bone scan with identification of "hot spots" and on plain x–rays by osteo–lytic ...
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Some physicians administer gastric and duodenal ulcer prophylaxis in the form of a proton pump
inhibitor (PPI) if the patient has a history of gastrointestinal ulceration
Empiric spinal manipulation and standard physical therapy may be beneficial
NSAID's o NSAIDs, narcotics, non–narcotics, oral corticosteroids, muscle relaxants, and
antidepressants are used for pain controll o Better than placebo but no specific support for one
specific drug over another o Ibuprofen o Naproxen
Oralnarcotics o Short term use only with subsequent referral to pain management specialist o
Acetaminophen with codeine o Oxycontin hydrochloride For extended pain relief up to 12 hours 7
Parenteral narcotics o Buspirone patch for extended pain relief up to 12–24 hours 7 o Fentanyl patch
for extended pain relief up to 12–24 7 o Short term use only with subsequent referral to pain
management specialist
Tri–cyclics antidepressants o Moderately strong evidence for use especially with co–existent
depression symptoms o Amitriptyline
PPI o Administered as prophylaxis against gastic or duodenal ulceration from NSAIDs 7
– Misoprostil
The effectiveness of most treatment options has not been proven in high quality, randomized,
controlled trials

Lumbar Tissue: A Case Study
DOI: 2/17/2014. Patient is a 55–year–old female cashier who felt pain on the left side of lower back
and left foot due to walking incorrectly due to a previous work injury. The patient is subsequently
diagnosed with postlaminectomy syndrome, not elsewhere classified; degenerative disc disease,
lower back; arthropathy of lumbar facet; and low back pain. MRI of the lumbar spine without
contrast dated 1/4/16 (no official report) revealed posterior fusion at L4–5 with right L5 laminotomy
defect; and mild degenerative disc disease at L3–4, there is moderate narrowing of the L3 neural
foramina bilaterally. As per office notes dated 7/6/16, the patient presents for ongoing evaluation
and medication refill. He rates his pain as 9. His pain is located

Lumbar Interval Disc Degeneration
The impact of smoking in lumbar interval disc degeneration and sciatica was also reported several
times. Battié et al. (1991) studied the impact of smoking in lumbar interval disc degeneration of
identical twins using magnetic resonance imaging. Results showed that the risk of lumbar interval
disc degeneration was 18% greater for smokers compared to non–smokers. Non–occupational lifting
was also studied as a risk factor for herniated lumbar intervertebral disc (Mundt et al. 1993). For this
study, 287 patients with symptoms of herniated lumbar disc were involved and compared with
control subjects without back pain taking in consideration the age, sex, source of care and
geographic area. Based on their data, they showed that the risk of herniated ... Show more content
on Helpwriting.net ...
The first study published (Videman, et al., 1998) was involved monozygotic twins in Finns, with
alleles of the TaqI and FokI polymorphism being associated with reduced magnetic resonance
imaging signals of thoracic and lumbar discs. Another more recent study which confirmed the
previous study was based on 205 Japanese volunteers and patients between age 20 and 29 years.
From this study was found that Tt genotype of the TaqI polymorphism were more frequently
associated with multilevel disc disease, severe disc degeneration and disc herniation than the TT
genotype (Kawaguchi et al., 2002). In addition, influence of TaqI polymorphism to lumbar
degenerative disc disease verified in Chinese population (Cheung, et al., 2006). The fact that
replication of TaqI polymorphism was appeared in three different populations makes VDR as the
most robust of genes associated with disc degeneration disease. The reason for this is not clear but a
possible explanation is based on the fact that the polymorphism can affect the receptor level and
function of vitamin D. Based on the fact that vitamin D influence the sulphate metabolism which is
important for sulphation of glycosaminoglycans (GAGs) during proteoglycan synthesis, the latter
can lead to changes in the structural characteristic of the extracellular matrix in the intervertebral

1.Discuss The Condition/Diagnosis In Terms Of Basic...
1. Discuss the condition/diagnosis in terms of basic information, pathology, phases of healing.
Cervical degenerative disc disease is a common cause of neck pain and radiating arm pain. It
develops when one or more of the cushioning discs in the cervical spine starts to break down due to
wear and tear. There may be a genetic factor that predisposes some people to more rapid wear.
Injury may also contribute and sometimes can cause the development of the degenerative changes.
When cervical degenerative disc disease becomes indicated, the pain might develop slowly over
time or appear suddenly. The signs can range from mild annoying neck aches to debilitating pain,
numbness, and/or weakness that radiates into the arm and hand.
2. Identify ... Show more content on Helpwriting.net ...
Cervical Traction: decompression of the nerve roots to relieve pain and altered sensation
Cold Pack: Used to diminish physiologic functions such as blood flow, inflammatory response or
muscle activity
5. Identify therapeutic goals as appropriate (indications) for your patient needs for each modality
identified.
TENS: Increase ROM, decrease muscle weakness and pain
Cervical Traction: decompress the nerve roots
Ultrasound: Soft tissue repair, Trigger points, chronic pain,
EMG biofeedback: Can be utilized to receive information related to motor performance, kinesthetic
performance or physiological response
6. Indicate each physical modality treatment parameters and include supportive statements for your
choice of these parameters.
TENS (Parameters): frequency 50 to 200 pps; pulse duration of 50 to 100 msec; uses the gate theory
mechanism and has fast pain relief.
Cervical Traction (Parameters): Acute/ 1st session– 6 to 10 lbs., static pull, 5 minutes, gradually
increase to patient tolerance. Routine Session– 20 to 30 lbs. or 7% of the patient's body weight,
intermittent pull– 15/15, Time: 20 minute. This treatment will distract the joints in the cervical
region and help alleviate the pain.
EMG biofeedback (Parameters): EMG signals need to be amplified
– gain = amplification factors, decrease noise EMG signal usually between

