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% Packages
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%\usepackage{opensans}          % Can't make this work so far. Shame. Would be lovely.
\usepackage[normalem]{ulem}     % For underlining links
% Most of the following are not required for the majority
% of cheat sheets but are needed for some symbol support.
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\usepackage{MnSymbol}           % Symbols
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% Document Info
\author{Siffi (Siffi)}
\pdfinfo{
  /Title (djd-and-ddd.pdf)
  /Creator (Cheatography)
  /Author (Siffi (Siffi))
  /Subject (DJD \& DDD Cheat Sheet)
}

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% Commands
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% Header and Footer
\pagestyle{fancy}
\fancyhead{} % Set header to blank
\fancyfoot{} % Set footer to blank
\fancyhead[L]{
\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{C}
    \SetRowColor{DarkBackground}
    \vspace{-7pt}
    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
    }
\end{tabulary}
\columnbreak
\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{DJD \& DDD Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{Siffi (Siffi)} via \textcolor{DarkBackground}{\uline{cheatography.com/122609/cs/22911/}}}
\end{tabulary}
\end{multicols}}

\fancyfoot[L]{ \footnotesize
\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{LL}
  \SetRowColor{FootBackground}
  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}Siffi (Siffi) \\
  \uline{cheatography.com/siffi} \\
  \end{tabulary}
\vfill
\columnbreak
\begin{tabulary}{5.8cm}{L}
  \SetRowColor{FootBackground}
  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Not Yet Published.\\
   Updated 30th January, 2021.\\
   Page {\thepage} of \pageref{LastPage}.
\end{tabulary}
\vfill
\columnbreak
\begin{tabulary}{5.8cm}{L}
  \SetRowColor{FootBackground}
  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Sponsor}}  \\
  \SetRowColor{white}
  \vspace{-5pt}
  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
\end{tabulary}
\end{multicols}}




\begin{document}
\raggedright
\raggedcolumns

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% from this page to resize cheat sheet text:
% www.emerson.emory.edu/services/latex/latex_169.html
\footnotesize % Small font.

\begin{multicols*}{2}

\begin{tabularx}{8.4cm}{x{2 cm} x{6 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{DJD - General}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{Can be:} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
{\bf{Primary}} & No specific cause can be identified \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
{\bf{Secondary}} & \seqsplit{Trauma/infection/developmental} anomaly \tn 
% Row Count 5 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Poor correlations between radiographic findings and symptoms} \tn 
% Row Count 7 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Target sites}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{Weight bearing joints} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{AC Joints} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{1st CMC} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{DIPs and PIPs} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{1st MTP} \tn 
% Row Count 5 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{In Lx, common in L4/L5, L3/L4} \tn 
% Row Count 6 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{4 cm} x{4 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{S\&S}}  \tn
% Row 0
\SetRowColor{LightBackground}
Moderate, achy pain & Stiffness \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
Occasional swelling & Crepitus \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
Reduced ROM & Normal Bloodwork \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
+ve Spurlings, Shoulder abduction , +ve cervical distraction & Aggravated by extension, ipsilateral lateral flexion \tn 
% Row Count 6 (+ 3)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{Consider myelopathy} \tn 
% Row Count 7 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{DDD - Findings}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{Decreased disc height (puts extra pressure on facet joints due to lack of impact absorption)} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{Osteophyte formation} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{Endplate sclerosis} \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{Vacuum phenomenon} \tn 
% Row Count 5 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{Subluxation} \tn 
% Row Count 6 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{Subchrondal cysts} \tn 
% Row Count 7 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{Consider MRI if conservative care does not improve symptoms after 3-6 weeks} \tn 
% Row Count 9 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{{\bf{Annulus disease:}} - disc height remains the same - weakened Annulus pulls on VB - osteophyte formation \newline {\bf{Vacuum phenomenon:}} Area of nitrogen gas in annular fibres when injured \newline - Microtrauma in annulus = annular tears, seperation of annulus from vb endpplate}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Presentation}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- \seqsplit{Radioculopathy/Encroachment} due to posterior osteophytes, facet and uncovertebral joint arthrosis, thickened bulging ligamentum flavum and a decreased in disc height} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{-  Age (\textgreater{}50 yo)} \tn 
