Top View Lumbar Vertebra With Cord

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Top View Lumbar Vertebra With Cord Left Nerve
Root
Gray ramus communications
Recurrent meningeal n.
Ligamentum flavum
Anterior primary division (ventral ramus)
Superior articular process
Medial branch of the posterior primary division
Capsule of Z joint
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Disc Displacement Subluxation
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Postural Compensation To A Subluxation
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Ruptured Disc And Path Of Pain
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Stages Of Intervebral Disc Damage
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Stages Of Ruptured Disc Nucleus Repair After
Alignment Occurs Relieving Pressure
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The Disk Nucleus Damaging End Plate Of Vertebral
Body
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The Disk Nucleus Damaging End Plate Of Vertebral
Body
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Intervertebral Foramen Shapes Measurements
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Measurement Of Interverebral Foramen Where Spinal
Nerve Root Impingement Occurs
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Para Sagittal Cryosection Showing Lumbar Disc
Nerve Root impingement acute Chronic
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Lumbar Nerve Root Graded In Subluxation
Degeneration Pathology
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Spinal Nerve Foramen Occluded By Ligaments In
Spinal Subluxation
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Medial Dorsal Nerve Branch That Is Measured In
Flowing Thermograpy
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Thermograpy Of Spinal Nerves At Vertebral Level
Show Autonomic Nerve Interferance-Subluxation
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Cervical Nerve Root Distribution To Head, Neck
Right Arm
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Spinal Subluxations Producing Neuromuscular
Symptom May Affect The Autonomic Nerve System
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Subluxations May Effect Specific Area Of Large Or
Small Intestine
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Subluxations May Effect Specific Area Of Large Or
Small Intestine
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Neurological Control Showing How Spinal Nerve
Interference Plays A Role in Asthma Bunchitis
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Subluxations In Mid Thoracic Area May Effect
Gastric Function
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Autonomic Nerve Control Of Organs Tissues Of
Neck
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Spinal Subluxations In Cervical Spine May Produce
Facial Symptoms Thru These Autonomic Nerve
Connections To The Face
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Nerves, Connection Between Cervical And Cranial

• Communications are established between the
  cervical and cranial nerves as follows
• From the anterior loops of the first and second
  cervical nerves by gray rami to the superior
  ganglion of the glossopharyngeal and the ganglion
  nodosum of the vagus.
• From the jugular ganglion of the vagus to the
  petrous ganglion of the glossopharyngeal also
  the superior ganglion of the sympathetic.
• From the second, third and fourth cervical nerves
  to the superior ganglion of the sympathetic by
  gray rami communicates.
• From the cavernous plexus of the sympathetic to
  the motor-oculi, troclear and abducenes, also to
  the internal and external geniculate bodies,
  superior quadrigeminate body and the pulvinar,
  from which arises the optic nerve.

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Nerves, Connection Between Cervical And
CranialContinued

• From the carotid plexus of the sympathetic to the
  gasserian ganglion of the trifacial, which in
  turn sends a branch to the abducenes.
• From the superior ganglion of the
  glossopharyngeal to the superior sympathetic
  ganglion, also the otic ganglion of the inferior
  maxillary division of the trifacial by the lesser
  superior petrosal nerve.
• From the otic ganglion of the inferior maxillary
  division of the trifacial to the spheno-palatine
  (Meckles) ganglion of the superior maxillary
  division of the trifacial by the greater superior
  petrosal nerve.
• From the ophthalmic division of the trifacial to
  the troclear and abducenes and to the motor-oculi
  through the ciliary ganglion.

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Nerves, Connection Between Cervical And
CranialContinued

• From the hypoglossal to the superior sympathetic
  ganglion, also the ganglion nodosum of the vagus
  and connects directly with the lingual branch of
  the inferior maxillary division of the trifacial.
• From the vagus via the auricular branch to the
  facial, and from the facial to the auditory by
  the pars intermedia.
• From the lingual branch of the inferior maxillary
  division of the trifacial to the facial by the
  corda-tympani nerve.
• From the carotid plexus of the sympathetic to the
  spheno-palatine (Meckles) ganglion of the
  superior maxillary division of the trifacial by
  the large, deep petrosal nerve.
• The great auricular arises from the second and
  third cervical nerves, passes upward behind the
  ear, over the head and connects with a branch of
  the facial in the parotid gland.
• All of the above nerves communicate by their
  peripheral fibers.

