Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 916
Infrastructure 216 I

From the Desk of Dr. Mark Studin
Academy of Chiropractic
Preamble: many of these issues are small, yet each issue is just that… an issue. If you take care of the small issues, then the larger issues often take care of themselves and you can focus on the larger issues… a larger, more profitable practice and more family time.

“The Neurosurgeon’s PA Missed This”

“I see it because I can” Mark Studin 2018


Thank you Dr. Brandon Burkley from Raleigh for the case.

The neurosurgeon’s PA missed all of this [see below] in the evaluation and report. They only commented on a different region. This is not an IME or Insurance Peer Review, this is a doctor that was referred to. The solution is below:

T11-12: Diffuse disc bulge with focal central disc protrusion resulting in anterior CSF effacement
without cord flattening. Neural foramina remain patent.

T12-L1: Diffuse disc bulge with large focal central disc extrusion extending inferior to the disc
space by approximately 20 mm (image 8 of series 2). This shows transverse dimension of 8 mm and AP
dimension of 7 mm (image 14 of series 5), contacting the thecal sac with resultant flattening at the
central aspect. Neural foramina remain patent.

L1-2: Diffuse disc bulge with focal central disc extrusion extending superior and inferior to the
disc space, craniocaudal extent of 13 mm (image 8 of series 2), propagating into the central canal
by approximately 5 mm (image 18 of series 5). Resultant contact and flattening of the thecal sac
with mild bilateral lateral recess stenosis. Facet osteoarthritis and early osseous overgrowth.
Neural foramina remain patent.

The solution is to call the neurosurgeon’s office and request [DEMAND] an immediate sit-down with the neurosurgeon. Remember, you are referring to them and they NEED your referral to cover their malpractice fees. When sitting with the neurosurgeon, insist that only they see your patients and not the PA understanding that you are the screening process based upon your training and most of your referrals are surgical cases, therefore the PA as a screener is not necessary.



Adjunct Associate Professor of Chiropractic, University of Bridgeport, College of Chiropractic
Adjunct Post Graduate Faculty, Cleveland University-Kansas City, College of Chiropractic
Adjunct Professor, Division of Clinical Sciences, Texas Chiropractic College
Educational Presenter, Accreditation Council for Continuing Medical Education Joint Partnership with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences

Academy of Chiropractic
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