CLINICAL CONSIDERATIONS OF SPINAL PATHOLOGIES
Many spinal conditions can cause pain directly or indirectly. Orthopaedic Medicine specialistics are best to diagnose. Specialistic history and examination (no MRI scan, x-rays... they have 5% validity that is for fracture only) are crucial for identyfing the most serious pathology (eg..: fracture, malignancy, infection or cauda equina syndrome). Above conditions are fortunately rare, less than 0.5 % of total disorders, 99% being mechanical deformities, trauma and/or mixed).
Two criterias are applied :
- Yellow flags
- Red flags
1. Yellow flags assessment for chronic pain and life disabilities (all surgeries = FAILED BACK PAIN SYNDROMES = psychosocial personality disorders):
- sickness behaviour (e.g.: prolonged rest);
- belief that pain/activity are harmful;
- lack of support / social withdrawal;
- work dissatisfaction poroblems;
- emotional mood personalities (negativity, passiveness, stress, depression, manipulative personality (cheating);
- application for social benefits/claims compensation;
- overprotective family;
- time of work (6 weeks plus)
- addictions (alcoholism, smoking, drug abuse...);
- irrational behaviour of treatment expectations ("surgery miracles", lay "expert self-believe = knowing it all -lay zero education, no or "little" knowledge is very dangerous, self-diagnosis, useless tests- ).
2. Red flags (serious conditions):
- LBP (low back pain) can be caused by variety of pathologies (adjacent structure) being : thoracic/hip spine, visceral (pelvis/abdomen, kidney, ovaries, bladder );
- CES (cauda equina syndrome = nerve trauma/compression/damage ). Symptoms are: leg weakness, loss of bowel/sexual functions, sensitivity changes around rectum/genitala ( saddle anaesthesia);
- inflammatory conditions (rare): ankylosing spondylitis, polymyalgia rheumatica, rheumatoid arthritis (very rare cause of LBP), coccydinia;
- infections: shingles before rash development, post-herptic neuralgia, discitis, osteomyelitis, bacterial/tuberculous, epidural abcess (post-surgical), neoplasm (secondary bone deposits);
Red flags are serious pathology indicators, never certainty (chronic back pain indicates suspicion of such conditions). Further investigations/referral should be considered in case of several red flags. Clinical experience judgement is crucial (e.g.: cancer/non-immediate referral, ces -immediate). Serious underlying pathology is not common. Specific questions are required to clarify (e.g. perineal numbness ). CES (medical history essential): saddle anaesthesia, recent bladder disfunction, faecal incontinence.
Physical examination: perianal sensory loss, laxity of the anal sphincter, severe/progressive deficit of lower extremities, major motor weakness/knee extension, ankle eversion, foot dorsiflexion. Spinal fractures: medical history: major trauma. fall, strenuous lifting, osteoporosis, sudden onset of central pain in the spine, which is relieved by laying down.
Physical examination: structural spinal deformity. Cancer or infection: medical history: age plus 50 or under 20. History of cancer: constitutional symptoms (fever, chills, unexpected weight loss), bacterial infection (e.g.: recent urinary tract). Drug abuse (intravenous), immune suppression, pain remaining supine, night pain = sleep disturbance/thoracic pain (aortic aneurysm ?). Myeloma /or rare primary cancer. Metabolic bone disease: osteoporosis (= vertebral collapse), osteomalacia, Paget disease. Asymptomatic (degenerative + structural changes): Spondylosis (spinal osteoarthritis + osteophythosis (bony spurs) + degenerative facet and discs ( DDD) ), spondylolisthesis/retro listhesis (forward /backward displaced with/without stress fracture in the pars interarticularis), severe scoliosis/kyphosis (idiopathic?).
EXAMINATION = DIAGNOSIS is the most important to establish CAUSE. ONLY Specialists in Orthopedic Medicine/Manipulative Therapy can DIAGNOSE.
Any medical so-called... diagnosis is FALSE, just guessing the condition by name... NON = CLINICALLY / is false, especially those based upon useless.....Mri scans / 75% false /x-ray is valid ONLY 5%. ALL surgical pseudo-diagnosis is FALSE, as surgeons have NO skills to diagnose just operate. ALL operations are PHONEY../ SCAM..../ UK / USA and others /. Osteopaths and Chiropractors cannot diagnose and treat chronic conditions, the treatment is based upon WRONG principals, hence MISDIAGNOSIS. Wrong diagnosis leads to non-effective, useless treatment and a vicious circle follows useless therapies and medications. Hospitals / NHS are unhelpful in diagnosis, as they have no spinal specialists. The USA is the worst in the world, that's why they operate on 1.5 million patients/insurance SCAM / plus, every year and prescribe TOXIC (read about Sacker leading killer / killing drugs.) 75000 people / USA / and 5000 people / UK, had been killed in the last year and how many more to come? Patients who are naive and desperate fall into a medical trap and ONLY when surgery fails they complain...this is too late. Those so-called surgeons who advocate useless surgery should undergo it THEMSELVES and experience doubtful..., but the ineffective outcome. Cheap is expensive, yet CRIPPLING LIFE MISERY often leads to suicide. Bertagnoli / Berlin carried out 6ooo disc replacement on desperate, NAIVE patients, with UNPROVEN results. LONG term. Those patients are experimental guinea pigs and WILL suffer chronic complications in the future. Bertagnoli has NO idea how to carry out a clinical DIAGNOSIS using scam MRI but protects himself with legal disclaimers indemnity, NOT be sued for damages. That is typical in case a fraud is proven, in any case, the poor patients have no legal chance.