% Row Count 5 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Flexion of the neck relieves arm pain} \tn 
% Row Count 6 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Not trauma related} \tn 
% Row Count 7 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- X-ray Changes} \tn 
% Row Count 8 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- pain relieved by rest, aggravated by activity} \tn 
% Row Count 9 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Muscle hypertonicity locally} \tn 
% Row Count 10 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Tender over the involve segment} \tn 
% Row Count 11 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Pain may refer over butt/hip/thigh} \tn 
% Row Count 12 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Reduced ROM} \tn 
% Row Count 13 (+ 1)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Gradual stiffness and loss of ROM} \tn 
% Row Count 14 (+ 1)
% Row 11
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Pain with ipsilateral LF / Ext} \tn 
% Row Count 15 (+ 1)
% Row 12
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- +ve Kemps, +ve Yeomans +ve SLR +ve Braggards +ve Slump} \tn 
% Row Count 17 (+ 2)
% Row 13
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- +ve Valsalva} \tn 
% Row Count 18 (+ 1)
% Row 14
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Assess for: Foot hyperpronation \{\{nl\}\} Breathing \{\{nl\}\} LCS \{\{nl\}\} Hip abductor weakness} \tn 
% Row Count 20 (+ 2)
% Row 15
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- SMR changes - MYELOPATHY (UMNL - Clonus, Babinski, Hoffman, L'hermittes, Increased reflexes, Stiffness on gait/posture)} \tn 
% Row Count 23 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{DDD on X-ray}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{8.4cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/siffi_1589992924_dafdfdfd.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{Osteophyte formation on the left image \newline Vacuum phenomenon circled on the right image}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{DDD DDX}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Cx}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Disc lesion} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{SOL} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Tumour} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{TOS} \tn 
% Row Count 5 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Inflammatory arthropathy} \tn 
% Row Count 6 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{Rotator Cuff pathology} \tn 
% Row Count 7 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Heroes Zoster} \tn 
% Row Count 8 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{Peripheral nerve entrapment syndrome} \tn 
% Row Count 9 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{CRPS} \tn 
% Row Count 10 (+ 1)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Lx}}} \tn 
% Row Count 11 (+ 1)
% Row 11
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Disc lesion} \tn 
% Row Count 12 (+ 1)
% Row 12
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{Strain/sprain} \tn 
% Row Count 13 (+ 1)
% Row 13
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Stenosis} \tn 
% Row Count 14 (+ 1)
% Row 14
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{DISH} \tn 
% Row Count 15 (+ 1)
% Row 15
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Fibromyalgia} \tn 
% Row Count 16 (+ 1)
% Row 16
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{Hip OA} \tn 
% Row Count 17 (+ 1)
% Row 17
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Spondylolisthesis} \tn 
% Row Count 18 (+ 1)
% Row 18
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{F\#/Compression f\#} \tn 
% Row Count 19 (+ 1)
% Row 19
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Infection} \tn 
% Row Count 20 (+ 1)
% Row 20
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{Neoplasm} \tn 
% Row Count 21 (+ 1)
% Row 21
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{RA/Rheumatologicadisease} \tn 
% Row Count 22 (+ 1)
% Row 22
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{Viscerosomatic referral - AA, GI, GU} \tn 
% Row Count 23 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Hemispheric Spondylosclerosis}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{8.4cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/siffi_1589994645_dsdasdf.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{A semicircle shaped sclerosis at the endplate on the vertebral body - {\bf{can be similar to blastic mets}} \newline However, blastic mets are more likely to occur in the middle of the vertebral body and would be irregular}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Red Flags}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Hx of trauma} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Corticosteroid use} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Osteoporosis} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Prior hx of cancer} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Unexplained weight loss} \tn 