Symptoms And Symptoms Of Chronic Pain
SPONDYLOSIS – CHRONIC PAIN SYNDROME
Introduction and Definition of Chronic Pain
About 100 million Americans suffer from Chronic Pain, defined as pain that lasts longer than six
months. Chronic pain can be mild or excruciating, episodic or continuous, merely inconvenient or
totally incapacitating. With chronic pain, signals of pain remain active in the nervous system for
months or even years. This can take both a physical and emotional toll on a person.
Causes and Etiology of Chronic Pain
Chronic pain can be caused by many different factors. Often conditions that accompany normal
aging may affect bones and joints in ways that cause chronic pain. Other common causes are nerve
damage and injuries that fail to heal properly. The most ... Show more content on Helpwriting.net ...
Even the body 's most basic defenses may be compromised: There is considerable evidence that
unrelenting pain can suppress the immune system. Because of the mind–body links associated with
chronic pain, effective treatment requires addressing psychological as well as physical aspects of the
condition.
Some kinds of chronic pain have numerous causes. Back pain, for example, may be caused by a
single factor, or any combination of these factors:
Years of poor posture
Improper lifting and carrying of heavy objects
being overweight, which puts excess strain on the back and knees
A congenital condition such as curvature of the spine
Traumatic injury
Wearing high heels
Sleeping on a poor mattress
No obvious physical cause
Ordinary aging of the spine (degenerative changes)
Disease can also be the underlying cause of chronic pain. Rheumatoid Arthritis, Osteoarthritis and
Fibromyalgia are well–known culprits, but persistent pain may also be due to such ailments as
Cancer, Multiple Sclerosis, Stomach Ulcers, AIDS, and gallbladder disease.
In many cases, however, the source of chronic pain can be a very complex and even mysterious
issue to untangle. Although it may begin with an injury or illness, ongoing pain can develop a
psychological dimension after the physical problem has healed. This fact alone makes

Essay On Chiropractic Care
If you suffer from lower back pain, you're not alone. At some point in their lives, about 80 percent of
the United States' population will have back pain, says WebMD. The causes are varied, but one
thing is known for sure: back pain is annoying, often debilitating and can have serious impacts on
the lives of those affected. One of the most popular, and effective, methods of treating this type of
pain is through chiropractic care. If you're looking for back pain management in Frisco, TX,
consider this non–surgical, non–invasive type of treatment.
What is Chiropractic Care?
The main principle of chiropractic care is to properly align the patient's musculoskeletal system,
particularly the spine. The belief is that proper alignment will allow the body to naturally heal itself.
Chiropractors use gentle manipulation to attempt to restore this mobility to the ... Show more
content on Helpwriting.net ...
This is most commonly due to age. Discs can also become damaged injured or torn, causing
weakness within the disc. Sometimes this weakening puts pressure on the jelly–like center of the
disc, which can cause it to become herniated. Also called a slipped disc or bulging disc, this injury
causes the center of the disc to press on the sensitive nerves in the spine, which can result in
excruciating pain.
Chiropractic Care for Lower Back Pain
Chiropractors commonly use manipulation of the spine to help patients with lower back pain. They
do this by using controlled, sudden forces that often improve range and quality of motion. This
high–velocity, short–lever arm thrust is applied to the abdominal vertebrae in those with lower back
pain. Depending on the injury, the chiropractor may also incorporate exercise and rehabilitation to
alleviate the pain and help align the spine. Over time, many patients experience relief from
chiropractic care for their lower back pain.
Tieperman Health and Wellness Offers Chiropractic Care for Lower Back

Magnetic Resonance Imaging And Its Effects On The Brain
MRI it is stands for Magnetic resonance imaging which is the best modality to choice when we want
to see the of the spine, it is not invasive procedure, not associated with ionizing radiation to the
patient, and provides an excellent soft tissue contrast compared to the other imaging modality. MRI
it is use for clarification substantially all spine problem such as degenerative disc diseases and
infectious or inflammatory diseases of the spinal cord, identify any spinal tumors, vascular
malformations, bone diseases and trauma of the spine. However cervical spine imaging had some
challenges to MR imaging due to the small structures such as neural foramina and the lack of fat
within it, also the neural foramina are positioned in an ... Show more content on Helpwriting.net ...
Cervical degenerative disc disease is less common than the lumbar area and it often called cervical
spondylosis, the stresses of the changes in ligaments and facet joints to enlarge become hypertrophy
as they need to spread the load over a larger area leading to compression of the spinal cord and
nerves causing some symptoms that can be range from mild to severe this is starting with pain and
over the years the symptom gets worse like spread out of the pain from the region that is affected to
shoulders and base of the skull, also down from arms to the hands ending in fingers and this is
because of compression to the nerves that courses down to supply the hands, the pain may get worse

Still Alice Essay
"Alzheimer's disease (AD) is a slowly progressive disease of the brain that is characterized by
impairment of memory and eventually by disturbances in reasoning, planning, language, and
perception." (Howard Crystal) In Health 1000 we were asked to read the book Still Alice. I have
never dealt with or have done any study on Alzheimer's disease before reading this book. After
finishing this book it has really opened my eyes to how bad of a disease and how it cripples the
mind. I never imagined the effect of this disease on a patient and the patient family. This book is
about a upper middle aged lady named Alice who is diagnosed with Alzheimer's disease, and how
she and her family learn how to deal with disease. One of the things this book ... Show more content
John holds on to hope the whole book until he reads how the Amylix wasn't able to stabilize the
Alzheimer patients. John starts to cry after finding out, because this is basically the final straw. It
was his last ditch effort and in knowing it failed it symbolized that he failed and that Alice was
doomed. This forced him to admit to himself that the women loved and cared so much for was no
longer there and will never be there again. Alice ended up telling her colleagues about her diagnosis
much later than when she told John. She only told them when she realized how much her teaching
has slipped up and knowing it was only going to get worse with time. Alice would forget a whole
lecture even though she just spent hours reviewing and studying her notes before class. One time she
even went into her classroom and sat down for a few minutes just to get up and walk out of her
classroom without teaching one thing. Alice ends up sending a formal letter to all her colleagues
letting them know that she has Alzheimer and is going to be stepping down. Most of them stop by
her office and offer their condolences after receiving her letter. After finding out her colleagues
pretty much avoided Alice but if they did run across her they were polite, but quick to excuse
themselves from her presence. This was hurtful for Alice because she once considered everybody in
her department almost like a second family. I feel the one most effected

