Intro

Question 1

Why isn’t the patho-anatomical model sufficient for spine? (3)

Answer 1

• lack of specific assessment techniques (ie one segment at a time)
• poor correlation between signs (including imaging) and symptoms
• little consideration of psychosocial factors

Question 2

Reasons to get X-ray (4)

Answer 2

• trauma
• suspect fx
• worsening hard neuro signs
• dislocation not relocating

Question 3

Classification systems

Answer 3

• allows division into sub-sets of like pts
• based on algorithms of S/S
• low back first, now neck developing

Question 4

3 things the patho-anatomical model DOES work well for

Answer 4

• large disc herniations with radiculopathy
• stenosis (pseudoclaudication)
• specific spinal cause (cancer, fx, infection)

Question 5

Nominalist approach

Answer 5

• classification and tx occurs without knowing causative agent or etiology
• diagnostic label from clusters of S/S

Question 6

Problems with classification approach (3)

Answer 6

• subjectivity of classification process
• mutually exclusive/exhaustive categories
• generality or specificity of diagnostic label

Question 7

Exam flow

Answer 7

History (red/yellow flags), systems review, exam, eval, tx based on classification

Question 8

Headache questions (5)

Answer 8

• dx of migraines?
• visual disturbances (photosensitivity)
• one-sided?
• aura (usu knows its coming)
• flash like disturbances?

Question 9

Current categories for non-specific neck pain

Answer 9

1. neck pain with mobility deficit (ex unilateral neck pain)
2. neck pain with headache
3. neck pain with movement (ex whiplash)
4. neck pain w radiating pain

Question 10

Clinical Prediction Rules

Answer 10

• algorithmic decision tools designed to aid clinicians in determining a diagnosis, prognosis, or response to intervention
• set of clinical findings from history, phys exam, and dx tests
• meaningful predictor of condition or outcome
• eg Ottawa foot rules, Cspine rulse

Question 11

Diagnostic CPR for Cspine

Answer 11

cervical radiculopathy

Question 12

Prognostic CPR for Cspine

Answer 12

Whiplash, Cervical radiculopathy

Question 13

Interventional CPRs

Answer 13

Cervical manip, Thoracic manip for neck pain, TrP for headache, traction for mechanical neck pain