% Row Count 5 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Fever} \tn 
% Row Count 6 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Chills} \tn 
% Row Count 7 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Recent infection/surgery} \tn 
% Row Count 8 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- S\&S of CES/myelopathy} \tn 
% Row Count 9 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{DDD Management}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{US} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Electrical stimulation} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{Traction for radiculopathy} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Myofascial release of CX and shoulder girdle} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{CX and TX mobilisation/SMT (can be contraindicated by centtral /lateral recess stenosis} \tn 
% Row Count 6 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Mckenzies in direction of centralisation} \tn 
% Row Count 7 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{Nerve mobilisation (gentle and slow)} \tn 
% Row Count 8 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Home exercises for: LS, Traps, cervical rotators} \tn 
% Row Count 9 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{Cervical support pillow} \tn 
% Row Count 10 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Avoid prolonged cervical extension , rotation, lateral flexion and axial loading , reading posture} \tn 
% Row Count 12 (+ 2)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{Big Three exercises} \tn 
% Row Count 13 (+ 1)
% Row 11
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Postural advice/breathing exercises} \tn 
% Row Count 14 (+ 1)
% Row 12
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{Referral to specialist - if fails to show improvement, persistent motor weakness, progressive neuro deficit or myelopathy} \tn 
% Row Count 17 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{2.584 cm} x{2.508 cm} x{2.508 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{8.4cm}}{\bf\textcolor{white}{Phases of disc degeneration}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Phase I}} & {\bf{Phase II}} & {\bf{Phase III}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
- \seqsplit{Dysfunctional} phase & - Unstable Phase & - \seqsplit{Stabilisation} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
- Tears on the outer annulus by repetitive microtrauma & - Loss of mechanial integrity of the tri-joint complex & - Further disc resorption, disc space narrowing, disc fibrosis \tn 
% Row Count 8 (+ 5)
% Row 3
\SetRowColor{white}
- Interrupts blood supply to disc & - In Disc, multiple annular tears occurs, Internal disc disruption, \seqsplit{resorption/loss} of disc space height & - Endplate destruction \tn 
% Row Count 16 (+ 8)
% Row 4
\SetRowColor{LightBackground}
- Impairs nutritional supply and waste removal & - In \seqsplit{zygapophyseals} - cartilage degeneration, capsular laxity, subluxation & - Osteophyte formation \tn 
% Row Count 22 (+ 6)
% Row 5
\SetRowColor{white}
 & \seqsplit{Biomechanical} - segmental instability & - More likely to have discogenic pain \tn 
% Row Count 25 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{1.76 cm} x{6.24 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Modic Changes}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Type 1:}} & Marrow oedema - pain generator - Converts to Type II \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
{\bf{Type 2:}} & Occurs within 3-6 mths to 1 year. Fatty degeneration of subchondral marrow - chronic \tn 
% Row Count 5 (+ 3)
% Row 2
\SetRowColor{LightBackground}
{\bf{Type 3:}} & Rare - extensive bony sclerosis \tn 
% Row Count 7 (+ 2)
% Row 3
\SetRowColor{white}
{\bf{Causes}} & Local instability + inflammation, biomechanical changes to DDD \tn 
% Row Count 9 (+ 2)
% Row 4
\SetRowColor{LightBackground}
 & Genetics \tn 
% Row Count 10 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Type 1}} Hyposignal  on T1, Hypersignal on T2 \newline {\bf{Type 2}}  Hypersignal on both \newline {\bf{Type 3}} Hyposignal on both}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{4 cm} x{4 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Potential sites of impingement}}  \tn
% Row 0
\SetRowColor{LightBackground}
Central disc \seqsplit{herniation/posterior} osteophyte & Lateral disc herniation/uncinate hypertrophy \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
Facet Hypertrophy & Thickening of the Ligamentum Flavum \tn 
% Row Count 5 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Management}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{X-Ray/MRI for further investigations} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Mobilisation} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- PIR into the direction that does not cause peripheralisation} \tn 
% Row Count 4 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Nerve Mobilisation - flossing \& Tensioning} \tn 
