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PLENARY SESSION C: CATEGORIZING, DIAGNOSING AND MANAGING THE LUMBAR SPINE

PLENARY SESSION C: CATEGORIZING, DIAGNOSING AND MANAGING THE LUMBAR SPINE Whose Patient is it Anyways? Case History Panel. Moderator – Dr. Gil Faclier MD Panelists – Dr. Eric Massicotte - MD – Dr. Michael Gofeld MD – Anja Franz RPT – Dr. Ed Cambridge DC

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PLENARY SESSION C: CATEGORIZING, DIAGNOSING AND MANAGING THE LUMBAR SPINE

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  1. PLENARY SESSION C: CATEGORIZING, DIAGNOSING AND MANAGING THE LUMBAR SPINE • Whose Patient is it Anyways? • Case History Panel

  2. Moderator – Dr. Gil Faclier MD • Panelists – Dr. Eric Massicotte - MD • – Dr. Michael Gofeld MD • – Anja Franz RPT • – Dr. Ed Cambridge DC • – Darryl Yardley RPT

  3. Case History #1 • Treatment of Unilateral Radiating Leg Pain

  4. Treatment of Unilateral Radiating Leg Pain • Radicular pain can be an extremely painful condition that is difficult to manage. Using a case history approach this session looks at differential diagnosis, indications for tests, medication, injection, surgery and therapy.

  5. Case History #1 • Treatment of Unilateral Radiating Leg Pain • 34 year old male.  • 2014 back surgery L4-5 microdiscectomy.  • Did well post-op however recurrent leg pain started within three months. 

  6. Case History #1 • Treatment of Unilateral Radiating Leg Pain • Repeat MRI done in 2014 showed herniation at L4-5.  • The patient declined surgical RX.  • 3 years later presented to assessor with intermittent radiating leg pain. 

  7. Case History #1 • Treatment of Unilateral Radiating Leg Pain • Can be pain free with a minimum of 1 hour per day of stretching.  • If he doesn’t stretch pain is 8/10 and needs Percoset. 

  8. Case History #1 • Treatment of Unilateral Radiating Leg Pain • Panel Questions

  9. Case History #2 • Differential Diagnosis Low Back, Buttock and Groin Pain

  10. Case History #2 • Differential Diagnosis Low Back, Buttock and Groin Pain • Determining whether pain is referred from the back, buttock, SI joint, hip bursa or hip joint can be difficult. Using a case history approach this session looks at which tests and examinations are most helpful in teasing out the source of pain.

  11. Case History #2 • Differential Diagnosis Low Back, Buttock and Groin Pain • 30 y.o. female with pain right buttock, lateral hip and groin.  • Has had intermittent low back and buttock pain beginning in her 20’s. 

  12. Case History #2 • Differential Diagnosis Low Back, Buttock and Groin Pain • She is now a new mom with pain beginning in 3rd trimester in pregnancy however pain is getting worse.  • Beginning to radiate down the right leg. • Can’t lie on her right side.  Finding it hard to walk.  Better when she sits. 

  13. Case History #2 • Differential Diagnosis Low Back, Buttock and Groin Pain • Lumbar X-ray – mild degenerative changes L4-5, L5-S1 • SI Joint X-ray – Mild to moderate degenerative changes with no definite erosions • EMG – No significant findings • . 

  14. Case History #2 • Differential Diagnosis Low Back, Buttock and Groin Pain • Panel Questions

  15. Case History #3 • Differential Diagnosis and Treatment of Bilateral Radiating Leg pain

  16. Case History #3 • Differential Diagnosis Low Back, Buttock and Groin Pain • 50 year old male experiencing leg pain with walking.  • Can walk 1-2 blocks before legs feel heavy and painful.  • Periodically if he walks further the pain gets better and he can keep walking. 

  17. Case History #3 • Differential Diagnosis Low Back, Buttock and Groin Pain • MRI shows a large central disc bulge at L5-S1 and a congenitally small canal.  • Mild-moderate L5-S1 joint arthropathy.

  18. Case History #3 • Differential Diagnosis Low Back, Buttock and Groin Pain • Panel Questions

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