Examination Of Spine Research Articles

Physical therapist attitude and opinion about cervical spine examination: A national Spanish survey

A correct examination is essential during a differential diagnosis of neck pain patients. Therefore, the objective of this study was to provide an update on the properties considered most important by physical therapists (PTs) when conducting accessory and physiological movement tests during the cervical spine physical examination. A total of 84 private physiotherapy centres participated in this online cross-sectional survey including 415 active physiotherapists and members of one autonomous Spanish Physiotherapists School. This survey included information about the characteristics of the respondents (eg, weekly patient care, highest qualification and specific training in osteopathy and manual therapy), their opinion about the accuracy and reliability of accessory and physiological movement tests, the frequency and importance of mobility and pain responses, and the most commonly reference used to make a judgement. Pain responses are most frequently used by physiotherapists at a rate of 79.8% and also rated as important by 42.65% respondents mobility aspects such as quality of end-feel (17.3%), quantity of translation (16.4%) and quality of resistance (13.3%) during passive accessory intervertebral movement tests. During passive and active physiological movement tests, the most frequent properties assessed were the quality of motion path (80.5% and 84.3%, respectively) and quantity of angle bending (81.7% and 77.6%, respectively). Pain responses are used as reference by 54.7% to make a clinical judgement during passive accessory intervertebral movement tests. Physical therapists face validity in relation to passive accessory intervertebral movement test for assessing spinal segmental motion aspects has been decreasing with more attention devoted to pain responses. The current scepticism regarding the motion properties assessed with these tests is associated with utility aspects such as validity, sensitivity, accuracy and specificity.

T1 Mapping Quantifies Spinal Cord Compression in Patients With Various Degrees of Cervical Spinal Canal Stenosis.

Age-related degeneration of the cervical spinal column is the most common cause of spinal cord lesions. T1 mapping has been shown to indicate the grade and site of spinal cord compression in low grade spinal canal stenosis (SCS). Aim of our study was to further investigate the diagnostic potential of a novel T1 mapping method at 0.75 mm resolution and 4 s acquisition time in 31 patients with various grades of degenerative cervical SCS. T1 mapping was performed in axial sections of the stenosis as well as above and below. Included subjects received standard T2-weighted MRI of the cervical spine (including SCS-grading 0-III), electrophysiological, and clinical examination. We found that patients with cervical SCS showed a significant difference in T1 relaxation times within the stenosis (727 ± 66 ms, mean ± standard deviation) in comparison to non-stenotic segments above (854 ± 104 ms, p < 0.001) and below (893 ± 137 ms, p < 0.001). There was no difference in mean T1 in non-stenotic segments in patients (p = 0.232) or between segments in controls (p = 0.272). Mean difference of the T1 relaxation times was significantly higher in grade III stenosis (234 ± 45) vs. in grade II stenosis (176 ± 45, p = 0.037) vs. in grade I stenosis (90 ± 87 ms, p = 0.010). A higher difference in T1 relaxation time was associated with a central efferent conduction deficit. In conclusion, T1 mapping may be useful as a tool for SCS quantification in all grades of SCS, including high-grade stenosis with myelopathy signal in conventional T2-weighted imaging.

In vivo 3D tomography of the lumbar spine using a twin robotic X-ray system: quantitative and qualitative evaluation of the lumbar neural foramina in supine and upright position

