Hands On

In November, 1995 I attended a conference in St. Louis, "Cervical and Lumbar Spine for Chiropractors -- A Hands on Workshop." This was presented by the "Practical Anatomy and Surgical Technique Workshop of St. Louis." The purpose of the course is fairly obvious from the title, and the speakers and instructors were outstanding.

Our first speaker, Gregory Baal, MD, is a neurosurgeon who reviewed surgical procedures for the lumbar spine. Subjects included disc lesions, spinal stenosis, and spondylolisthesis. We treat these patients all the time and help them a great deal, but there are patients that do not respond to our conservative chiropractic care. Following his lecture we had hands on experience in the laboratory with cadavers just like in first and second year of chiropractic school. Applying the anatomy to the clinical situations faced each day made this very interesting. Greg Cramer, DC, PhD, from National College was in attendance in addition to the lab assistants. Dr. Cramer and Dr. Darby are authors of Basic and Clinical Anatomy of the Spine, Spinal Cord, and ANS. This is an excellent text. We have many good authors within our profession. At next year's conference, Dr. Cramer will speak on "Pain of Spinal Origin, Pain Generators, and Clinically Relevant Nociceptive Pathways."

That afternoon we had an open forum discussion with Joseph Ferezy, DC, DACAN, regarding the side posture adjusting and neurologic deficit. Most of the doctors in attendance do side posture adjusting on patients with neurologic deficit. Obviously, cauda equina syndrome, advancing neurologic deficit, increasing patient pain and symptomatology are reasons to reconsider your approach. Dr. Ferezy, author of The Chiropractic Neurologic Examination, is another example of an excellent text written by a chiropractor.

The second day began with a review of the anatomy of the cervical spine with Paul Young, MD, a St. Louis neurosurgeon. This was followed by cervical dissection. It was interesting to see the dissection of the vertebral artery as it courses its way up through the transverse foramina of the individual vertebrae. From there we observed how it takes a lateral curve and enters the transverse foramen of the atlas. Upon exit, it goes posterior and superior up through the atlanto-occipital membrane and the dura mater in the region of the foramen magnum at the occiput.

A very informative part of the weekend was Dr. Ferezy's presentation on the relationship between cervical adjustments and strokes. After a literature review, Dr. Ferezy discussed the potential causes of stroke. He went on to discuss the intense focus of the media on adjustments as a cause of stroke, often without a direct relationship existing. He discussed the commonly used George's test and the possible false positives and false negatives involved with that test. In this brief article I cannot go into all the important points that he discussed but I would recommend chapter 10 in his book, Neural Ischemia and Cervical Manipulation, or his article in Advances in Chiropractic (Vol. I, 1994 Mosby Yearbook): "Neurovascular Assessment for Risk Management in Chiropractic Practice."

Our weekend was completed with Paul E. Young, MD, reviewing cervical surgical procedures, including the anterior diskectomy and fusion.

Dr. Fourdyce put a great deal of time and effort into this conference/workshop, and did a great job. This year's program is scheduled for November 8-9. I would recommend contacting the Practical Anatomy and Surgical Technique Workshop in St. Louis: (314) 535-4000, or fax to (314) 535-8214.

Mark King, DC
Cincinnati, Ohio