% Row Count 5 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Ice} \tn 
% Row Count 6 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- NSAID} \tn 
% Row Count 7 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Anti- inflammatory nutritional advice} \tn 
% Row Count 8 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Trp therapy} \tn 
% Row Count 9 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Stabilisation exercises (if cervical)} \tn 
% Row Count 10 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Sensorimotor Training} \tn 
% Row Count 11 (+ 1)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Aerobic Exercise and Weight Training} \tn 
% Row Count 12 (+ 1)
% Row 11
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Graded Exposure for fear and pain provoking activities} \tn 
% Row Count 14 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{2.32 cm} x{5.68 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Stenosis}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Locations}} & Spinal stenosis, Central canal \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
 & Foraminal \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
 & Lateral Recess Stenosis \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
{\bf{Measurements}} & Normal = \textgreater{}15mm \tn 
% Row Count 6 (+ 2)
% Row 4
\SetRowColor{LightBackground}
 & Stenosis = 13mm \tn 
% Row Count 7 (+ 1)
% Row 5
\SetRowColor{white}
 & Definite Narrowing = \textless{}10mm \tn 
% Row Count 8 (+ 1)
% Row 6
\SetRowColor{LightBackground}
{\bf{Causes}} & Posterior Bulges, herniations, osteophytes, ligamentum flavum \tn 
% Row Count 11 (+ 3)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{{\bf{MRI}}} \tn 
% Row Count 12 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{Grade 1: loss of \textless{}50\% of subarachnoid space without cord deformity} \tn 
% Row Count 14 (+ 2)
% Row 9
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Grade 2: Denotes spinal cord deformity without signal change} \tn 
% Row Count 16 (+ 2)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{Grade 3: Spinal cord signal change at site of compression} \tn 
% Row Count 18 (+ 2)
% Row 11
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- MRI rules out non-degenerative causes of stenosis - tumour, syrinx, MND, MS} \tn 
% Row Count 20 (+ 2)
% Row 12
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{CT myelography:}} Differentiation of osseous and SOL} \tn 
% Row Count 22 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{MRI/ CT Axial Gold Standard \newline Mainly affects the L5 NR}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Types of Stenosis}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Congenital (short pedicles/small canal diameter)} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- {\bf{Acquired:}} Trauma, Disc Lesion, Spondy, Tumour, Bone disease, Abscess, Hematoma, Arthritis} \tn 
% Row Count 3 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{4 cm} x{4 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Symptoms}}  \tn
% Row 0
\SetRowColor{LightBackground}
Insidious Onset \textgreater{}50y & LBP, numbness, tingling, radicular pain \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
Bilateral leg + low back symptoms - relieved by bending forward + sitting & Worse with extension, walking downhill + standing for long periods \tn 
% Row Count 6 (+ 4)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{Chronic  compression on the spinal cord - loss of fine motor skills of the hand, lower extremity pain, paresthesia, numbness, weakness, gait and balance disturbances, difficulty walking, loss of bowel/bladder control} \tn 
% Row Count 11 (+ 5)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Face not usually affected} \tn 
% Row Count 12 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{If presence of fasciculations, atrophy, signs of denervation - consider ALS} \tn 
% Row Count 14 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Trefoil Canal}} A triangular shape on MRI due to the narrowing of the canal}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Clinical Findings}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Decreased Cx ROM (extension can induce symptoms)} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- +ve L'hermittes, +ve Spurlings, +ve Cx distraction +ve Valsalva if central cord} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Mix of LMNL + UMNL signs (myelopathy)} \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- UL and LL SMR should be done (long tract signs)} \tn 
% Row Count 5 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- +ve Kemps (anything that requires extension)} \tn 
% Row Count 6 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- +ve SLR (if foraminal/lateral recess stenosis)} \tn 
% Row Count 7 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- {\bf{Assess for vascular claudication:}} 5 Ps : Pulsenessless, paralysis, paresthesia, palor and pain \{\{nl\}\} Pt report symptoms - provoked by walking, relieved by standing} \tn 
% Row Count 11 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{DDx}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- ALS, MS (younger patient), PLS (cranial nerve involvement)} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Vitamin B12 deficiency} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Tumour} \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Abscess} \tn 