ObjectivesSupine lumbar spine examinations underestimate body weight effects on neuroforaminal size. Therefore, our purpose was to evaluate size changes of the lumbar neuroforamina using supine and upright 3D tomography and to initially assess image quality compared with computed tomography (CT).MethodsThe lumbar spines were prospectively scanned in 48 patients in upright (3D tomographic twin robotic X-ray) and supine (30 with 3D tomography, 18 with CT) position. Cross-sectional area (CSA), cranio-caudal (CC), and ventro-dorsal (VD) diameters of foramina were measured by two readers and additionally graded in relation to the intervertebral disc height. Visibility of bone/soft tissue structures and image quality were assessed independently on a 5-point Likert scale for the 18 patients scanned with both modalities. Descriptive statistics, Wilcoxon’s signed-rank test (p < 0.05), and interreader reliability were calculated.ResultsNeuroforaminal size significantly decreased at all levels for both readers from the supine (normal intervertebral disc height; CSA 1.25 ± 0.32 cm2; CC 1.84 ± 0.24 cm2; VD 0.88 ± 0.16 cm2) to upright position (CSA 1.12 ± 0.34 cm2; CC 1.78 ± 0.24 cm2; VD 0.83 ± 0.16 cm2; each p < 0.001). Decrease in intervertebral disc height correlated with decrease in foraminal size (supine: CSA 0.88 ± 0.34 cm2; CC 1.39 ± 0.33 cm2; VD 0.87 ± 0.26 cm2; upright: CSA 0.83 ± 0.37 cm2, p = 0.010; CC 1.32 ± 0.33 cm2, p = 0.015; VD 0.80 ± 0.21 cm2, p = 0.021). Interreader reliability for area was fair to excellent (0.51–0.89) with a wide range for cranio-caudal (0.32–0.74) and ventro-dorsal (0.03–0.70) distances. Image quality was superior for CT compared with that for 3D tomography (p < 0.001; κ, CT = 0.66–0.92/3D tomography = 0.51–1.00).ConclusionsThe size of the lumbar foramina is smaller in the upright weight-bearing position compared with that in the supine position. Image quality, especially nerve root delineation, is inferior using 3D tomography compared to CT.Key Points• Weight-bearing examination demonstrates a decrease of the neuroforaminal size.• Patients with higher decrease in intervertebral disc showed a narrower foraminal size.• Image quality is superior with CT compared to 3D tomographic twin robotic X-ray at the lumbar spine.

Peer review in MRI: A quality improvement programme and pilot study

IntroductionThe aim of this pilot study was to implement a peer review programme to evaluate MRI images and protocols, with the goal of improving quality and standardising protocols. MethodA plan-do-check-act method of action research was adopted. A checklist was designed and two radiographers scored the images (Optimal, Diagnostic or Suboptimal). A sample of five Lumbar Spine examinations were selected and reviewed on two separate occasions, one month apart. A consultant radiologist also scored the selected examinations. ResultsThere was excellent intra-rater reliability for both observers. At first assessment, Cohen's weighted Kappa analysis indicated moderate inter-rater agreement (0.457) rising to substantial agreement (0.606) at second assessment. Variations in sequence parameter settings by the radiographers were noted. Feedback via educational sessions were implemented and enhancement of protocols were made. ConclusionsRadiographers manipulate many parameters during MRI examinations, and image quality can be degraded if sequences are not optimised. This may lead to misinterpretation.Initial results suggest peer review can result in improved image quality, better protocols, and improved staff confidence.There are opportunity costs involved in releasing staff from clinical work and time and resources required for image appraisal training, however we suggest this model can be extended to other departments and modalities as a healthcare improvement initiative. Implications for practiceInitial results suggest peer review processes performed by radiographers can result in improvement to protocols and image quality in MRI. With appropriate training, radiographers can implement and undertake appraisal of image quality in MRI as part of clinical governance. The purpose of feedback must be made clear, and good professional relationships should be forged to allow candid and supportive feedback with a focus on development and education.

Multiple CNS Tumors in a Patient With Neurofibromatosis Type 2: Classical Presentation of a Rare Disease

