Are you a Chiropractic Primary Spine Physician? A Self-Test Challenge

Written by: James Demetrious, DC, DABCO

What is a Primary Spine Physician?

Chiropractic Primary Spine Physicians are highly trained neuromusculoskeletal (NMS) specialists with advanced clinical competence. With a dedication to higher learning, such specialists earn the trust of allied physicians’ collegiality, respect, and referrals. CPSPs serve as initial gatekeepers for spinal and complex NMS complaints.

The PSP concept was originally proposed by Haldeman, and subsequently promoted by different institutions with varied designations (Primary Spine Practitioner, Primary Spine Care Providers, and Primary Spine Care Physician). This paradigm change in spinal health care was elegantly summarized and presented in a White Paper published by the Wisconsin Chiropractic Association. Murphy et al. have advanced the merits of the primary spine practitioner role in the US.

Through PostGradDC, we offer advanced coursework to elevate chiropractic practitioners to higher standards of clinical excellence.

Some Introspection

Can you improve your clinical acumen? Can you manage complex cases, order and interpret advanced diagnostic tests, and develop complicated differential diagnoses. Can you perform highly skilled High Velocity-Low Amplitude Spinal Manipulation (HV-LA SM)? Are you aware of the nuanced indications and contraindications to making appropriate medical and ancillary consultations?

A Self-Test Challenge

I offer some introspective questions to delineate whether respective physicians meet the mantle of advanced clinical competency. No softballs here. The following are some of the learning topics that I teach on behalf of PostGradDC:

  1. What is the prevalence of disc herniation, annular tears, and synovial cysts in asymptomatic populations stratified by age?
  2. Can you describe the degradative effect of fluoroquinolone medications on connective tissues, the relationship of up-regulated matrix metalloproteinases, tissue inhibitors of metalloproteinases, and the causal relationship to aortic and cervical arterial dissection? Are you aware of the latency period for connective tissue degradation? The common names of those medications?
  3. Can you describe differential etiologies that produce upper and lower radicular symptoms?
  4. What are the benefits of micro-endoscopic surgery using tubular retractors? Patient selection criteria? Risks/benefits of spinal arthroplasty, ACIF, PLIF, XLIF, or OLIF procedures?
  5. Are patients with a familial history of Leiden Factor V, elevated d-Dimer levels, or atrial septal defects absolute or relative contraindications for HV-LA SM?
  6. What are the adverse effects associated with large particulate steroid transforaminal injections, intra-articular steroid injections, and RF ablation? What are the possible risks/benefits of ortho-biologic PRP?
  7. Does a patient with unilateral 50-69% ICA stenosis represent a relative or absolute contraindication for HVLA SM? How best to manage that patient?
  8. Can you describe the NEXUS and Canadian C-spine Rule risk factors concerning the American College of Radiology Appropriateness Criteria?
  9. What MRI sequences improve the conspicuity of periarticular edema? How does a Czervionke Grade 4 synovitis affect chiropractic dosing and patient recovery?
  10. What is Hakim’s Triad and its relationship to normal pressure hydrocephalus? What is the Hummingbird sign? Indications for ventriculo-peritoneal shunt?
  11. Can you identify normal and atrophied rectus capitis posterior Mi/Ma, obliquus capitis Inf/Sup, and myodural bridges? Can you identify torn alar ligaments, denticulate ligaments, the posterior atlantooccipital membrane, and the tectorial membrane on MRI in axial, coronal, and sagittal views?
  12. Which region of the spine takes precedence for surgery with Tandem Spinal Stenosis that produces progressive gait, bladder, or bowel deficits?
  13. What is the best chiropractic approach in the care of symptomatic lumbar transitional segments and Bertolotti syndrome?
  14. Is Kyphoplasty safe and effective? Indications and contraindications for the referral?
  15. Does anti-cyclic citrullinated peptides provide improved sensitivity/specificity of which arthritide?

How Did You Do?

Can you converse with medical colleagues about those complex conditions and approaches with a high degree of competence? Can you improve your skills to manage all of those cases?

If you are interested in exploring the answers to the above questions and elevating yourself amongst your peers, I recommend that you sign up for coursework at PostGradDC.

Opportunities for Clinical Advancement

Advanced post-graduate training allows motivated doctors of chiropractic to achieve higher levels of competence.  Our growing catalog of advanced lectures will enhance your ability to serve patients. Our focus is on advanced differential diagnosis, imaging, appropriateness criteria, and improving outcomes.

PostGradDC offers advanced post-graduate chiropractic continuing education. Our founder, Dr. James Demetrious, is a nationally distinguished board-certified chiropractic orthopedist, educator, author, and editor. For current, evidence-based, and clinically intuitive CE Coursework, attain your advanced training at