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IVD Lumbar Disorder
#1
Texas
I was getting all my medical info together this evening and came across a notation left by the visit with my last DD whom was unable to find me at MMI at the time. His notes said he suspected IVD Lumbar Disorder. I researched it some and learned it can be viewed differently by varying doctors-different interpretations. What I learned is two things: the disorder is a hodge-podge disorders in the lumbar all the way from a bulge to the most necrotic, damaged, degenerated bone and tissue capable. The other opinion is that medical science sees people who have been injured and at the time of injury, unbeknownst to them of course, they have these disorders in the lumbar spine that are genetic diseases for which they can neither explain or give cause to correct since they do not understand them.

I will be coming up on my Statutory MMI and impairment rating at the end of this month and am desperately trying to get prepared for that exam with as much knowledge about what the DD can base his opinion on. In one opinion he could say : I have IVD Lumbar Disorder caused by an injury and in the course of the injury, it aggravated some underlying problems. These possible underlying problems have been totally refuted as being part of the compensable injury by the IC. I am still appealing that.

The other opinion the Dr. may come to is this IVD Lumbar disorder can not be properly explained and since it can't be explained, it is also misunderstood. Because of that he can only base my impairment rating on what the AMA guides say about IVD Lumbar Disorder. Those guidelines I have found are 10% or less.

Scary thought since I am unable to walk, unable to dress my self, unable to sit, stand for long periods have no feeling, other than nerve pain in my entire right leg and half of my left. It took over a year to have my first surgery which was a discektomy/laminectomy at L4-L5. Three weeks later it again herniated. Since then my IC has been keeping me fairly sated on drugs and pool therapy. However, at the end of February of this year, I was still able to walk. Although, I was using a cane, I was still able to a point.

Any assistance in this would be greatly appreciated. Sorry about the length. Because of my back issues, I can not sit very long and have to lie down. That enables me to think of something more to say. Very irritating!
The tree of liberty should be refreshed from time to time with the blood of tyrants. We have three in office right now-obama, holder, and napo!
 
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#2
PB. Just to give you a heads up in reference to the dd visit.

He/She will already have read your medical records. He/ She will do a brief exam. Probablt 10 to 15 minutes in length. That is where you need to be thinking very clearly. Make sure he looks at all points ( related to the injury ). Point out any area you feel he/she has not examined. ( I did that at mine. ) After that, you will have a modified FCE. They will measure your range of motion first. Then they will measure your strenght at other activities.

Just a question. What are you going to do after the rating???? It will be very difficult to get a rating above 15% What I am refering to is. What happens after the monitay benifits run out???? Some to think about, huh??????
8-05, Micro laminectomy/disectomy. 10-05 lumbar fusion L5-S1. 2-07 exploritory surgery. 12-07 medical implant, Spinal Cord Stimulator. now receiving SSDI. After going back to school, I received my degree as a mechanical engineer. What can I say, it was the only way I had to beat the system. 
 
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#3
Yeah, it's very tough to think about. However, I have been told that I might be eligible for unemployment, if I am able to work. Of course, therein lies another problem. But I was terminated through no fault of my own, but I think also there a statute of limitations on that. But, If I'm unable to work, I can either sit or lie down all day or I can find some way to change my circumstance. Maybe school, but I don't know what I'd be interested in and when I find that out, it becomes a question as to whether or not I can physically do it.
The tree of liberty should be refreshed from time to time with the blood of tyrants. We have three in office right now-obama, holder, and napo!
 
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#4
(((His notes said he suspected IVD Lumbar Disorder)))

It's my opinoin only. Since the doctor note only states {suspected}, it means un-confirmed. Being said, since not confirmed medically, I don't see how it can be used and hold any weight.

Evidence= Meaning confirmed information, proven fact.
Reply's are intended solely for informational purposes. They are based on personal opinions, experience, or research and are "not to be taken as fact or legal advice", otherwise, always consult an attorney or a doctor.
 