Neurofibromatosis type 2 is a genetic autosomal dominant disorder caused by a spontaneous mutation in the gene located on chromosome 22 q11-13.1, which usually emerges in adolescence or early adulthood and is characterized by the development of bilateral vestibular schwannoma. We hereby report the classical case of Neurofibromatosis type 2 in a 25-year-old young male with multiple tumors associated with the disease. This patient presented to us with 3 years history of multiple painless nodules on his skin, facial weakness, left-sided progressive hearing loss, and 20 days history of weakness in the left lower limb. On Examination, he was vital with a GCS of 15/15. He was anemic with no jaundice. He had left inguinal lymphadenopathy along with multiple subcutaneous nodules on different areas, including the scalp, face, left mid-axillary line over the abdomen. He also had Right-sided facial palsy and horizontal nystagmus. CNS examination revealed an upgoing plantar on the left side, right facial nerve palsy, and bilateral vestibulocochlear nerve paralysis. Spine examination revealed spinal tenderness in the lower lumbar region. Superficial abdominal reflexes were absent. Upper limb and right lower limb power, tone, and reflexes were normal while the tone and power in the left lower limb were reduced power being ⅗. Reflexes were also exaggerated in the left lower limb. The right ankle showed swelling, most probably a plexiform neuroma. On investigations, he had normochromic normocytic anemia with mild leucocytosis. Platelets were normal. The rest of the biochemical investigations, including serum electrolytes, liver function tests, and renal function tests, were also normal.MRI brain and spine confirmed bilateral acoustic neuroma and multiple cranial and peripheral nerve tumors i.e., classical presentation of a rare disease neurofibromatosis. He was referred to the neurology unit for further assessment and treatment.

T2-SPACE imaging of the cauda equina for the assessment of leptomeningeal metastatic disease

The diagnosis of leptomeningeal metastatic disease (LMD) is frequently challenging and MRI of the spine is an important part of the diagnostic paradigm. We sought to examine the value of adding 3-dimensional, heavily T2-weighted, Sampling Perfection with Application optimised Contrasts using different flip angle Evolution (T2-SPACE) imaging of the lumbar spine to the MRI protocol for patients with suspected LMD. MRI spine examinations including T2-SPACE imaging of the lumbar spine performed for suspected or known LMD were retrospectively reviewed by a neuroradiologist to determine the additional benefit of the T2-SPACE sequence. The accuracy of T2-SPACE was also compared to contrast-enhanced T1-weighted imaging (ceT1WI) and standard T2-weighted imaging (T2WI). 59 patients with T2-SPACE were identified over a 20-month period, 17 having abnormal appearances on ceT1WI, including 12 with appearances consistent with LMD. In eight of these 12 patients, nodules visible on T2-SPACE were visible on T2WI, though T2-SPACE improved the temporal comparison of slowly progressive cauda equina nodules in two cases. In three patients, T2-SPACE identified nodules which were not readily identifiable on T2WI, though were visible on ceT1WI. In one patient, LMD visible on ceT1WI was not appreciable on T2-SPACE or T2WI due to the lack of a nodular component. In six patients, T2WI showed equivocal nodularity, which could be confidently attributed to facet joint arthropathy or a tortuous vessel. In conclusion, T2-SPACE has high sensitivity and specificity for the detection of nodular lesions of the cauda equina and can confidently characterise equivocal findings on standard T2WI.

Complication Events After Spinal Surgery Performed by American Board of Orthopaedic Surgery (ABOS) Part II Candidates (2008-2017).

Retrospective cohort study. To evaluate complications following spine surgery using American Board of Orthopaedic Surgeons (ABOS) Part II examination data from 2008 to 2017. Recent research has demonstrated the importance of surgical experience and clinical volume in minimizing complications after spine surgery. This may be challenging for orthopedic spine surgeons who are just starting their practice. We performed a retrospective review of surgical cases submitted to the ABOS by candidates taking the Part II Spine examination between 2008 and 2017. Complications, including peri-operative mortality as reported by candidates to the ABOS, were tracked over time. Complications were classified as surgical or medical using a predefined algorithm. Multivariable Poisson regression analyses adjusting for confounders were used to assess rates of complications and mortality over time. All analyses controlled for biologic sex, age, surgical diagnosis, and surgical location. A total of 37,539 spine surgical patients were analyzed, with an average of 3754 cases performed each year. Following adjusted Poisson analysis, we determined that cases in 2017 had an increased likelihood of complications when compared to those treated in 2008 (IRR 1.20; 95% CI 1.09, 1.32). Similar findings were encountered for surgical complications (IRR 1.20; 95% CI 1.07, 1.34). In contrast, spine surgical cases reported to the ABOS in 2017 had a 55% lower likelihood of mortality when compared to procedures performed in 2008 (IRR 0.45; 95% CI 0.24, 0.84; P = 0.01). Our analysis of ABOS Part II candidates demonstrates that reported complication rates may be increasing while mortality is decreasing. The etiologies behind these findings are likely multifactorial. Encouragingly, we believe that observed reductions in mortality suggest overall improvements in patient safety following spine surgery. At a minimum, our data provide benchmarks through which spine surgeons, hospitals, and residency or fellowship programs can evaluate performance.Level of Evidence: 4.