Questions On Real Deal Or Gimmick Surgery?
PERCUTANEOUS ENDOSCOPIC LUMBAR DISCECTOMY VS MICROSURGICAL
DISCECTOMY Real Deal or Gimmick Surgery? INTRODUCTION The technology behind
medicine is constantly evolving, the driving force being to develop new solutions, that are quicker,
safer, more cost effective, minimally invasive with better visibility and shorter hospital stay.
Advances in endoscopic surgery have improved the way in which almost all surgical specialities
have approached various pathologies. Endoscopes give better visibility with minimal exposure to
get to the proposed operative site. Open microdiscetomy has been the procedure of choice for
patients with radiculopathy associated with a herniated disc. Since the advances in endoscopic
surgery, it has found its way into the treatment of spinal disorders such as herniated discs, however
is there a benefit to endoscopic discectomy? CASE A 28 year old female presented to our institution
with a three–month history of right sciatic pain in the S1 distribution. She was initially treated
conservatively with analgesia and physiotherapy, however her pain continued despite these
interventions. She had no weakness or bowel or bladder symptoms. On examination she had a
positive Lasegue?s test at 30 degrees on the right. No motor of sensory deficits were found. A
lumbar Magnetic Resonance Image (MRI) scan done showed a paracentral disc bulge at L5/S1
impacting the traversing right S1 nerve root, and exit foraminal stenosis (Fig 1). She was taken to
the

Biological Therapy Case Study
5. Biological therapy
Recently, the application of biotechnology to repair or allow regeneration of degenerative
intervertebral disc has become a hotspot. Biological treatment of degenerative intervertebral disc has
two main purposes: to restore the structure and the elimination of pain 68. From the current results
of animal experiments, biological methods are expected to be able to restore the structure of
degenerative disc, but whether it can eliminate the pain is still not clear. Recent results from animal
studies have shown that injection of growth factors can reduce the expression of inflammatory
cytokines in degenerative intervertebral discs. Biologically active substance injection: for early
intervention of intervertebral disc, can ... Show more content on Helpwriting.net ...
Normal intervertebral disc relatively lacks cell tissue, cell density is only 5. 8 × 103/ mm3 and with
aging there is significant reduction in cell density. Therefore, the potential strategy for the treatment
of degenerative intervertebral discs is to expand the number of intervertebral disc cells and restore
disc function. Mesenchymal stem cells (MSCs) may have such capabilities. MSCs can be easily
obtained from autologous bone marrow and adipose tissue. A prospective clinical study in patients,
who underwent lumbar disc herniation with intervertebral discography and then injected with HUC–
MSCs (Human umbilical cord tissue–derived mesenchymal stem cells) into the painful degenerated
intervertebral disc showed significantly improved pain and lumbar function after treatment. The
intensity of the intervertebral disc signal in one of the patients increased after two years of
treatment, indicating an increase in water content in the degenerated disc 73. Kenneth Pettine's study
provides evidence of safety and feasibility in the non–surgical treatment of discogenic pain with
autologous BMC (bone marrow concentrate), with durable pain relief and ODI improvements
through two years 74. Percutaneous injection of MSCs into the intervertebral disc may uniquely
fulfill the objectives of treating disc pathology with clinical

Scoliosis Is The Curvature Of The Spine, Forming An S Or A...
Scoliosis is the curvature of the spine, forming an s or a c–shape. It affects many people, including
myself. Multiple Sclerosis is a "chronic degenerative disease of the central nervous system, in which
the myelin that sheathes the nerves is somehow eaten away and scar tissue forms in its place,
interrupting the nerves' signals" (Mairs 261). If not treated properly, both conditions are
degenerative. Both conditions do not have a cure, but they do have treatments that are not fully
guaranteed to be the ultimate fix. One may wonder how a person with Scoliosis can relate to another
with Multiple Sclerosis since they are completely different conditions. Although both Mairs and I
suffer from different conditions, we faced similar obstacles that our condition caused. Being pitied
based on a condition is a burden to those that are close, such as family and friends. When Mairs's
family helped Mairs with the chores and tried to make her feel as comfortable as a normal person,
Mairs began to be skeptical that "they were faking. Tugging at the fringes of [her] consciousness
always is the terror that people are kind to [her] only because [she is] a cripple" (Mairs 265). She
also added that she "always suspected them of...professing fondness while silently putting up with
[her] because of the way [that she was]. A cripple, [she has] been a little cracked ever since" (Mairs
266). Sometimes I wondered if my relatives and friends pitied me for having Scoliosis. My friends
and relatives

Paraspinal Morphine: A Case Study
DOI: 7/18/1999. Patient is a 63–year–old male crew leader who sustained a work–related injury
when he tripped over a mat at work. As per OMNI, the patient is status post left knee arthroscopy in
2001, knee replacement in 2004 and gastric bypass surgery in 5/2013.
A urine d rug screen obtained on 07/23/15 was consistent with Norco, Zantac and Motrin.
Based on the progress report dated 02/09/16, the patient presents for follow–up. He describes
ongoing difficulty with pain in both shoulders, wrists, low back and the bilateral lower extremities
from the knees to the calves. His symptoms include pain, spasms, numbness and tingling. He rates
his pain level as a 9/10 in intensity, but it is reduced to a 7/10 with use of his medications. He
reports that morphine is helping, but he is still taking 5–6 Norco a day. He is also taking a stool
softener three times a day as well as Linzess. However, he continues to have significant
constipation.
On examination of the lumbar spine, there is tenderness and guarding of the paraspinal musculature.
Range of motion is decreased secondary to pain.
The IW ambulates with a left antalgic gait pattern with use of an assistive device.

