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21. Appropriate Use Criteria: Imaging of the Spine

. All Rights Reserved. 2 Table of Contents Description and Application of the Guidelines 3 Administrative Guidelines 4 Ordering of Multiple Studies 4 Pre-test Requirements 5 Spine Imaging 6 CT of the Cervical Spine 6 MRI of the Cervical Spine 10 CT of the Thoracic Spine 14 MRI of the Thoracic Spine 17 CT of the Lumbar Spine 20 MRI of the Lumbar Spine 23 MRA of the Spinal Canal 26 Spine Biblography 27Guideline Description and Administrative Guidelines | Copyright © 2018. AIM Specialty Health. All (...) tumor assessment; developmental vertebral abnormalities) and CT myelography Abnormalities detected on other imaging studies which require additional clarification to direct treatment Fracture evaluation ? Following initial evaluation with radiographs Post-myelogram CT or CT following other cervical spine interventional procedure Post-trauma ? Neurologic deficit with possible spinal cord injury ? Progressively worsening pain Significant acute trauma to the cervical spine region When the patient’s

2018 AIM Specialty Health

22. Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications

in the upper thoracic spine, 4.1 mm at the T11–T12, and 4 to 7 mm in the lumbar regions. The epidural space has extensive thin-walled, valveless venous plexi (plexus venous vertebralis interior, anterior, and posterior), which are vulnerable to damage during needle placement and advancement of spinal cord stimulator leads and epidural and intrathecal catheters. These epidural veins are mainly found in anterior and lateral aspects of the epidural space. Furthermore, the fragility of these vessels increases (...) -thirds of the participants (67%) had separate protocols regarding aspirin (acetylsalicylic acid [ASA]) or nonsteroidal anti-inflammatory drugs (NSAIDs). Moreover, 55% stopped ASA before spinal cord stimulation (SCS) trials and implants, and 32% stopped ASA before epidural steroid injections (ESIs). However, 17% admitted that they used different protocols for cervical spine injections as compared with lumbar spine injections. Most did not express familiarity with selective serotonin reuptake

2018 American Society of Regional Anesthesia and Pain Medicine

23. Cervical Spine Collar Clearance in the Obtunded Adult Blunt Trauma Patient

, bone misalignment (subluxations, listhesis, interspinous widening, or splaying), or single-level ligamentous injury involving all three columns. A priori, our committee consensus of clinical judgment was that a 3 of 1,000 rate (0.3%) was an upper acceptable limit for a missed unstable C-spine injury. Spinal cord injuries included spinal epidural hematomas, subdural hematomas, cord edema, or cord contusions. Nonligamentous soft tissue injury was captured, when specified. If discrepancies existed (...) significance in the classification of acute thoracolumbar spinal injuries. In: Banaszkiewicz PA, Kader DF. , eds. Classic Papers in Orthopaedics. London, England: Springer Link; 2013; : 289–292. Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine. 1983; 8: 817–831. Whiting PF, Rutjes AWS, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, Leeflang MMG, Sterne JAC, Bossuyt PMM. and QUADAS-2 Group. QUADAS-2: a revised tool for the quality

2015 Eastern Association for the Surgery of Trauma

24. Consensus Practice Guidelines on Interventions for Lumbar Facet Joint Pain from a Multispecialty, International Working Group Full Text available with Trip Pro

of treatment is a source of contention and scientific debate. Regarding prevalence, the cited frequency of lumbar facet joint pain ranges from as low as 4.8% in the multicenter National Low Back Pain Survey evaluating final diagnoses of 2374 patients with low back pain (LBP) referred to an orthopedic or neurosurgical spine surgeon, to over 50% in systematic reviews on prevalence studies using varying criteria for diagnostic blocks performed by interventional pain physicians. The wide disparity in reported (...) regulatory agencies and payers. The Spine Intervention Society (SIS; formerly the International Spine Intervention Society) has published guidelines on the performance of lumbar facet blocks and radiofrequency (RF) neurotomy, but these rigorous criteria have not been followed in recent randomized controlled trials (RCTs), and are not adhered to in domestic and international guidelines. Whereas stringent selection criteria have been anecdotally associated with high RFA success rates, the increased false