Exposure of the breast, corresponding radiation risks and radiation protection for women, undergoing conventional X-ray examinations

The purpose of this work is to investigative radiation protection of the female breast in different X-ray examinations, including radiography. It is actual, because Publication ICRP №103 takes female breast to maximum irradiating organs. Analysed: risk of ionizing radiation, FB cancer, volume and dynamics X-ray examinations, female breast organ dose and effective dose. In conformity with data of Publication ICRP №103, effective dose of patients at mammography increased in 2,4 time and reach 0,48 mSv for examination as compared with 0,20 mSv with data of Publication ICRP №60. It is shown, that among different cancer, female breast cancer takes first place and constancy increased. Quantity of mammograms for 10 years increased in 2 time and collective dose increased in 2 times at last 7 years. Female breast average organ dose in mammography is 0,96 mGy and effective dose 0,05 mSv. It is only a part of summary irradiation from all X-ray examinations. The average mean value female breast organ dose of all radiography is 1,84 mGy (anterio-posterior projection – 1,57 mGy, lateral – 2,91 mGy) and effective dose – 0,25 mSv (anterioposterior – 0,26 mSv, lateral – 0,17 mSv). Considerable female breast irradiation is caused by X-ray spine examinations (thorax and lumbar). It is necessary to ensure radiation protection of female breast in diagnostic radiology, including quality control and optimization. Also need to shut female breast by X-ray protection apron, particularly in the lateral projection.

Physical Examination of the Spine Using Telemedicine: A Systematic Review.

Study Design:This is a systematic review.Objective:To systematically review (1) the reliability of the physical examination of the spine using telehealth as it pertains to spinal pathology and (2) patient satisfaction with the virtual spine physical examination.Methods:We searched EMBASE, PubMed, Medline Ovid, and SCOPUS databases from inception until April 2020. Eligible studies included those that reported on performing a virtual spine physical examination. Two reviewers independently assessed all potential studies for eligibility and extracted data. The primary outcome of interest was the reliability of the virtual spine physical exam. Secondary outcomes of interest were patient satisfaction with the virtual encounter.Results:A total of 2321 studies were initially screened. After inclusion criteria were applied, 3 studies (88 patients) were included that compared virtual with in-person spine physical examinations. These studies showed acceptable reliability for portions of the low back virtual exam. Patient satisfaction surveys were conducted in 2 of the studies and showed general satisfaction (>80% would recommend).Conclusions:These results suggest that the virtual spine examination may be comparable to the in-person physical examination for low back pain, though there is a significant void in the literature regarding the reliability of the physical examination as it pertains to specific surgical pathology of the spine. Because patients are overall satisfied with virtual spine assessments, validating a virtual physical examination of the spine is an important area that requires further research.

Development of a Telemedicine Neurological Examination for Spine Surgery: A Pilot Trial.