Neck Pain Untreated Research Paper
What Can Happen if You Leave Your Neck Pain Untreated
It is not that uncommon for people to experience pain, and completely ignore it or casually dismiss
it; however, dismissing even minor pain that has not been diagnosed and initially treated can
potentially lead to catastrophic results, especially when it comes to vital areas like the neck. Because
the neck is supported by the spine, it is imperative to address any pain associated with the neck area.
Pain is the body's way of informing people that there is something wrong, and it should never be
ignored, regardless of how minor the pain may seem.
While some neck pain is self–limiting, meaning that is will subside over the course of several days,
there are certain conditions and injuries ... Show more content on Helpwriting.net ...
One common cause of neck pain that is progressive in nature is a herniated disc. At the very least, a
herniated disk will require intervention by a specialist that deals with corrective procedures
concerning the spinal column, and in the worst case scenario, there may be a need for surgery. If left
untreated, a herniated disc will intensify in the level of pain that it causes. It will also limit mobility.
As the body attempts to make adjustments to compensate for the pain and weakness that is common
with herniated disks, it increases the chance of additional injuries in other areas.
Another possible cause of neck pain that could have long–term implications, if not treated
immediately, is pain caused by the onset of arthritis or other types of degenerative bone and joint
diseases. When left untreated, this type of pain can expedite the degenerative process, hurrying the
onset of limited mobility. Additionally, untreated degenerative joint disease that is left untreated will
also lead to unbearable pain that worsens as time progresses, subsequently requiring the use of pain
medications to help the individual to effectively manage their

Regenerative Spine Treatment
It has been observed that almost everyone older than 50 has some form of degenerative spine
disease. The spine naturally wears down as the body ages as the spinal discs gradually deteriorate
and the cartilage protecting the joints begins to show signs of wear and tear. If a person has been
diagnosed with a degenerative spine condition, then they have to visit a spine specialist who be will
likely begin recommending many options for treatment. Mostly, the treatment will begin
conservatively, though sometimes surgery is needed if all conservative treatments have been
exhausted and the person is still suffering from chronic neck or back pain. Some of the conservative
degenerative spine treatment options, includes: Physical therapy–This approach

Lmbar Spine Injury Case Summary
DOI: 6/1/2010. Patient is a 52–year–old male truck driver/warehouse worker who sustained injury
when he was struck by a cardboard roll that a co–worker was handing down to him. The patient was
subsequently diagnosed with cervical degenerative disc disease. MRI of the cervical spine from
2012 (no official report) revealed cervical disc disease at C5–C6 and C6–C1 with moderate disc
degeneration and moderate foraminal narrowing, worse on the right/ As per 4/1/16, the patient was
seen at the request of his primary treating physician, Dr. Kevin Pelton. It was also noted that the
patient did sustain lumbar spine injury. The patient complaints of neck pain which radiates over his
right shoulder and into both upper extremities. He rates his pain

Degenerative Disc Disease
With the New Year comes a renewed passion for fitness goals, whether it is running your first 5K,
competing in a triathlon or simply committing to walking a mile every day. But if you have chronic
pain caused by a stiff neck or degenerative disc disease, it may be difficult to find the motivation to
achieve the success you crave or take control of your overall health and physical fitness. While a
diagnosis of degenerative disc disease may seem alarming, patients should keep in mind that it is
neither a disease nor strictly degenerative. The phrase degenerative disc disease actually describes
the symptoms of pain and possible associated radiating weakness or numbness stemming from a
degenerated disc in the spine. The word "degenerative" – though

How Get The Eligibility For Getting Concealed Carry License?
How to get the eligibility for getting Concealed carry license?
Description: Acquiring Concealed carry license is quite a challenging task now as you have to cross
the barriers of different strict r restricted eligibility criteria that have been established by US
government.
Concealed carry license cannot be acquired easily rather the holder needs to prove his eligibility for
acquiring the same. If the holder fails to prove his eligibility, then he will not get the chance of
having this incense ever. If you want to know about the eligibility criteria for having this license,
then you need to visit the official site online. Else online surfing can also be treated as one of the
suitable means for getting detailed info about the same.
List of eligibilities for having the license of concealed carry
If you are not of 21 years then you are not at all eligible in getting Concealed carry license. This is
because in United States this particular age is treated as the standard age for using concealed carry.
The holder can be higher in age but should not go below 21 years.
Firearm competency needs to be proved. If you are incapable of using the firearm then you will not
get the license at all.
If you are representing US army overseas, then it will be easier for you to acquire the license for
carrying concealed firearms of different kinds.
Firearm needs to be handled with care and safety and for that different safety regulations need to be
abided with greater sincerity.
If

Intervertebral Divided: A Case Study
1. Introduction & Background
Herniatiοn of intervertebral disc is οne of the cοmmοn (Stafford, 2007) cause οf lοwer back and leg
pain (Atlas, 2001) leading tο the use of medical services and lοng–term sick leave and absence frοm
jοb (Hagen and Thune, 1998). This cοnditiοn it is alsο referred as sciatica neuralgia pain in the
distribution οf the sciatic nerve due tο pathοlοgy οf the nerve (Merkey and Bokduk, 1994).
The lower back pain is a public health problem causing suffering and physical stress to patients
affecting 12% to 35% of people according to studies with 10% of suffering becoming chronically
disabled (Maniadakis and Gray, 2000). In addition, is an enormous economic issue for society with
estimated medical cost at 12 billion pounds ... Show more content on Helpwriting.net ...
All along your spine, nerves are branching off from the spinal cord and travelling to various parts of
your body (to help you feel and move). The nerves pass through small passageways between the
vertebrae and discs, so if a herniated disc presses into that passageway it can compress (or "pinch")
the nerve. That can lead to the pain associated with herniated discs (Marchand and Ahmed, 1990).
Risk factors causing this situation seems to be the frequent lifting of weight, the driving of a motor
vehicle, obesity, smoking and poor general health according to (Heliovaara, 1989). In opposite most
sports are not associate with an increased risk of herniation (Munt et al., 1993).
Herein we literature reviewing the risk factors of herniation of intervertebral lumbar spine disc not
only those who shows positive correlation with the disease, but also those who seems to are
negatively related in order the disease to be easily prevented. It is critical to mention that the
knowledge of the pathophysiology of disc herniation it is a valuable asset for spine

Air Of Lower Back Pain Radiation
See all 4 photos
Air of lower back pain radiation
Source: Neuros Clinic hospital on October 9
What is low back pain.
Lower back pain can be defined as pain felt in the lower back. If you were to draw a horizontal line
that divides the back into two equal parts, the lower back in this regard would be back to start
slightly below this line (about 2 cm) and ending at the waist. The pain in this area can be acute,
sudden onset and may limit or interfere with daily activity. It can also be a dull pain that sometimes
occurs near the waistline, and thigh, leg or foot (sciatica). The pain is limited to the back without
radiating down the leg is most common. Lower back pain can be classified as:
Acute back pain – This is usually is sudden onset and lasts a few days or weeks, usually no more
than 6 weeks.
Pain–– chronic lumbar refers to pain that lasts more than three months. Pain can be a persistent dull
pain constant, can be progressive, or can only be aggravated by certain activities.
Low back pain (sometimes known as lumbago) is one of the most common complaints that patients
have in the department of patients outside. About 55% of all visits to the orthopedic clinic will be
related to back pain. Although the condition is more common in older people, it can also occur in
younger people, but the predisposing factors and the causes may be different in relation to age
group. (See back pain you need to know for details on the causes)
The underlying causes of low back pain (LBP) in