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Spinal Subluxation May Lead To Neurovascular
Problems, Vaso Construction, Vaso Dilation,
Aneurism Can Be Explained Chiropractically
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The Heart Receives Nerve Supply From Spinal
Nerves
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Disc And Nero Canal Measurements
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Pain Pattern From Right Sacroiliac Subluxation
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Possible Reason For Different Recovery
Correction Time
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Spinal Adjustment Demonstrated
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Spinal Motion Examination
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Thoracic Vertebral Adjustments
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Sacroiliac Evaluation And Adjustment
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Left Atlas Subluxation
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Headpiece Placement For Proper Line Of Drive To
Adjust Atlas C-1
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Subluxation Of Occipt Atlas C1
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Dr. Grostic, Dr. Laney, Dr. Humber And Dr.
Dickholtz Technique
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Instrument Adjustment Of Atlas/C-1 VS Traditional
Hand Adjustment
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Cervical Lordosis Measurement
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Cervical Extension, Neutral And Flexion
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X-Ray Measurement Of Subluxation Correction
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Extension Shows Subluxation Of C-5
Flexion Shows Gross Subluxation C-5, C-6 And
Instability
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Almost A Dislocation Of C4 On C-5
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Pre Post Subluxation Measurement
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Facet Subluxation
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Z Joints In Cervical, Thoracic Lumbar Vertebra
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Lateralolisthesis
Anterolisthesis
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Flexation Extension Subluxation Measurements
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Lumbar Spinal Improvement After C-1 Adjustment
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Before After
Spinal Improvement 6 Mos After C-1 Adjustment
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Before After
Postural Improvement After Upper Cervical
Adjustment
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Before After
MRI Before After Chiropractic Care
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Spondylogenic Reflex Syndromes Due Subluxation Of
L-3
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Spondylogenic Reflex Syndromes Due To Subluxation
Of C-2
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The Legal Establishment Of Chiropractic
The practice of chiropractic is a privilege
authorized by the legislatures of the various
states under the authorities reserved to the
states in the U.S. Constitution. The realities of
chiropractic practice flow from this legal
establishment, and, ultimately, in every
instance, the doctor of chiropractic will be held
accountable to such provisions, statutes and
regulations as have been established by state
law. Any attempt to encode professional practice
guidelines for the chiropractic profession must
begin with a thorough, objective examination of
this legal establishment and reflect the
realities, authorities and limitations contained
therein.
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The Legal Establishment Of Chiropractic Continued
The legal development of chiropractic began
shortly after the initial articulation of
chiropractic principles and, by the 1920s,
chiropractic was well on the way to formal legal
recognition and regulation through licensure in
numerous states. The first law passed by a state
legislature authorizing and regulating the
practice of chiropractic as a separate and
distinct health care profession was in Kansas on
March 20, 1913. This action was followed in quick
succession by the legislature of North Dakota in
that same year, and by Arkansas, Oregon, Nebraska