This was a prospective cohort study. The objective of this study was to design and test a novel spine neurological examination adapted for telemedicine. Telemedicine is a rapidly evolving technology associated with numerous potential benefits for health care, especially in the modern era of value-based care. To date, no studies have assessed whether. Twenty-one healthy controls and 20 patients with cervical or lumbar spinal disease (D) were prospectively enrolled. Each patient underwent a telemedicine neurological examination as well as a traditional in-person neurological examination administered by a fellowship trained spine surgeon and a physiatrist. Both the telemedicine and in-person tests consisted of motor, sensory, and special test components. Scores were compared via univariate analysis and secondary qualitative outcomes, including responses from a satisfaction survey, were obtained upon completion of the trial. Of the 20 patients in the D group, 9 patients had cervical disease and 11 patients had lumbar disease. Comparing healthy control with the D group, there were no significant differences with respect to all motor scores, most sensory scores, and all special tests. There was a high rate of satisfaction among the cohort with 92.7% of participants feeling "very satisfied" with the overall experience. This study presents the development of a viable neurological spine examination adapted for telemedicine. The findings in this study suggest that patients have comparable motor, sensory, and special test scores with telemedicine as with a traditional in-person examination administered by an experienced clinician, as well as reporting a high rate of satisfaction among participants. To our knowledge, this is the first telemedicine neurological examination for spine surgery. Further studies are warranted to validate these findings.

Evaluation of cervical radiographs in Dutch Warmblood horses, using a novel radiographic grading system for the cervical articular process joints

SummaryClinical and radiographic examination of the cervical spine has been of increasing interest in the prepurchase examination and clinical work‐up conducted for horses. The objective of this study was to describe a grading system useful for evaluating all the cervical articular process joints (cAPJs). Additionally, the findings of the cervical radiographs (occiput, cAPJ and intercentral joint space grading, intra‐ and intervertebral sagittal ratios, and intervertebral disc width measurements) were reported, and their association with clinical complaints in a large group of Dutch Warmblood horses (n = 598) were investigated. Significant associations were found between cAPJ radiographic grades and clinical complaints using the chi‐squared test (C2‐3 [P = 0.01], C5‐6 [P = 0.006], C6‐7 [P &lt; 0.001], and C7‐T1 [P = 0.02]). Higher occiput grades were significantly associated with clinical complaints (chi‐squared test, P = 0.005). A large variability was found for intra‐ and intervertebral ratios and minimum intercentral joint space in the control group, but no significant association between intercentral joint space and clinical complaints was observed using the Kruskal–Wallis test followed by post hoc testing with the Wilcoxon rank sum test with a Bonferroni correction. The main limitations of this study were that only information regarding localisation was used for the statistical analyses, without any other details of the clinical complaints. Furthermore, clinical records were retrospectively reviewed, and a bias towards cervical findings in the clinical data recordings should be considered. It was concluded that knowledge of the distribution of the radiographic findings evaluated in this study and their associated clinical relevance can be useful in reaching a science‐based diagnosis in daily practice.

The Idiopathic Hypertrophic Spinal Pachymeningitis

Idiopathic hypertrophic spinal pachymeningitis (IHSP) is a rare inflammatory condition characterized by chronic inflammatory hypertrophy of the dura mater. It can involve the entire spine. However, most cases are reported in the cervical and thoracic spine. It can progress from local pain to radiculopathy and eventually develop myelopathy. The aetiology of IHSP is not known. However, it has been suggested to be associated with many diseases. Here we report a case of IHSP in 21-year-old female who presented with paraplegia. The diagnosis was made on MRI Spine and histopathological examination. It was treated with surgical decompression, steroid therapy and patient improved gradually.