Wobblers Syndrome Research Paper
Wobbler syndrome is a disease of dogs that affects their spine in the neck region and is a very
important and common cause of neurologic disability in large breed dogs. Wobblers disease is
classified under a degenerative or idiopathic disease. Wobbler syndrome or wobblers is the most
common name used but Veterinary literature has used multiple different names to describe this
condition, this is in part due to the confusion regarding the mechanisms causing it. The name most
commonly used in veterinary articles is cervical spondylomyelopathy (which means a disease of the
neck vertebrae affecting the spinal cord). Other common names are CVI – cervical vertebral
instability, CVM – cervical vertebral malformation, CVMM – cervical vertebral malformation–
malarticulation, ... Show more content on Helpwriting.net ...
This disease can have multiple different effects on canines including a strange or wobbly gait, neck
pain and stiffness, weakness, possibly unable to walk including partial or complete paralysis,
possible muscle loss near the shoulders, possible worn or scuffed toenails from uneven walking,
increased extension of all four limbs, and difficulty getting up from lying position. To diagnose
wobblers syndrome besides viewing the obvious visual symptoms such as the wobbly gait,
weakness and pain a veterinarian will do multiple different test including taking x–rays and MRIs.
Once the animal has been diagnosed with this disease there is a couple different treatment options
from medical options to surgical options. The non –surgical management may allow some
stabilization of the condition for a short period. It is only recommended in dogs with mild pathology
or small disc bulges and very slow disease progression. There are a few different non–surgical
options available including exercise modification which consists of absolute rest in the short term
and modified exercise in the long term, anti–inflammatory medications, physical therapy,
manipulative therapies which can range from laser therapy, ultrasound therapy, and even

Joint Pain And Arthritis
Joint Pain, Aging, and Arthritis – Understand Your Pain
Joint pain is not necessarily always a part of ageing. It can be a serious problem as it can affect our
functional capacity. Arthritis is a common term which means inflammation and stiffness of joints
leading to joint pains. It can have a number of etiologies including osteoarthritis , gout, rheumatoid
arthritis among others. Osteoarthritis is a degenerative disease because of wear and tear of cartilage
leading to joint pains and soreness. Rheumatoid arthritis is an inflammatory joint disease which is
not benign and can even cause death if not managed properly. Fibromyalgia is a chronic disease
which causes pain at numerous points throughout the body.The underlying mechanism is
oversensitive

Anterior Cervical Disc Replacement Vs Discectomy Fusion
Anterior Cervical Disc Replacement vs Discectomy Fusion Is there any benefit? INTRODUCTION
Degenerative or spondylitic changes to the cervical spine occur with age. In some people, this
change results in impaction on the spine or exiting nerve roots. Surgical methods have been
proposed to treat these patients, the most common and well accepted being Anterior Cervical
Discectomy and Fusion (ACDF). It is well documented that this is a proven and successful
operation, when done appropriately(1). Artificial disc replacement (ADR) has however been
suggested as an alternative procedure in selected patients, to prevent the biomechanical
complications associated with an ACDF(1). There is debate as to whether this approach to treatment
is superior to an ACDF. I will summarise the current data on the topic to establish whether ADR is
superior to ACDF. CASE A 50 year old male presented to the Out–patient department with a two
month history of worsening pain in the right upper limb, extending to the middle finger. This pain
was not improving with analgesia prescribed by his general practitioner. He also complained of
weakness in the affected limb for the preceding two weeks. He denied any lower limb symptoms,
had no difficulty with micturition or defecation and no gait disturbance. His examination was
significant for grade four weakness in right elbow extension and an absent tricep jerk on the
ipsilateral side. A clinical diagnosis of a C7 radiculopathy was made. Magnetic

Lmbar Bulging Case Summary
DOI: 11/13/2014. Patient is a 32–year old male technician who sustained injury at the time he was
breaking loose a pulser component, he felt a sharp pain to his right side, low back buttocks and right
leg. The patient was subsequently diagnosed with lumbar degenerative disc disease, radiculopathy
and, lumbar spinal stenosis. Per MRI of lumbar spine without contrast dated 12/23/14 revealed at
L4–5 there is disc space height loss, disc bulging and facet degenerative change; at L5–S1 there is
posterior disc bulging resulting in mild narrowing of the central canal, and; at T11 to T12 there is
posterior disc bulging resulting in mild narrowing of the central canal. As per focused history and
physical dated 3/17/15, patient is presented to the office

Cervical Spondylosis Papers
Cervical Spondylosis
Jerjean Casalem
Lonestar College System
Summary
Cervical Spondylosis, also known as osteoarthritis or arthritis of the neck, is a common condition
that arises as the age advances. It is a degenerative joint disease that condition develops when the
cartilage and bones in the neck became damaged due to deterioration primarily accumulated through
aging in addition to the habitual contributing factors. This affects the quality of life by the recurrent
neck and shoulder pain, suboccipital pain and headache. However, this degenerative condition,
though, extremely common, countless patients who depict the set of symptoms are undiagnosed,
unaware of the conditions, therefore, are not undertaking measures to ... Show more content on
Helpwriting.net ...
Reading and writing this research paper, I acquired more knowledge of current personal situation.
Being a patient suffering from this condition at an early age, I am well aware of the discomforts and
pain endured which leads to the lack of sleep at night. Physical fitness does help, however, it has to
be in moderation and some are modified in order to avoid aggravating the affected region. Although,
I have not utilized the physical therapy, yoga fitness has helped tremendously, in addition to
practicing proper biomechanics and healthy eating