% Row Count 5 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Neoplasm} \tn 
% Row Count 6 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Syringomyelia} \tn 
% Row Count 7 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Arnold-Chiari} \tn 
% Row Count 8 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Vascular disease} \tn 
% Row Count 9 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Cord infarction} \tn 
% Row Count 10 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Radiation myelopathy} \tn 
% Row Count 11 (+ 1)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Encephalitis} \tn 
% Row Count 12 (+ 1)
% Row 11
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Drug use} \tn 
% Row Count 13 (+ 1)
% Row 12
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- DDD/DJD} \tn 
% Row Count 14 (+ 1)
% Row 13
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Mechanical LBP} \tn 
% Row Count 15 (+ 1)
% Row 14
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Myofascial pain} \tn 
% Row Count 16 (+ 1)
% Row 15
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- F\#} \tn 
% Row Count 17 (+ 1)
% Row 16
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Hip pathology} \tn 
% Row Count 18 (+ 1)
% Row 17
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Rheumatological disease} \tn 
% Row Count 19 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Management}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- No myelopathy or significant NR involvement, conservative care is considered} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- SMT/mobilisation (if more than moderate degenerative changes)} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Nerve mobilisation (home exercises) and cervical traction (reduce nerve adherance, facilitate nerve gliding, reduce intaneural swelling and improve axoplasmic flow)} \tn 
% Row Count 8 (+ 4)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Heat, massage, US, electrical stimulation} \tn 
% Row Count 9 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Stretching, STW of cervical and shoulder girdle musculature} \tn 
% Row Count 11 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Cx strengthening} \tn 
% Row Count 12 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- {\bf{Surgical referral if:}}} \tn 
% Row Count 13 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Rapid deterioration} \tn 
% Row Count 14 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Significant disability} \tn 
% Row Count 15 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- \textgreater{}3mm instability on flex/ext views} \tn 
% Row Count 16 (+ 1)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Abnormal findings on neurodiagnostic testing} \tn 
% Row Count 17 (+ 1)
% Row 11
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Significant concave cord deformity} \tn 
% Row Count 18 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{Criteria for successful management :  \newline Lower initial VAS and disability score \newline Younger age \newline Radicular symptoms described as pain rather than paresthesia/weakness \newline Higher BMI}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Cervical Myelopathy}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{Weakness, stiffness/clumsiness in the hands} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Urinary urgency - bladder + bowel incontinence in late stages} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Clinical S\&S}}} \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Clonus} \tn 
% Row Count 5 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{+ve L'Hermitte's} \tn 
% Row Count 6 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{UMNL signs below lesion} \tn 
% Row Count 7 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{LMNL at level of compression} \tn 
% Row Count 8 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Loss of vibration and joint position sense - Hands more than feet} \tn 
% Row Count 10 (+ 2)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{+ve Babinskis + Hoffmans} \tn 
% Row Count 11 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Hyperreflexia in the legs, gait changes, difficulty with tasks that require dexterity/fine movement} \tn 
% Row Count 13 (+ 2)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{Weakness in the legs, difficulty walking (spastic gait)} \tn 
% Row Count 15 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- If presence of fasciculations, atrophy/denervation - ALS should be considered}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.88 cm} x{7.12 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Management}}  \tn
% Row 0
\SetRowColor{LightBackground}
- MRI & - Check for Tumours, Central Disc Herniations, Atlanto-axial subluxation (in neck) \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Usually caused by cx spondylosis} \tn 
% Row Count 4 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Immediate Neurosurgical evaluation} \tn 
% Row Count 5 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}