and Colorado, by 1915. This represented the
beginning of a recognition process that was not
completed until 1974 when Louisiana finally
adopted a chiropractic licensure law.
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The Legislative Establishment Of Subluxation As
An Element In Chiropractic Practice
The concept of the subluxation has previously
been defined via the consensus paradigm statement
quoted earlier. This clinical element of
chiropractic is recognized not only in
chiropractic education, literature, philosophy
and practice, it is strongly established in both
state and federal legislation as a primary
element of chiropractic clinical responsibility.
These laws also identify the adjustment of the
subluxation to restore the normal nerve function
as a unique service not provided by medicine,
osteopathy or any other health care
discipline. Many states specifically identify the
concept of subluxation in there chiropractic
practice statutes. Most states imply an
understanding of the subluxation complex by
specifying the responsibility of the doctor of
chiropractic for adjusting the spine and adjacent
tissues for the elimination of nerve interference.
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Subluxation As An Acceptable Primary Diagnosis
Subluxation is a responsible and credible
diagnosis for the doctor of chiropractic and this
condition should be recognized and reimbursed as
a primary diagnosis by all third-party payment
organizations, both public and private. The
analytical/diagnostic determination of a
subluxation indicates the need for chiropractic
care.
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Spinal Adjustment And Spinal Manipulation
The ICA holds that the chiropractic spinal
adjustment is unique and singular to the
chiropractic profession. The chiropractic
adjustment shall be defined as a specific
directional thrust that sets a vertebra into
motion with the intent to improve or correct
vertebral malposition or to improve it
juxtaposition segmentally in relationship to its
articular mates thus reducing or correcting the
neuroforaminal/neural canal encroachment factors
inherent in the chiropractic vertebral
subluxation complex.
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Spinal Adjustment And Spinal Manipulation
The adjustment is characterized by a specific
thrust applied to the vertebra utilizing parts of
the vertebra and contiguous structures as levers
to directionally correct articular malposition.
Adjustment shall be differentiated from spinal
manipulation in that the adjustment can be only
applied to a vertebral malposition with the
express intent to improve or correct the
subluxation, whereas any joint or to put the
joint through its range of motion.
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• Wisconsin Physicians Service
  Chiropractic Care
• Indicates the condition has existed longer than
  12 months and there is a reasonable basis for
  concluding that the condition is permanent.
• A previous CT scan and/or MRI is acceptable
  evidence if a subluxation of the spine is
  demonstrated
• Demonstrated by Physical Exam Evaluation of
  musculoskeletal/nervous system to identify
• Pain / tenderness evaluated in terms of location,
  quality, and intensity. These findings may be
  identified through one or more of the following
  observation percussion, palpation, provocation,
  etc. Furthermore, pain intensity may be assessed
  using one or more of the following visual analog
  scales, algometers, pain questionnaires, etc.
• Asymmetry / misalignment identified on a
  sectional or segmental level, through one or more
  of the following observation (posture and gate
  analysis), static palpation for misalignment of
  vertebral segments, diagnostic imaging, etc.
• Range of motion abnormality (changes in active,
  passive, and accessory joint movements resulting
  in an increase or a decrease of sectional or
  segmental mobility) may be identified through one
  or more of the following motion, palpation,
  observation, stress diagnostic imaging, range or
  motion measurements, etc.
• Tissue, tone changes in the characteristics of
  contiguous, or associated soft tissues, including
  skin, fascia, muscle, and ligament may be
  identified through one or more of the following
  procedures observation, palpation, use of
  instruments, tests for length and strength, etc.