Degenerative Disc Disease Essay
The pain in your neck has become so severe you've decided to enlist the help of a cervical disc
neurosurgeon plato tx, who diagnosed you with degenerative disc disease. Although the name of this
condition sounds quite frightening, it may not be as scary as it sounds. Knowing exactly what you
are facing and the pain–relief options that are available may help you to feel better about your
situation.
Cervical Disc Neurosurgeon Plato TX: What Degenerative Disc Disease Is
When you think about it, your neck is actually quite amazing. Not only is it able to swivel around
180 degrees, it is in charge of carrying your 9– to 12–lbs. head: that's a lot to hold up and maneuver.
Because of how much your cervical, or neck, spine has to endure, it's no wonder ... Show more
content on Helpwriting.net ...
When it affects your neck, it takes place in the top seven vertebrae in your spine, known as the
cervical spine. Over time, or if you suffer an injury, your discs can break down. Oftentimes, the
proteins contained within the disc space can cause a good amount of inflammation, which can result
in pain, tingling, and numbness in your neck, shoulders, arms, and even hands.
The Good News About Degenerative Disc Disease
If a cervical disc neurosurgeon plano tx diagnoses you with degenerative disc disease, you are likely
worried about the future. After all, a diagnosis such as this seems like it is a sentence for a lifetime
of pain. Patients worry that as they get older, the degeneration will get progressively worse, as will
the pain. Fortunately, that may not be the case at all.
The term "degenerative disc disease" is quite misleading. It does not apply to the symptoms getting
worse over time, but rather the process of the disc degenerating over time. And although the
condition of the disc may get worse as you age, the pain usually gets better, particularly if your body
responds to the treatment you receive, which could range from physical therapy to

Medical Case Study: Clinical Presentation
Clinical Presentation
G. J. is a 28 year–old male patient with no past medical history. On September 13, 2015, he was
admitted at Kendall Regional Medical Center with a chief complaint of worsening back pain lasting
for over a month. He denies any recent trauma or falls, numbness, tingling, or paresthesia. No
urinary symptoms or fever. The patient has been trying multiple medical management options in the
outpatient setting, but they have all failed to relieve the pain. G. J. was sent to the hospital for
consideration of surgical management given that patient's medical management was unsuccessful.
Patient is admitted to internal medicine for further evaluation and investigation. With the analysis of
several MRIs, the patient is diagnosed with ... Show more content on Helpwriting.net ...
Generally, when herniation occurs at the lower levels of the lumbar spine, as it is in the case of
patient G.J., the nerves in the lower back become irritated causing a condition called lumbar
radiculopathy. Lumbar radiculopathies characterize by excruciating pain that shoots down the
buttocks along the legs. Low back ache often precedes pain in the lower limbs. Radicular pain
worsens with movement at the level of the waist, sneezing, and coughing. Urinary and bowel
incontinence may be present in severe cases (Degenerative Disc Disease & Sciatica Symptoms,
Causes, Treatment,

Low-Back Pain
INTRODUCTION: Low–back pain (LBP) is a common cause of disability in our society. Pain in the
lower back can have many origins. The differential diagnosis for low back pain comprises
mechanical, non–mechanical, and visceral causes and includes for example degenerative disc
disease, spondylolysis, spondylolisthesis, spinal stenosis, spondylodiscitis. It can be divided into
structural and non–structural. Structural causes include any process that causes mechanical
compression of nerve root, such as herniated disc and of degenerative diseases (osteophyte) of spine.
Non–structural causes include diabetic radiculopathy which likely occurs due to infarction of a
nerve root or herpes zoaster causes radiculopathy due to viral mediated inflammation

Degenerative Disc Disease (DDD)
Degenerative Disc Disease (DDD) Degenerative Disc Disease (DDD) is not a disease as much as it
is the normal changes in your spines discs as you age. This can be speed up by other primary issues
such as continued trauma from carrying heavy packs on your pack such as going to college, or even
more so when carrying 60 pound backpacks on force marches in the military. Spinal discs are soft
compressible discs that separate the vertebrae that make up the spine. DDD can take place within
the spine but most often occurs at the lumbar disc levels and also the cervical disc level. More so the
lumbar region because of the amount of weight distributed at the L–1 to L–5 levels. Herniated discs
which is an abnormal bulge open of a spinal disc is common ... Show more content on
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The diagnosis can be reinforced with ancillary services such as x–ray, CAT scan or MRI. Usually
these tests since expensive are considered after initial simple treatment is not successful. Simple
treatment would be oral non–steroidal, Physical Therapy exercises to take home and use. Also if this
condition continues you have to rule out tumors, bone disease or infection. For treatment initially
ice/heat therapy is used with medications such as Motrin or Naproxen. If the symptoms continue and
the treatment is not successful then more evasive treatment is available. In my case I was going to
Physical Therapy twice a week initially and using a Transcutaneous Electrical Nerve Stimulation
(TENS) Unit to help reduce the spasms and pain. I now use a portable TENS unit for pain relief. If
this does not work the last resort would be surgery to repair the damaged discs. In this case the
bones are permanently fused but the drawback to this is you have now speed up the arthritic changes
in bone and later in life will have to deal with that pain. Surgery is a last

Cervical Spondylosis
Cervical spondylosis is common and progresses with increasing age. It is the result of degenerative
changes in the cervical spine, including disc degeneration, facet arthropathy, osteophyte formation,
ligamentous thickening and loss of cervical lordosis. Spinal stenosis, or narrowing of the spinal
canal, may occur as a result of progression of spondylotic changes. Spinal cord or nerve root
function may be affected, resulting in symptoms of myelopathy or radiculopathy.(McDonnell and
Lucas 2012) Cervical spondylosis is a common cause of neck pain, radiculopathy and myelopathy.
Degenerative changes in a disc can cause it to prolapse or osteophytes to be formed. Each of these
can cause pressure on the spinal cord leading to myelopathy or radiculopathy.