2020 American Society of Regional Anesthesia and Pain Medicine

25. Consensus Practice Guidelines on Interventions for Lumbar Facet Joint Pain

confirmation, which is potentially problematic at upper lumbar vertebrae. For example, a study performed in the thoracic spine found that misidentifica- tion of the targeted spinal level occurred between 16% and 43% of the time depending on the scanning technique, with IA at 6 weeks and 3 months Differences favoring MBB non- significant at 6 months. Cohen et al 134 Case- control 511 who under MBB (n=212), IA (n=212) or MBB and IA (n=87) before RFA MBB with 0.5–0.75 mL LA or IA with 0.5–1 mL LA+steroid MBB (...) of the seven Revel’s criteria (above) including pain reduction by recumbency resulted in 92% sensitivity and 80% specificity. Manchikanti et al 50 Prospective n=120 =75% pain reduction MBB (double comparative diagnostic blocks) The prevalence of clinical findings (pain better by sitting/lying, pain worsened by sitting/standing/walking/coughing/lumbar spine range of motion, positive straight leg raising test and pain referral pattern) were similar between positive and negative block groups. Back pain

2020 American Academy of Pain Medicine

26. Diagnosis and Treatment of Lumbar Disc Herniation with Radiculopathy

for symptomatic lumbar disc herniation with radiculopathy as reflected in the highest quality clinical lit - erature available on this subject as of July 2011. The goals of the guideline recommendations are to assist in delivering optimum, efficacious treatment and functional recovery from this spinal disorder. Scope, Purpose and Intended User This document was developed by the North American Spine So - ciety Evidence-based Guideline Development Committee as an educational tool to assist practitioners who (...) outcomes of surgical and nonsurgi- cal management of sciatica. Spine (Phila Pa 1976). Aug 1 1996;21(15):1777-1786. 3. Atlas SJ, Deyo RA, Keller RB, et al. The Maine Lumbar Spine Study, Part III. 1-year outcomes of surgical and nonsurgical management of lumbar spinal stenosis. Spine (Phila Pa 1976). Aug 1 1996;21(15):1787-1794; discussion 1794-1785. 4. Atlas SJ, Keller RB, Chang Y , Deyo RA, Singer DE. Surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: five-year

2012 North American Spine Society

27. Guidance on Competencies for Spinal Cord Stimulation

skills in patient selection, implantation, follow up and detection/ management of complications e.g. infection and neural compromise. After care: Emergency full spine MRI scanning must be available. Arrangements must be in place for urgent referral for neurosurgical or spinal surgical opinion. ENDORSED BY: THE SOCIETY OF BRITISH NEUROLOGICAL SURGEONS THE NEUROMODULATION SOCIETY OF THE UNITED KINGDOM AND IRELAND GUIDANCE ON COMPETENCIES FOR SPINAL CORD STIMULATION GUIDELINES Section A: Core (...) Guidance on Competencies for Spinal Cord Stimulation July 2020 Guidance on Competencies for Spinal Cord Stimulation2. Spinal cord stimulation (SCS) has been used for more than 40 years for a variety of conditions including pain and cardiovascular problems. SCS has been supported by NICE for treatment of neuropathic pain; however experience in using the therapy for other indications is increasing and techniques of stimulus delivery are still evolving. Outcomes are dependent on a variety

2020 Faculty of Pain Medicine

28. Spinal Injections

Meaningful Improvement 5 Coverage Table 7 Prior authorization 8 Billing 8 2 ESI language corrected September 2018; Hyperlinks to evidence resources added May 2018. Introduction There are different kinds of spinal injections, each with a different purpose, risk level, and degree of effectiveness. Spinal injections can provide pain relief and functional improvement for up to several months, but their effects are not permanent. They involve the injection of a steroid and/or anesthetic into the spine (...) September 2018; Hyperlinks to evidence resources added May 2018. Facet Injections Injections directly into the facet joint are ineffective at relieving pain and have no role in diagnosing conditions; hence, both therapeutic and diagnostic facet injections are not covered. Epidural Injections With epidural injections, substances are injected within the spine but outside the spinal canal. Depending on what is injected, they can be done as part of a diagnostic imaging procedure (using contrast medium