To demonstrate a subluxation based on physical
examination, two of the four criteria mentioned
under the above physical examination list are
required, one of which must be asymmetry/misalignm
ent or range of motion abnormality.
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Misalignment Level (Adjustment Listing)
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Factors which influence the visit frequency and
length of time in VSC

• Number, type, level and severity of VSC,
  advancing complications in body systems and
  paravertebral involvement. The longer the time
  after the onset of the subluxations, the greater
  the visit frequency and length of time for
  recovery. As the condition goes from the acute to
  the chronic, the time and frequency of visits
  begins to pyramid into months, years and a life
  time of care.

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Factors which influence the visit frequency and
length of time in VSC Continued

• Neuronal disturbance at the subluxation level or
  spinal biomechanical deficit. Many VSC, acute and
  chronic, will not only show subjective symptoms
  at the segment level because of denervation of
  the supporting connective tissues.
• The degree of nerve root compression or stretch
  or impingement producting sensory, motor, or
  trophic neuronal disturbance. Degree of nerve
  injury 1st 2nd 3rd 4th 5th.
• The degree of spinal cord compression or stretch
  or impingement producting sensory, motor or
  trophic neuronal disturbance. Degree of nerve
  injury 1st 2nd 3rd 4th 5th.

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Factors which influence the visit frequency and
length of time in VSCContinued

• Anatomical and Physiological Complications
• Anomaly, block vertebra, lordosis, hypolordosis,
  hyperlordosis, kyphosis, military neck, scoliosis
  (CS) types, pelvic tilt, leg deficiency

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Factors which influence the visit frequency and
length of time in VSCContinued

• Advancing pathological Complications
• Erosion, exostosis, natural fusion, ankylosis,
  hypertrophic spurs, osteophytes, wedging,
  compression, discopathy, muscular atrophy,
  muscular contracture, muscular flaccidity,
  ligamentous atrophy, ligamentous contracture,
  ligamentous flaccidity, spinal surgery spinal
  fusion, and other osseous pathology, etc., etc.
• Accurate descriptive vertebral subluxation
  complex diagnosis or findings would be helpful in
  anticipating the length of time and frequency of
  visits. This may be an oversimplification of the
  patients anticipated needs, but it should be far
  more accurate thqan the methods which have been
  employed by third party administrators in the
  past.
• The VSC or VSS may be described in 5 component
  parts.

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Multiple Component VSC Diagnosis
First Level of subluxation, such as
C-5 Second The connective tissue involvement
describing the disc, muscle, ligaments or
fascia Third The neurological component,
involving the nerve roots, or spinal cord and
our impression as to the neurophysiology or
neuropathological involvement Fourth The altered
biomechanics such as scoliosis, kyphosis, pelvic
tilt, cervical stenosis Fifth The advancing
complications in the innervated tissues and/or
the patients symptoms
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Sample Diagnosis
Primary 839.05 subluxation of C-5 vertebra
722.4 degeneration cervical disc 729.2
radiculitis 737.3 kyphosis Secondary 839.20
subluxation of L-5 vertebra 722.1 displacement
lombar disc 782.0 parasthesia 737.7
scoliosis
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200
4,000
13,000
250
4,500
10,000
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Cost 25,000
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The Chiropractic Spinal Manipulation Codes Should
Be Replaced With New Codes

• A code fee is needed for a pre adjustment
  evaluation, NO ADJUSTMENT CLINICALLY NECESSARY
• The adjustment procedures codes fee should
  reflect the relative value consideration of
  equipment cost, time for the procedure, the post
  graduate education and training above and beyond
  the college core curriculum. Some computerized
  adjusting procedure equipment cost over 25,000.
  Distraction adjusting procedures take more time
  than a mechanical or drop table adjustment. See
  the cost of equipment in the picture of adjusting
  procedure.

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Chiropractic Services - General
The term physician under Part B includes a
chiropractor who meets the specific qualifying
requirements set forth in 2020.26 but only with
respect to treatment by means of manual
manipulation of the spine (to correct a
subluxation demonstrated by X-ray to
exist). Implementation of the chiropractic
benefit requires an appreciation of the disparate
orientation of chiropractic theory and experience
and those of traditional medicine since there are
fundamental differences regarding etiology and
theories of the pathogenesis of disease.
Judgments about the reasonableness of
chiropractic treatment should be based on the
application of chiropractic principles. So that
Medicare beneficiaries receive equitable
adjudication of their claims based on such
principles and are not deprived of the benefits
intended by the law, carriers should make use of
chiropractic consultation in the review of
Medicare chiropractic claims. The regulations
contradict by using medical necessity instead
of chiropractic necessity. Claims review is
performed by RNs instead of personnel trained in
Chiropractic Principles. Secondary review is in
consultation with a chiropractic consultant who
is usually picked by medical personnel because
the chiropractor doesnt hold to chiropractic
theory principles. Dr. R.C. Herfert, D.C.
Former ICA Insurance Chairman and BCBSM
Chiropractic liaison for 30 years.
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COMMUNICATING THE VERTEBRAL SUBLUXATION COMPLEX R
.C. Herfert, D.C.