Failed Back Surgery Syndrome Research Paper
Failed back surgery syndrome (FBSS) or postlumbar surgery syndrome are terms used to describe
unsatisfactory outcome after lumbar spine surgery. 1 FBSS is persistent or recurring low back pain,
with or without sciatica following one or more lumbar operations. 2 The rate of the FBSS increases
in the last two decades despite of the advances in surgical technology. 3, 4 A recent systemic
literature review of discectomies for lumbar disc herniation demonstrate 5%–36% of patients after 2
years had FBSS below the age of 70 years. 5, 6 Another retrospective cohort study of 35,558 patient
in south korea, received lumber disc surgery, re–operation rate at 5 years was 13.4%. 7 Epidural
fibrosis after lumbar surgery is a progressive disease associated with radicular pain and unfavorable
outcomes. Epidural scar usually developed in response to tissue damage, mainly nucleus pulposus,
or hematoma during surgery. 8 After surgery, the lumbar spine progress into degenerative changes,
and development of spinal stenosis, central or foraminal, due to facet joint or disc degeneration, or
segment instability. 6 Stenosis can also be initiated or exacerbated by epidural adhesions. 9
Acceleration of the degenerative changes in the adjacent segments occurs after fusion. Furthermore,
fusion of the lumbar spine into the sacrum may accelerate the development of ... Show more content
The duration of analgesia ranges from 1–12 months. 3 Epidural steroid injections are the most
commonly used procedure. It can be administered primarily by three approaches: transforaminal,
interlaminar, or caudally to alleviate radicular pain. A recent meta–analysis study found that one
third to one half of patients can avoid spine surgery in short term with epidural steroid injection. 11
On the other hand, repeated surgery for epidural scar had only a 30%–35% success rate.

Personal Narrative: My Life As An Athlete
Many people dread Mondays, but I always looked forward to Mondays spent at TOPSoccer. This
student–run, community–based program enables children with disabilities to learn the sport in a
supportive environment. This is where I met Evan, an 11–year–old with cerebral palsy. Evan was
limited in his mobility and had speech difficulties, which made communication trying at times, so
forging a relationship with him was challenging; understandably, he wasn't the most willing
participant. Over the next four years together, I continually sought new ways to engage Evan,
whether pushing his wheelchair around the field house or playing catch. With my encouragement,
Evan's attitude began to change. By my senior year, Evan's grinning face and clapping hands ...
Show more content on Helpwriting.net ...
My lab at Children's Hospital of Philadelphia studies the pathologies of patients with primary
immune deficiencies who are susceptible to autoimmune diseases as well as life–threatening
infections. As a research assistant, my work focuses on the roles of novel genes and pathways in our
large cohort of pediatric patients with common variable immune deficiency. Optimizing
experimental setups to achieve the best results can be a trying process, but hopefully will come with
the reward of contributing to improved treatment for future patients. In some ways, it reminds me of
my freshman soccer team's goal to participate in the NCAA tournament. We worked tirelessly to get
there, reaching the NCAA Division III Elite Eight my senior year. Working in academic research,
which requires similar focus and effort, has fortified my love of science and sharpened my critical
thinking skills. I plan to take these experiences with me as I pursue a career in

Raadiculopathy: A Case Study
This is a 48–year–old male with a 6/7/1995 date of injury. A specific mechanism of injury has not
been described.
DIAGNOSIS: Intervertebral disc disorder with radiculopathy lumbar region. HNP lumbar.
01/15/16 Progress Report noted that the patient has lower back pain and left leg pain. It was noted
that the provider spoke with the patient over the phone. He has continuing pain in the right lower
extremity. The epidural injections have been denied. He has a herniated disc on the right L2–3. He
has been suffering from symptoms in the right leg for the last 5 months. He cannot tolerate the pain.
He would like to pursue surgery. The examination of the thoracic spine was normal. The exam of the
lumbosacral spine showed that all musculature ... Show more content on Helpwriting.net ...
He returned to see Dr. Kahmann and underwent further diagnostic studies. Approximately eight
months ago, he underwent a two–level decompression. However, about three months after that, he
was taken back to surgery for redo decompression at L2–3. Currently, there is constant burning pain
in his left lower extremity along with hyposthesia and weakness. He finds it difficult to sleep at
night because of his pain. Lumbar spine examination revealed well–healed anterior and posterior
surgical scars. Lower extremity neurological examination revealed decreased sensation in the L2,
L3, L4, L5 and S1 dermatomes. There was 4+/5 to 5–/5 strength in the left peroneals and left EHL,
and an absent left AJ reflex. The SLR is positive on the left. Lasegue maneuver and femoral stretch
are negative. Gait is waddling. Unable to heel walk on the left. Able to toe walk with some difficulty
on the left. Lumbar ROM was significantly reduced. The patient is currently

The Tthoracic Spine
The thoracic spine encompasses the upper– and middle–back region. It joins the cervical spine and
extends down about five inches past the bottom of the shoulder blades, where it connects with the
lumbar spine.
There are 12 vertebra making up the thoracic spine. While the cervical spine is built for flexibility
(e.g. turning the head) and lumbar spine is built for power and flexibility (e.g. lifting heavy objects,
touching the toes), the thoracic spine is built for stability and does not have the same flexibility. This
stability plays an important role in holding the body upright and providing protection for the vital
organs in the chest.
The thoracic spine is an intricate construct of bones, muscles, spinal segments, connective tissues,
nerves, ... Show more content on Helpwriting.net ...
The aging process and general wear and tear can lead the cartilage in the facet joints to become thin
or even disappear or even produce an overgrowth of bone spurs and enlargement of the joints. This
can lead to swelling due to arthritis in the thoracic spine and cause tenderness, pressure on the nerve,
and limited range of motion. Facet joint disorder can also result from osteoarthritis.
Vertebral fractures. Compression fractures are perhaps the most common form of thoracic problems.
While they can be caused by an accident, generally they are the result of osteoporosis and the aging
process usually occurring in the lower region of the thoracic spine.
Kyphosis (hunchback). Poor posture or a deformity, such as ankylosing spondylitis can be the cause
of kyphosis, which is the rounding of the back. While kyphosis is primarily a deformity, it can also
be a source of pain and stiffness.
Scoliosis. Scoliosis is a condition in which the spine abnormally curves sideways and can
sometimes produce upper back pain.
Occasionally, more serious underlying diseases or a problem are caused by pain in the upper back.
Tumors putting pressure on the spine along with certain disease of the lungs, heart, kidneys and
abdominal organs can also pain and should not be