2018 Washington State Department of Labor and Industries

29. Psychosocial Adjustment after Spinal Cord Injury (updated 2014)

by Professor Ashley Craig, Sydney Medical School–Northern; The University of Sydney1 ACI Psychological Adjustment after Spinal Cord Injury ACKNOWLEDGEMENTS First edition, 2002: This document was originally published as a fact sheet for the Rural Spinal Cord Injury Project (RSCIP), a pilot healthcare program for people with a spinal cord injury (SCI) conducted within New South Wales involving the collaboration of Prince Henry & Prince of Wales Hospitals, Royal North Shore Hospital, Royal Rehabilitation (...) , The University of Sydney. The revision was funded by the NSW Agency for Clinical Innovation. The work by Selina Rowe, Manager, NSW Spinal Outreach Service, Royal Rehab, Ryde, and Frances Monypenny, ACI Network Manager, State Spinal Cord Injury Service, Chatswood, NSW, Australia, in coordinating and managing the project to review and update this fact sheet, one of a suite of 10 fact sheets, is acknowledged. All recommendations are for patients with SCI as a group. Individual therapeutic decisions must

2014 Agency for Clinical Innovation

30. Guide for Health Professionals on the Psychosocial Care of People with Spinal Cord Injury (updated 2014)

and resilience model approaches to SCI care, it is desirable that whenever possible, decisions about treatment and ongoing care should be made collaboratively with the individual, their family, carers and other professionals involved in their care. The work by Selina Rowe, Manager, NSW Spinal Outreach Service, Royal Rehab, Ryde, and Frances Monypenny, ACI Network Manager, State Spinal Cord Injury Service, Chatswood, NSW, Australia, in coordinating and managing the project to review and update this fact sheet (...) , one of a suite of 10 fact sheets, is acknowledged. 1 Rehabilitation Studies Unit, Sydney Medical School–Northern, The University of Sydney 2 Clinical and Health Psychology, University of Western Sydney ACKNOWLEDGEMENTS2 Guide for Health Professionals on the Psychosocial Care of Adults with Spinal Cord Injuries It was my pleasure to be awarded the inaugural NSW Office for Science and Medical Research Spinal Exchange Program Fellowship in 2005, during which I participated in a series of activities

2014 Agency for Clinical Innovation

31. Guidelines for the prescription of a seated wheelchair or mobility scooter for people with a traumatic brain injury or spinal cord injury

Rehabilitation Centre Adrian Byak Physiotherapist Spinal Cord Injury Assistive Technology Seating Service Northern Sydney Central Coast Health Service Private Practice Danielle Collins Senior Occupational Therapist Spinal Cord Injury Prince of Wales Hospital Spinal Unit Allie Di Marco Occupational Therapist Spinal Cord Injury Private practice Linda Elliott Statewide Equipment Advisor EnableNSW Health Support Services NSW Health Bill Fisher Rehabilitation Engineer Assistive Technology Seating Service Northern (...) Sydney Central Coast Health Service Kate Hopman Senior Occupational Therapist Traumatic Brain Injury Liverpool Hospital Brain Injury Rehabilitation Unit Greg Killeen Spinal cord injury consumer representative Suzanne Lulham Director, Service Delivery Lifetime Care & Support Authority Jodie Nicholls Senior Occupational Therapist Brain Injury Westmead Brain Injury Rehabilitation Unit Representative of Occupational Therapy Australia – NSW Division Thi Hong Nguyen Brain injury consumer representative

2012 Agency for Clinical Innovation

32. Obstetric Management of Patients with Spinal Cord Injuries

an obstetrician with experience in caring for women with disabilities, maternal-fetal medicine subspecialists, anesthesiologists, spinal rehabilitation physicians, nurses, physiotherapists, occupational therapists, lactation consultants, pediatricians, and neonatologists . Common Complications Autonomic Dysreflexia Autonomic dysreflexia (sometimes called autonomic hyperreflexia) is the most serious medical complication that occurs in women with SCIs and is found in 85% of patients with lesions at or above T6 (...) management of a parturient with spinal cord injury and autonomic hyperreflexia. Anaesthesia 2003;58:823–4. Article Locations: Baker ER, Cardenas DD, Benedetti TJ. Risks associated with pregnancy in spinal cord-injured women. Obstet Gynecol 1992;80:425–8. Article Locations: Krassioukov A, Warburton DE, Teasell R, Eng JJ. A systematic review of the management of autonomic dysreflexia after spinal cord injury. Spinal Cord Injury Rehabilitation Evidence Research Team. Arch Phys Med Rehabil 2009;90:682–95