Магнитно-резонансная томография с аксиальной нагрузкой в диагностике нарушений статики поясничного отдела позвоночника

Introduction The diagnosis of spinal statics disorders requires a study conducted both with and without axial load. Standard multislice computed tomography (MSCT) and magnetic resonance imaging (MRI) are limited to the examination of the patient in the supine position. Axial loading techniques have expanded the indications for the use of high-tech methods of radiological diagnosis in assessing the statics of the lumbar spine. Methods 124 patients underwent conventional radiographic examination of the lumbar spine in the frontal and lateral projections in a standing position and an MRI study before and during axial load. Radiography with functional tests was used for cases with displaced vertebras. The Pearson correlation coefficient was used to compare the data; the significance of the methods was evaluated using calculations of diagnostic performance indicators. Results An increase of the angle of lordosis was noted in tests with axial load (r = 0.93). Indicators of scoliotic deformity obtained with MRI with axial load corresponded to X-ray data (r = 0.89). The diagnostic efficiency of MRI with a dosed axial load was the following: Se = 91.7 %, Sp = 89.2 %, Ac = 90.6 %; the results of MRI in the upright position were slightly lower: Se = 89.2 %, Sp = 73.9 %, Ac = 83.3%. Spondylolisthesis was found in 11 patients. The instability data obtained by comparing MR studies before and during the axial load with radiography with functional tests revealed their almost complete correspondence (r = 0.88). Discussion Axial-loaded MRI can provide additional information on statics, which is necessary to assess the nature of pathological changes. MR techniques based on low-field tomographic systems are limited in the diagnosis of extended deformations. MRI with axial load is a method of choice, especially when dynamic monitoring is necessary, due to the absence of ionizing radiation. Axial loading of the spine in MSCT study seems promising.

The Virtual Spine Examination: Telemedicine in the Era of COVID-19 and Beyond

Study Design:Narrative review.Objectives:Describe a comprehensive spine telemedicine examination.Methods:We discuss telemedicine examination techniques for commonly encountered spine conditions.Results:Techniques to evaluate gait, the cervical spine, the lumbar spine, adult spinal deformity patients, and adolescent scoliosis patients via telemedicine are described. We review limitations of the spine telemedicine examination and discuss special considerations such as patient safety and criteria for in-person assessment.Conclusions:While there are limitations to the spine telemedicine examination, unique strategies exist to provide important information to the examiner. Efforts have already been undertaken to validate and expand the capabilities of the spine telemedicine examination.

Infographic. Cooling strategies to attenuate PPE-induced heat strain during the COVID-19 pandemic

In order to determine the cause of a perinatal death it is important to correlate the postmortem findings with the clinical histories of both mother and infant. The postmortem examination...

Magnetic resonance imaging findings of patients with neck pain in Erbil City

Background and objective: Neck pain is one of the most common symptoms in the general population; several work-related and individual factors have been verified as being related to neck pain. This study aimed to determine the pathologic MRI findings of patients presented with neck pain and assess its association with some probable risk factors for cervical spine lesions. Methods: This descriptive cross-sectional study involved a convenient sample of 100 patients with neck pain referred to the radiology department of Rizgary teaching hospital in Erbil for Magnetic Resonance Imaging examination of the cervical spine from June 2013 to February 2014. Results: The age of the patients ranged from 21 to 70 years, with a mean age ± SD of 40.19 ±10.44 years. Around 42% of patients were between 30-39 years, and 60% were females. Clinical symptoms of the patients revealed that51.6% had radicular pain with cervical MR images abnormalities in 59% of the patients. The most common degenerative abnormality on MRI was disc bugle, which accounted for 37.3 % of total degenerative changes. MRI findings were most common at the C5/C6 level. A significant association was found between the cervical MRI abnormalities and the occupation and practicing neck (P = 0.03 and 0.001, respectively). However, no association was found with age, gender, BMI, and smoking habits of the patients. Also, there was a highly significant (P = 0.001) association between radicular pain, with disc bulge and disc protrusion. Conclusion: MRI is a useful investigation tool for diagnosing different clinical conditions among patients with cervical pain. Considering the diagnostic accuracy and cost-effectiveness, it is the key diagnostic tool for early detection of the degenerative changes and initiating appropriate treatment.