CTE Case Study
There have been many studies recently on CTE on NFL and NHL; the majority of the studies are
NFL players. CTE is a progressive degenerative disease of the brain, and its found in people with a
history of repetitive brain trauma and in the early 1900's was called punch drunk syndrome, the
reason it was it called that was from boxers getting repeated hits to the head According to Boston
University. This later caused them to have weakness in lower limbs, unsteadiness of gait, slowness
of muscular movement, and many other things that make a person look like they may be drunk. CTE
is caused by symptomatic concussions as well as asymptomatic sub concussive hits to the head
which are small hits the do not show any symptoms of a concussion. The ... Show more content on
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Of the brains mentioned the position that had the most cases of Linemen with 44, and second being
running backs according to New York Times. The reason linemen make up the most of the CTE
cases is they have accumulation of small hits to the head, rather then the bone rattling hits that other
positions will get. According the New York Times a linemen sustained 62 small hits in a single game
at the college level. It was also stated each impact came with an average force that is equivalent if
the linemen had driven his car into a brick wall at 30 mph. With that the symptoms can occur years
after the head blows have stopped, so the players may not be aware they have CTE until years after
they retire. With the 110 players who had a cases of CTE there was one place–kicker and one punter
that had cases of CTE, this means that CTE can occur in any position on the field of football.
According to New York Times graph it said that out of the 110 NFL players 8 were younger then 40,
44 were between the ages of 41–69, and 58 being 70 or older. There have also been cases of CTE in
hockey. The most known case of CTE from an NHL player is Derrick Boogard, who was considered
one of the most feared enforcers in the league. An enforcer is a player who will fight or check the
offender of the opposing team that may have made a viscous play. Enforcers will get a great deal of
head trauma from the punches of the offender of

Back Pain Case Studies
o Pain commences most commonly with an incident of trauma (e.g., blow to the back);or occurs
spontaneously with (i.e., metastatic cancer to bone), or without apparent cause (e.g.,idiopathic back
pain)3 o Pain may impair ambulation, be associated with paresthesias, or be intermittent in nature o
Pain may occur with cough, sneeze, during Valsalva maneuver (straining at the stool)3 o Patients are
generally quite fearful that the pain may be a indication of serious medical illness or that it will
impact lifestyle and work performance o Pain may be localized to the lower back or extend into the
posterior thigh or buttocks area (e.g. paresthesias indicating a neurologic aspect of the condition)3 o
History of previous back pain, and medications or ... Show more content on Helpwriting.net ...
– Smoking increases risk of sciatica
Primary diagnostic tools3 o History and physical exam are primary tools followed by x–rays or
other imaging exams and possible neurological tests
lmaging6 o X–rays are first approach usually; visualizes bony structures and alignment but will not
visualize muscles or ligaments
– Imaging studies will either show no abnormalities or varying degenerative changes expected as
part of the normal aging process o MRI is used to evaluate for infection, tumor, inflammation, disc
herniation or rupture, or neuroformaminal stenosis o CT is used to demonstrate disc rupture, spinal
stenosis, or tumors – CT is usefulin the emergent situation when quick assessment is desirable;or
when MRI is contraindicated (i.e., cardiac pacemaker, metal implants, tool and dye workers) o
Radioactive bone scans are used to evaluate for metastatic disease, infection, osteoporosis o
Myelogram will enhance images to visualize the spinal cord and nerve roots especially in the case of
previous surgical intervention o Discography combined with MRI is often used for pre–planning of
surgery to correlate the symptoms with a speciAc disc level
Functional testing

Vertebral Column Essay
Anatomy and Physiology of the Vertebral Column In humans, the vertebral column is also called the
spine or backbone. It has 24 articulating vertebrae portions and nine vertebrae that are fused in the
coccyx and sacrum. The vertebral column protects the spinal cord in the spinal column, providing
both protection and flexibility. The vertebral column is grouped by region (See Figure 1), with 7
vertebrae in the cervical curve nearest the neck; moving to 12 thoracic vertebrae (mid–upper back);
to 5 lumbar vertebrae (lower back). Each individual vertebrae are made up of a body (the centrum),
arches that protrude from the upper and lower parts of the centrum, and various processes that arise
from the centrum and/or arches. Arches that extend from the top of the centrum are neural arches;
the ones found underneath the centrum are hemal or chevron arches. These arches (also called
facets) form articulations. Together, the notches from two contiguous vertebrae for an opening for
the spinal cord to pass called the intervertebral foramen (Snell, 2008). There are regional differences
in the vertebral structure. Cervical vertebrae have large spinal canals, oval shaped vertebral bodies
and facets that are oriented obliquely. Thoracic vertebrae form the transition between the cervical
and lumbar. The upper 4 thoracic vertebrae are like cervical vertebrae with vertically oriented
articular facets and posteriorly directed spinous processes. The lower four thoracic vertebrae contain
more

Chiropractic Case Summary
DOI: 07/16/2002. This is a 71–year–old male superintendent who sustained an injury when he hit
his head on generator and hurt his neck. Patient is diagnosed with cervical strain, cervical
degenerative disc disease, cervical facet arthropathy, cervicalgia, lumbago, lumbar degenerative disc
disease, lumbar facet arthropathy, and sciatica. As per office visit note dated 5/18/2016, patient
complains of flare–up of his muscle spasms. He requested for more chiropractic therapy, which he is
currently receiving for his chronic pain. It allows him to have better range of motion of his neck,
back, and bilateral upper extremities. He has been able to walk 1 mile every 2 to 3 days for exercise
as well as perform at–home physical therapy. Prior to chiropractic ... Show more content on
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Physical examination revealed that the patient's back is less tender. There is facet tenderness over
the bilateral L3–S1. There is also slight pain with limited rotation, flexion, and hyperextension. The
right lower extremity is noted to be weaker. The lumbar spine examination is positive for seated
straight–leg raise on the left and facet loading. As per treatment plan, the patient will be
continuously evaluated for medication regimen and make alterations as necessary. It was noted that
the patient states that there is continued need for his Zanaflex as necessary for flare–up of muscle
spasms until he is able to start up chiropractor therapy again. He will try to discontinue the
medication next month with chiropractor therapy. As per office notes dated 5/23/16, the patient's
pain level is 5–6/10. He states continued need for his Zanaflex as necessary for fare–up until he is
able to start up chiropractic therapy. He continues to have neck pain with intermittent periods of
sharp–stabbing pain over the right side with radiation to the bilateral upper extremities with
numbness as well as associated cramping into upper extremity and into fingers. Current medications
include Zanaflex, Nexium, Celebrex, and

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