2020 American College of Obstetricians and Gynecologists

33. An Update of Comprehensive Evidence-Based Guidelines for Interventional Techniques in Chronic Spinal Pain - Part 2 - Guidance and Recommendations

An Update of Comprehensive Evidence-Based Guidelines for Interventional Techniques in Chronic Spinal Pain - Part 2 - Guidance and Recommendations Objective: To develop evidence-based clinical practice guidelines for interventional techniques in the diagnosis and treatment of chronic spinal pain. Methodology: Systematic assessment of the literature. Evidence: I. Lumbar Spine • The evidence for accuracy of diagnostic selective nerve root blocks is limited; whereas for lumbar provocation (...) disc decompression, and implantable therapies. V. MAnAGEMEnT of LoW BACK PAIn Low back pain is the most common of all spinal, and even chronic, pain problems. Lumbar intervertebral discs, facet joints, sacroiliac joints, ligaments, fascia, muscles, and nerve root dura have been shown to be capable of transmitting pain in the lumbar spine with resulting symptoms of low back pain and lower extrem- ity pain (8,10,11,13,17,33,36,374,551). Lumbar disc herniation and spinal stenosis are di- agnosed

2013 American Society of Interventional Pain Physicians

34. Pharmacological Therapy for Acute Spinal Cord Injury Full Text available with Trip Pro

March 2013 Article Contents Article Navigation Pharmacological Therapy for Acute Spinal Cord Injury R. John Hurlbert, MD, PhD, FRCSC * Department of Clinical Neurosciences, University of Calgary Spine Program, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada Search for other works by this author on: Mark N. Hadley, MD ‡ Division of Neurological Surgery, † Correspondence: Mark N. Hadley, MD, FACS, UAB Division of Neurological Surgery, 510 –20 th Street South, FOT 1030, Birmingham (...) ) and in the rehabilitation unit ( P = .035). Overall, hospital stay was not different between the 2 groups, leading the authors to conclude that MP may predispose SCI patients to pneumonia, but had no adverse effect on long-term outcome. Poynton et al retrospectively identified 71 consecutive SCI patients admitted to their rehabilitation facility between June 1991 and December 1994. American Spinal Injury Association (ASIA) motor and sensory scores were recorded at the time of injury, time of transfer

2013 Congress of Neurological Surgeons

35. Clinical Assessment Following Acute Cervical Spinal Cord Injury Full Text available with Trip Pro

to measure potential neurological improvement after therapy and, importantly, to determine its functional significance. Pain of the spinal cord, spinal column, or other orthopedic origin is often of clinical significance following acute SCI. Pain can be horribly debilitating, hindering patient performance and limiting functional abilities beyond that predicted by the patient's neurological deficits. These 3 topics (neurological assessment, functional outcome, and pain associated with SCI) are the focus (...) of this contemporary update on the Clinical Assessment Following Acute Spinal Cord Injury, previously produced and published by the Joint Section on Disorders of the Spine and Peripheral Nerves of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons. SEARCH CRITERIA A computerized search of the database of the National Library of Medicine (PubMed) of the literature published from 1966 to 2011 was performed for each of the 3 subtopics reviewed in this guideline: neurological

2013 Congress of Neurological Surgeons

36. Treatment of Subaxial Cervical Spinal Injuries Full Text available with Trip Pro

of patients who presented with a delayed diagnosis and neurological deterioration. SUMMARY Subaxial cervical spine fractures and dislocations encompass a broad spectrum of acute traumatic injuries. Adequate decompression of the neural elements and the restoration of sufficient spinal stability to allow early mobilization and rehabilitation remain basic treatment tenets. Although nonsurgical treatment can be employed successfully, surgical treatment of these injuries achieves these goals more consistently (...) immobilization by either internal fixation or external immobilization to allow for early patient mobilization and rehabilitation is recommended. If surgical treatment is considered, either anterior or posterior fixation and fusion is acceptable in patients not requiring a particular surgical approach for decompression of the spinal cord. Treatment of subaxial cervical fractures and dislocations with prolonged bed rest in traction is recommended if more contemporary treatment options are not available

