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Anatomy of a Lumbar Spine MRI: Indications for Imaging and Interpretation of Imaging for Surgical Referral

Teaser: 

1Samuel Yoon MD, MSc, 2Tiffany Lung MD, BKin, 3 Albert Yee MD, MSc, FRCSC, FIOR,

1Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada.2Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada. 3 Professor of Surgery, Department of Surgery, University of Toronto, Marvin Tile Chair Division Chief of Orthopaedic Surgery, Division of Spine Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.

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Abstract: Despite guidelines from multiple medical organizations including Choosing Wisely Canada, routine screening for low back pain symptoms with advanced imaging modalities such as Magnetic Resonance Imaging (MRI) persists. While sensitive, the high prevalence of asymptomatic or non-correlative degenerative findings limits their usefulness for routine screening. Given the constraints on Canadian healthcare resources this is a cause for significant concern. Lumbar MRI examinations should be ordered only with clear clinical indications and never for simple triage. Suitable indications include patients with symptoms of Cauda Equina Syndrome, suspected spinal malignancies, vertebral infections, or a progressive neurologic deficit correlating to a dermatomal and/or myotomal distribution.
Key Words: Appropriateness in diagnostic imaging, lumbar MRI, low back pain, surgical indications.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

Pre-test CME Quiz Post-test CME Quiz
Lumbar spine MRI is not a useful screening tool as incidental degenerative findings are extremely common.
Routine lumbar MRI usage to investigate low back pain is inappropriate and can cause harm to patients through wasted time and resources, as well as possible nocebo effects.
Lumbar spine MRI is indicated if accompanying Red Flag symptoms, such as recent systemic illness, high suspicion for tumour, or progressive/severe neurological symptoms/signs are present with the back pain.
Elective referrals to spine surgical specialists should confirm that the patient's clinical spinal condition aligns with advanced imaging findings.
The majority of patients with low back pain will improve with conservative management modalities.
Understanding clinical patterns of lumbar related axial pain and lower extremity referred neurologic symptoms is a more useful guide for determining whether or not patients are surgical candidates than obtaining images of structural change.
Patients suspected of having Cauda Equina Syndrome or exhibiting rapid progressive neurological decline in a dermatomal/myotomal distribution should be referred immediately for surgical evaluation.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Back Health, Appropriateness in diagnostic imaging, lumbar MRI, low back pain, surgical indications
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MOVE IT! 'Prescribing Exercise' in Healthcare

Teaser: 

Dr. Marina Abdel Malak, MD, CCFP, BSc.N,

is a Family Physician in Mississauga, Ontario. She has served on several committees and groups, including The Primary Care Network and Collaborative Mental Health Network. She has a passion for medical education, patient empowerment, and increasing awareness about the relationship between mental, emotional, and physical health. Dr. Abdel Malak is highly involved in quality improvement initiatives, and her research interests include strategies to support physician wellness, patient self-management, and optimizing physician education.

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Abstract: The benefits of physical activity are far reaching, ranging from cancer prevention to disease treatment. However, there may be confusion among healthcare providers how to recommend physical activity to their patients: how long, what activities, and how to do so. This article briefly reviews the benefits of exercise, and details strategies physicians can use to encourage their patients to be physically active.
Key Words: Exercise, physical activity, prescription, patient education, health promotion, lifestyle.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

Pre-test CME Quiz Post-test CME Quiz
1) Physicians are in an optimal position to counsel their patients about physical activity
2) Guidelines for activity varies among individuals by age, and should be tailored to each patient
3) Exercise prescriptions can be used in practice to motivate and counsel patients on physical activity
Encouraging patients to become physically active is a core role of the physician.
Prescribing exercise significantly increases patients' motivation and integration of physical activity into their daily routines.
Exercise recommendations vary, but the general rule of 150 minutes a week is widely quoted.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Preventive Health, exercise, physical activity, prescription, patient education, health promotion, lifestyle
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Social Determinants of Health and Low Back Pain

Teaser: 

1Ted Findlay, DO, CCFP, FCFP, 2Dr. Eugene Wai, MD, MSc, CIP, FRCSC,

1Medical Staff, Calgary Chronic Pain Centre at Alberta Health Services, Calgary, Alberta. 2Associate Professor, University of Ottawa Division of Orthopaedic Surgery, Cross Appointment to School of Epidemiology and Public Health, Ottawa, ON.

CLINICAL TOOLS

Abstract: It has long been recognized that, following an intervention, two patients with very similar or even identical pathophysiology can have dramatically different outcomes. There is increasing recognition of the role and importance of the social determinants of health as a factor in explaining these differences. This article reviews a number of recent studies that explain the impact of these social determinants, specifically in chronic pain and low back pain. It includes commonly used screening tools and advice for interventions.
Key Words: Social determinants of health, chronic pain, low back pain, screening, social prescription.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

Pre-test CME Quiz Post-test CME Quiz
1. According the World Health Organization, the impact of the social determinants of health on health and illness may outweigh that of health care or lifestyle choices.
2. The social determinants of health identified as being of the most importance specifically for low back pain include education and job position.
3. Most communities across Canada will include a number of resources that can be readily accessed as part of a "Social Prescription".
1. Incorporating social work support at an early stage may have the potential to improve treatment compliance and outcomes for those low back pain patients who have notable challenges related to the social determinants of health.
2. Well validated and easily utilized screening tools already exist for the routine screening of social determinants of health.
3. Sleep disorders are shown to affect nearly half of all people reporting chronic pain, with a bidirectional relationship.
Proper patient selection and pre-operative optimization of all modifiable factors improve outcomes and decrease the possibility of FBSS.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Back Health, social determinants of health, chronic pain, low back pain, screening, social prescription
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Exercise and Dementia: A Step-by-Step Approach to Prescribing Exercise

Teaser: 

Dr. Alykhan Abdulla, BSC, MD, LMCC, CCFP, DipSportMed CASEM, FCFP, CTH (ISTM), CCPE, Masters Cert Phys Leader, ICD.D

Assistant Professor University of Ottawa Faculty of Medicine, Academic Clinical Professor University of Ottawa Faculty of Nursing Medical Director The Kingsway Health Centre, The Kingsway Travel Clinic, The Kingsway Cosmetic Clinic, Editor in Chief/Author Journal of Current Clinical Care SPORTS MEDICINE, Past Chair Section of General and Family Practice Ontario Medical Association, Bruyere Foundation

CLINICAL TOOLS

Abstract: Dementia is a threat to the aging population. Although dementia cannot be reversed there is evidence that physical exercise can improve activities of daily living, balance, quality of life, funtion, strength, and mental function through various parameters. This article will focus on aerobic training, resistance training, and flexibility training.
Key Words: dementia, exercise, aerobic training, resistance training, flexibility training, exercise prescription.
Approach to Exercise Prescription includes asking questions during a patient's routine visit.
1. Ask about a patient's level of physical fitness.
2. Review their activities, assessing intensity, duration, and frequency.
3. Develop a fitness goal.
Prescribing exercise to patients with dementia that includes focus on aerobic training, resistance training, and flexibility for the prevention of injuries will help reduce the symptoms of dementia and improve function.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Sports Medicine, dementia, exercise, aerobic training, resistance training, flexibility training, exercise prescription
Disclaimer: 
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