Editor's Note: Article submitted for publication by the American Academy of Spine Physicians.
Spine disorders represent one of the most common causes of pain and disability in the United States and worldwide. Back pain is one of most common reasons for seeking medical care, accounting for tens of millions of patient visits each year. The growing elderly population contributes to a rising incidence of degenerative spine disorders and related conditions. Common age-related disorders include spinal stenosis, hypertrophic arthropathy (joint arthritis), degenerative disc disease, radiculopathy, osteoporosis and vertebral compression fractures. The growing incidence of diabetes and obesity will contribute to the back pain epidemic.
Emerging Trends
The spine care field is rapidly evolving. Ongoing technological advances and biological discoveries heighten awareness of the complexity of the spine and related disorders. Molecular diagnostic methods, such as imaging, expose new features of pathology and redefine "early stage disease," thus prioritizing conservative care. Widespread adoption of advanced imaging will forge a path to data-driven spine care and facilitate the search for biological solutions which promote favorable tissue regeneration and repair.
There will be a growing appreciation for the hands-on evaluation of spine integrity. Dr. Manohar Panjabi, professor of biomechanics at Yale and scientific consultant to the American Academy of Spine Physicians (AASP), established that "knowledge of biomechanics is essential in the analysis of spine function." The doctor of chiropractic (DC) is well-trained in the care of early-stage disease, biomechanics and the rehabilitative approach to spine care.
Diagnostic imaging represents one of the most important sources of data and insight in spine care. Dr. David Durrant, chiropractic neurologist and president of the AASP, acknowledged that "advances in molecular imaging, will reveal the fundamental basis of spine pathology and will expose the spectrum of disease in a manner which will facilitate cooperative spinecare."
The ability to better detect and characterize disease through the use of expanded fields-of-view; virtual tissue interrogation and better imaging resolution will heighten awareness of multilevel (co-existent) spine pathology at varying stages of development. Improved detection and characterization of multifocal pathology will support the concept of whole spine care, requiring a cooperative, multidisciplinary approach.
Health care is shifting toward multidisciplinary settings. Spine-care health systems have advanced diagnostic methods, interpretive expertise, unique data management solutions and a multidisciplinary staff. These attributes and resources support a more comprehensive approach to spine care. If DCs isolate themselves from a large, multidisciplinary spine care system, they isolate their patients from diagnostic and treatment options.
It will become increasingly important for the DC to become part of a multidisciplinary referral network or system. In the near future, patients and the public will be less likely to rely solely on the advice of a single physician or spine care discipline. They will be willing to travel to seek expertise, obtain consensus opinions and access a continuum of care.
Consumers will turn to the Internet to become more educated about their spine, disorders of the spine and available spine care. They will use online directories and profiles to evaluate the background and capabilities of individual professionals, integrated spine care teams and facilities.
There are more than 15 health care disciplines that address patients with disorders of the spine. Each discipline has a different philosophy and prioritizes different approaches. This trend, combined with the growing complexity of spine care decisions, supports the concept of the primary spine care provider.
A primary spine care provider (also referred to as a PSP, primary spine care physician or primary spine care professional) is a health care expert who has the training and skills required to offer basic care, coordination of care and long-term care. Dr. Scott Haldeman, medical neurologist, scientific consultant to the AASP and president of World Spine Care, acknowledged: "There is a need for a primary spine care specialty with practitioners who are readily accessible to patients and who will offer advice, relieve symptoms and coordinate care."
The AASP states that the DC offers a first-line, cost-effective and safe approach to spine care, and therefore recognizes the role of the DC as a primary spine care provider.
New Opportunities
There has never been a greater need for prioritizing conservative care and for multidisciplinary collaboration in spine care. Subsequently, there is an unprecedented opportunity for the DC to become one of the recognized and respected providers of spine care. To achieve and maintain this status, the DC needs to be properly informed and properly prepared to adapt and to contribute within the rapidly evolving field of spine care.
The public and other health care professionals also need to be informed about the role of the DC in spine care. Access to resources, along with professional affiliations and commitments, will influence the level of success.
The AASP recently developed a cooperative initiative with the Foundation for Chiropractic Progress (F4CP) to enhance awareness of the role of chiropractic in spine care and help shape the future of spine care. The AASP offers members of the F4CP numerous opportunities and resources, which can be used to enhance their practice and improve the delivery of spine care.
All members of the F4CP are given the option of complimentary directory member status with the AASP. Each directory member receives a unique user ID and PIN number which will provide access to the AASP Member Dashboard. The directory member can create a full-page profile listing on the International Directory of Spinecare Professionals and access a limited number of AASP member resources, such as certain brochures and spine care networking tools.
To help facilitate the role of chiropractic in collaborative spine care, the AASP grants each F4CP member with free directory member status the opportunity to upgrade to full member status with the AASP. Those who upgrade to full AASP membership are entitled to a first-year membership discount of approximately 50 percent.
Dual membership with the F4CP and the AASP entitles the member access to all member benefits, as well as access to a special public-relations toolkit with powerful messages delivered through infographics, two brochures, a PowerPoint slide presentation, a personalized press release and an action step guide. Interested professionals can join the AASP alone; however, dual membership has additional advantages.
The American Academy of Spine Physicians (AASP) represents one of the largest and most influential multidisciplinary spine organizations in the world. The organization is comprised of health care providers of all disciplines and specialties that care for patients with spine disorders. The primary mission of the AASP is to promote excellence in spine care through education, innovation and collaboration. For additional information about the AASP, contact the Member Services Office at (847) 697-4660 or visit the AASP website: www.spinephysicians.org.
The Foundation for Chiropractic Progress (F4CP) is comprised of more than 23,000 members, including doctors of chiropractic, students of chiropractic and leadership in the health care profession. To learn more or to become a member, visit www.f4cp.org. "Chiropractic Hits the Rails" in this issue provides information on the foundation's latest marketing campaign in support of chiropractic.
Many relevant diagnostic signs are not performed deliberately by the examiner or by the patient at the examiner’s direction. They are observed as the patient reacts to their condition. Fortin’s finger sign, Minor’s sign, and Vanzetti’s sign are three examples of this principle.
On Feb. 1, 2024, two more legislators – John R. Carter (R-Texas) and Robert “Bob” Good (R-Va.) – co-sponsored the Chiropractic Medicare Coverage Modernization Act of 2023, bringing the co-sponsor total to 155, two more than the total achieved over the entire two-year congressional cycle in which identical legislation last appeared (2021-22).
While working at the Lovelace Medical Center in Albuquerque, N.M., one of the primary care physicians stated that imaging every patient prior to receiving chiropractic was not medically necessary. It was at that point I reconsidered the need for the imaging of every patient to avoid malpractice.