2013 Congress of Neurological Surgeons

37. Metastatic spinal cord compression in adults: diagnosis and management

information (for example, in the form of a leaflet) to patients and their families and carers which explains the symptoms of MSCC, and advises them (and their healthcare professionals) what to do if they develop these symptoms. Contact the MSCC coordinator urgently (within 24 hours) to discuss the care of patients with cancer and any of the following symptoms suggestive of spinal metastases: pain in the middle (thoracic) or upper (cervical) spine progressive lower (lumbar) spinal pain severe unremitting (...) Early symptoms and signs Early symptoms and signs 1.3.2.1 Contact the MSCC coordinator urgently (within 24 hours) to discuss the care of patients with cancer and any of the following symptoms suggestive of spinal metastases: pain in the middle (thoracic) or upper (cervical) spine progressive lower (lumbar) spinal pain severe unremitting lower spinal pain spinal pain aggravated by straining (for example, at stool, or when coughing or sneezing) localised spinal tenderness Metastatic spinal cord

2008 National Institute for Health and Clinical Excellence - Clinical Guidelines

38. Nutritional Support After Spinal Cord Injury Full Text available with Trip Pro

following injury with resultant increased susceptibility for infection, impaired wound healing, and difficulty weaning from mechanical ventilation. – , These factors added to the inherent immobility, denervation, and muscle atrophy associated with spinal cord injury provide the rationale for nutritional support of spinal cord injured patients following trauma. The guidelines author group of the Joint Section on Disorders of the Spine and Peripheral Nerves of the American Association of Neurological (...) , and nutritional status in spinal cord injury patients . Exp Mol Pathol . 2000 ; 68 ( 1 ): 38 – 54 . 11. Nutritional support after spinal cord injury. In: Guidelines for the management of acute cervical spine and spinal cord injuries . Neurosurgery . 2002 ; 50 ( 3 suppl): S81 – S84 . 12. Hadley MN , Grahm TW , Harrington T , Schiller WR , McDermott MK , Posillico DB Nutritional support and neurotrauma: A critical review of early nutrition in forty-five acute head injury patients . Neurosurgery . 1986 ; 19 ( 3

2013 Congress of Neurological Surgeons

39. Deep Venous Thrombosis and Thromboembolism in Patients With Cervical Spinal Cord Injuries

encountered in patients who have sustained cervical spinal cord injuries. Several means of prophylaxis and treatment are available, including anticoagulation, pneumatic compression devices, and vena cava filters. In 2002, the guidelines author group of the Joint Section on Disorders of the Spine and Peripheral Nerves of the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) produced a medical evidence-based guideline on this important topic. The purpose (...) and 28 days after injury. Remarkably, none of the delayed admission group patients were prophylactically treated with sequential compression devices prior to admission. These authors provide Class II medical evidence that the early application of both chemical and mechanical prophylaxis reduces the incidence of DVT in patients with acute SCI. In 2009, Ploumis et al surveyed 25 spine surgeons to obtain a consensus on the use of pharmacologic thromboprophylaxis following spinal injury. The consensus

2013 Congress of Neurological Surgeons

40. An Update of Comprehensive Evidence-Based Guidelines for Interventional Techniques in Chronic Spinal Pain - Part 1 - Introduction and General Considerations

, systematic reviews, meta-analysis, interventional pain management, evidence synthesis, methodological quality assessment, clinical relevance, recommendations. Pain Physician 2013; 16:S1-S48 Guidelines An Update of Comprehensive Evidence-Based Guidelines for Interventional Techniques in Chronic Spinal Pain. Part I: Introduction and General Considerations From: 1 Pain Management Center of Paducah, Paducah, KY, and University of Louisville, Louisville, KY; 2 Mid Atlantic Spine & Pain Physicians of Newark (...) . This was associated with a 65% increase in expenditures; a 49% increase in the number of patients seeking spine-related care from 1997 through 2006 was the biggest contributor to the increase in expenditures. Rates of imaging, interven- tional techniques, drug use, chiropractic, physical thera- py, alternative complementary therapy, and surgery for spine problems have increased substantially over the past decade (46,47,54,79-93,147-212). Spinal interven- tional techniques are thus considered one of the major

2013 American Society of Interventional Pain Physicians

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