Evaluation of effective dose and entrance skin dose in digital radiology

Abstract Background: Ionizing radiation has an indispensable role in diagnostic radiology and clinical treatments. Apparently, medical exposure in diagnostic radiology pertains to be the preeminent man-made source of radiation. Objective: The aim of the present scientific study is to calculate the Entrance Surface Dose (ESD) and Effective Dose (ED) in digital radiography in Mazandaran province. Materials and methods: The study was performed on 3600 patients in digital X-ray rooms 15 hospitals and the required data were collected from two age groups (10&gt;15 years and adults) in each projection. Based on the results of this study, ESD and ED were calculated for skull (PA), skull (lateral), cervical spine (AP), cervical spine (lateral), chest (PA), chest (lateral), abdomen (AP), lumbar spine (AP), lumbar spine (lateral), pelvis (AP), thoracic spine (AP) and thoracic spine (lateral) examinations. It was calculated using PCXMC software (version 2.0). Results: In this study, mean ESDs for the 10-15 year group varied from 0.97±0.21 mGy to 3.62±1.38 mGy for chest (PA) and lumbar spine (lateral), respectively. For the adult group varied from 1.05±0.31 to 3.85±1.44 for cervical spine (AP) and lumbar spine (lateral), respectively. And also ED value was from in the range of 10.40 µSv to 378.46 µSv for skull (PA) 10-15 year group and abdomen adults, respectively Conclusion: This survey revealed a significant variation in the radiation dose of digital radiology examinations among hospitals in Mazandaran province. Application of a dose reference level (DRL) could be an optimization procedure for reducing the patient’s dose in Mazandaran province.

An interprofessional teaching approach for medical and physical therapy students to learn functional anatomy and clinical examination of the lower spine and hip

IntroductionPain of the lower back is a frequent symptom and is treated by different health professions. Anatomical as well as clinical knowledge is utmost important for all professions involved in this field. Here, we present a model that brings together an interprofessional team of experts to teach functional and clinical anatomy of the lower spine and hip area to medical and physical therapy students. MethodsTwo groups of medical students (n=60) and physical therapy students (n=77) were designated to two interprofessional clusters, with each cluster of students participating in three workshops, each lasting 40min. Workshops were guided by university anatomists, an orthopedic physician and physical therapists, and each provided specialized training, such as the conduction of clinical, orthopedic functional tests, the identification and palpation of anatomical structures and demonstrations of human anatomical joint prosections. A questionnaire, consisting of 18 questions regarding subjective anatomical and clinical knowledge and application of clinical assessment techniques was used as the evaluation tool before and after participation in the course. Furthermore, the amount of knowledge gained from peer group participants from the other profession versus the knowledge gained from the instructors was assessed. Descriptive statistics of data as well as quantitative data analysis was carried out for pre–post analysis. ResultsA total of 148 students participated in the pre-course evaluation and self-assessment and 113 students completed the post-course evaluation and self-assessment. 11 of the students, who completed the pre-course evaluation, and five students who completed the post-course evaluation failed to reveal their affiliation and these were only included in the general and corresponding cluster analysis. A final 132 pre-questionnaire and 97 post-questionnaire results were included in the analyses due to a likely group response bias. Scores for all combined groups showed an increase in the pre–post evaluation of 11.7% (P<.001). Cluster 1 and 2 (pre–post) score comparisons showed an increase of 13.7% (P<.001) and 8.8% (P<.001) respectively. A subgroup pre–post-questionnaire analysis demonstrated that medical students from both clusters had the highest increase in scores (17.6% and 19.9%) in comparison to their physical therapy counterparts (9.1% and 5.8%) (P<.001). Specifically, medical students profited highly from the anatomy in vivo (palpation) as well as clinical, orthopedic assessment exercises. Sub-question analyses showed that students learned from each other as well as from an interprofessional team of guiding experts/instructors, though mostly from the latter. ConclusionsThis course offers an appropriate and effective model that brings together an interprofessional team of experts to teach functional and clinical anatomy to medical and physical therapy students. Study results demonstrated an increase in subject-specific competencies in functional and clinical anatomy of the lower spine and hip. Medical students demonstrated the highest increase in subjective knowledge, especially in regard to clinical examination and assessment, which highlights the usefulness of this course early in the medical education. All students learned from the exchange with interprofessional group members as well as the instructors.