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#5
In my opinion, when going for an exam such as an IME / QME, these test should all be done, when it's said Nerves are a problem, inflamation at the Nerves are a problem, and so on;

The classical SLR test is performed with the patient lying supine with the legs fully extended. (In the patient with lower back pain, the leg with pain is the one evaluated.) The examiner places one hand under the ankle of the affected leg and the other hand on the knee - and then lifts the ankle and flexes the thigh relative to the pelvis. The test is considered positive if pain is reproduced or increased in the lower back or leg. If the SLR is ever positive, further testing must be pursued to define the nature of the irritation. It has been my experience that most docs stop with just the SLR. However, there are a few more simple steps that can be added easily and will increase the diagnostic value of this maneuver:

Goldthwaite's Test: Slide your hand under the patient's lower back and feel the lumbosacral spinous processes. As you lift the leg to a point of pain, feel for motion between these segments. If pain is experienced before the spinous processes separate, this suggests the irritation is rooted in the sacroiliac joint. If the pain manifests with motion of the lumbar segment, the lesion is more likely in that area.

Lift the Head: Once the leg is raised to the point at which symptoms are reproduced, instruct the patient to lift his or her head, bringing the chin to the chest. If this movement is limited or increases the pain in the lower back or leg, it suggests inflammation of the nerve root.

Bragard's Sign: If the SLR is positive, lower the leg on the affected side to just below the point of pain and quickly dorsiflex the foot. If the pain is duplicated or increased, this suggests sciatic neuritis.

Sicard's Sign: If the SLR is positive, lower the leg to just below the point of pain and quickly dorsiflex the great toe. If the pain is duplicated or increased, this suggests sciatic radiculopathy.

Cox Sign: If the patient raises the affected hip off the table instead of flexing the hip, this indicates prolapse of the nucleus into the IVF.

Seated SLR (Lesegue Sitting Test): With the patient seated, the affected leg is raised to the point of pain. The test is considered positive if pain is reproduced or increased in the lower back or leg. To avoid pain in the leg, the patient may lean back; this also would be considered a positive finding. This test is also a good cross-screening for malingering, as pain with a SLR should be reproduced with the seated SLR.

Deyerle's Sign: With the patient seated, the affected leg is raised to the point of pain. The knee is then slightly flexed and pressure is applied into the popliteal fossa. If the radicular symptoms are increased, the test is positive for sciatic nerve irritation above the knee due to stretching of the nerve over an abnormal mechanical obstruction.

Well Leg Raise: The SLR is performed on the unaffected leg. If pain is referred back to the symptomatic side, this indicates nerve root compromise by an extruded disc.

Fajerstajn's (pronounced "fire-stines"): This test is the same as Bragard's, just performed on the unaffected side. Pain produced with this maneuver suggests IVD syndrome or dural adhesions.

Vleeming's Active SLR: Basically, pain or poor motion control with active performance of the maneuver suggests SI joint dysfunction or compromised hip flexors.

So, what have I learned? The SLR is a great test, but it should not stand alone. If the patient experiences pain with a SLR, the doctor should be obligated to test further to define the source of the patient's complaints. Remember that when performing the SLR, always note where the pain goes. Is it in the back, the buttock or the leg? Does it go down to the knee or foot? Does it cause tension or pulling up into the neck?
Reply's are intended solely for informational purposes. They are based on personal opinions, experience, or research and are "not to be taken as fact or legal advice", otherwise, always consult an attorney or a doctor.
 
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#6
What is not stated with all these alleged tests of this or that, ( big in the chiropractic world ), is the sensitivity and specificity. If you read a little more on them you will find them to be generally non-specific, although Bragard's tends to hold up.

You will see many instances of DC's performing tests with someone's name attached to it and drawing all kinds of specific conclusions and detailed diagnoses. All fiction or wishful thinking I'm afraid. The research and reviews by Deyo and more so the landmark research by Nicolai Bogduk puts these named tests into proper perspective should you care to look into it more.