Remote Virtual Spinal Evaluation in the Era of COVID-19.

With the COVID-19 pandemic disrupting many facets of our society, physicians and patients have begun using telemedicine as a platform for the delivery of health care. One of the challenges in implementing telemedicine for the spine care provider is completing a comprehensive spinal examination. Currently, there is no standardized methodology to complete a full spinal examination through telemedicine. We propose a novel, remote spinal examination methodology that is easily implemented through telemedicine, where the patient is an active participant in the successful completion of his or her examination. This type of examination has been validated in a neurology setting. To facilitate the telemedicine visit, we propose that video instruction be shared with the patient prior to the telemedicine visit to increase the efficacy of the examination. Since the issuance of stay-at-home order across the states, many spine practices around the country have rapidly adopted and increased their telemedicine program to continue provide care for patients during COVID-19 pandemic. At a tertiary academic center in a busy metropolitan area, nearly 700 telemedicine visits were successfully conducted during a 4-week period. There were no remote visits being done prior to the shutdown. Implementation of our proposed remote spinal examination has the potential to serve as a guideline for the spine care provider to efficiently assess patients with spine disease using telemedicine. Because these are only suggestions, providers should tailor examination to each individual patient's needs. V. It is likely that physicians will incorporate telemedicine into health care delivery services even after the COVID-19 pandemic subsides because of telemedicine's efficiency in meeting patient needs. Using the standard maneuvers provided in our study, spine care providers can perform a nearly comprehensive spine examination through telemedicine. Further studies will be needed to validate the reproducibility and reliability of our methodology.

High Rates of Overuse-Related Structural Abnormalities in the Lumbar Spine of Youth Competitive Alpine Skiers: A Cross-sectional MRI Study in 108 Athletes.

Background:Alpine ski racing is known as a sport with unfavorable spinal loads and high rates of back overuse injuries at the elite level. However, little is known about overuse-related structural abnormalities occurring in the spine of youth athletes.Purpose:To describe the prevalence of abnormal magnetic resonance imaging (MRI) findings in the lumbar spine of youth competitive alpine skiers within the U16 category (under 16 years) with respect to sex, height growth, multifidus size, increasing age, and clinical relevance.Study Design:Cross-sectional study; Level of evidence, 3.Methods:A total of 108 youth competitive alpine skiers aged 13 to 15 years underwent MRI examination of the lumbar spine and measurement of the multifidus cross-sectional area on a 3-T Magnetom Prisma scanner. Complementary assessments included the determination of anthropometrics and biological maturation. Athletes were classified as symptomatic when, pursuant to the Oslo Sports Trauma Research Center questionnaire on health problems, at least 1 substantial back overuse–related health problem episode had been registered during the 12 months before the MRI examination.Results:Of the analyzed youth skiers, 37.0% presented with ≥1 abnormal MRI finding in the lumbar spine. The most prevalent findings in both sexes were disc degeneration (23.1%), Schmorl nodes (19.4%), end plate changes (10.2%), and pars interarticularis anomalies (10.2%); the pars interarticularis anomalies occurred exclusively in males. A smaller relative lumbar multifidus cross-sectional area was related to more frequent occurrence of disc protrusions (P = .018; R2 = 0.116) and end plate changes (P = .024; R2 = 0.096). Overall, the occurrence of abnormal MRI findings in the lumbar spine increased with age (P = .034; R2 = 0.054). Disc degeneration (particularly disc dehydration and disc protrusion) were significantly more prevalent in symptomatic versus asymptomatic athletes (P < .05 for all).Conclusion:As early as age 15 years or younger, competitive alpine skiers demonstrated distinct overuse-related structural abnormalities in the lumbar spine, with some of them being clinically relevant and restrictive of sports participation. As sex, height growth, multifidus size, and increasing age seem to play an important role for the occurrence of such abnormalities, considering these factors might be essential for prevention.