Bad Boy Bad Boy Wrote:In my opinion, when going for an exam such as an IME / QME, these test should all be done, when it's said Nerves are a problem, inflamation at the Nerves are a problem, and so on;

The classical SLR test is performed with the patient lying supine with the legs fully extended. (In the patient with lower back pain, the leg with pain is the one evaluated.) The examiner places one hand under the ankle of the affected leg and the other hand on the knee - and then lifts the ankle and flexes the thigh relative to the pelvis. The test is considered positive if pain is reproduced or increased in the lower back or leg. If the SLR is ever positive, further testing must be pursued to define the nature of the irritation. It has been my experience that most docs stop with just the SLR. However, there are a few more simple steps that can be added easily and will increase the diagnostic value of this maneuver:

Goldthwaite's Test: Slide your hand under the patient's lower back and feel the lumbosacral spinous processes. As you lift the leg to a point of pain, feel for motion between these segments. If pain is experienced before the spinous processes separate, this suggests the irritation is rooted in the sacroiliac joint. If the pain manifests with motion of the lumbar segment, the lesion is more likely in that area.

Lift the Head: Once the leg is raised to the point at which symptoms are reproduced, instruct the patient to lift his or her head, bringing the chin to the chest. If this movement is limited or increases the pain in the lower back or leg, it suggests inflammation of the nerve root.

Bragard's Sign: If the SLR is positive, lower the leg on the affected side to just below the point of pain and quickly dorsiflex the foot. If the pain is duplicated or increased, this suggests sciatic neuritis.

Sicard's Sign: If the SLR is positive, lower the leg to just below the point of pain and quickly dorsiflex the great toe. If the pain is duplicated or increased, this suggests sciatic radiculopathy.

Cox Sign: If the patient raises the affected hip off the table instead of flexing the hip, this indicates prolapse of the nucleus into the IVF.

Seated SLR (Lesegue Sitting Test): With the patient seated, the affected leg is raised to the point of pain. The test is considered positive if pain is reproduced or increased in the lower back or leg. To avoid pain in the leg, the patient may lean back; this also would be considered a positive finding. This test is also a good cross-screening for malingering, as pain with a SLR should be reproduced with the seated SLR.

Deyerle's Sign: With the patient seated, the affected leg is raised to the point of pain. The knee is then slightly flexed and pressure is applied into the popliteal fossa. If the radicular symptoms are increased, the test is positive for sciatic nerve irritation above the knee due to stretching of the nerve over an abnormal mechanical obstruction.

Well Leg Raise: The SLR is performed on the unaffected leg. If pain is referred back to the symptomatic side, this indicates nerve root compromise by an extruded disc.

Fajerstajn's (pronounced "fire-stines"): This test is the same as Bragard's, just performed on the unaffected side. Pain produced with this maneuver suggests IVD syndrome or dural adhesions.

Vleeming's Active SLR: Basically, pain or poor motion control with active performance of the maneuver suggests SI joint dysfunction or compromised hip flexors.

So, what have I learned? The SLR is a great test, but it should not stand alone. If the patient experiences pain with a SLR, the doctor should be obligated to test further to define the source of the patient's complaints. Remember that when performing the SLR, always note where the pain goes. Is it in the back, the buttock or the leg? Does it go down to the knee or foot? Does it cause tension or pulling up into the neck?
 
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#7
Cycler I would, you got a link?
Reply's are intended solely for informational purposes. They are based on personal opinions, experience, or research and are "not to be taken as fact or legal advice", otherwise, always consult an attorney or a doctor.
 
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#8
No links, just in the literature.
some :
http://www.biomedcentral.com/content/pdf...-14-26.pdf ( jump to the very bottom )



Bad Boy Bad Boy Wrote:Cycler I would, you got a link?
 
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