Other Anterior column conditions Course

Other Anterior column conditions Course

This course investigates the non-mechanical causes of pain arising from the anterior column. The anterior column refers to all structures anterior to the spinal canal, such as the intervertebral disc, the vertebral endplates and the vertebral body.

*Prerequisite - First Activities and Introduction Course, Principles of Clinical Diagnosis Course and Radicular Syndrome Course.



Understanding these potential causes of pain and being able to identify them in the clinic, depends to a large extent on the material in the course on mechanical discogenic pain. Somewhere between 25 and 75% of anterior column pain cases will be classified as mechanical based on the repeated movement assessment, so it is important that you are familiar with that clinical procedure. Do that course first if you are not confident with the procedure of the repeated movement assessment and the interpretation of patient responses.

Prior to research published in the 2000s, most anterior column pain was referred to as simply internal disc disruption, to distinguish these cases from those with disc protrusions and herniations causing radicular syndrome. These were the cases that were positive to controlled provocation discography. And of course there are those cases with high tech imaging evidence of overt discitis, osteomyelitis, fracture or neoplastic disease affecting the vertebral body. This course addresses those cases that are non-centralisers and show no evidence of repeatable, and rapidly reversible directional preference.

There are two main lessons in this course that refer specifically to anterior column infection

  • The first lesson looks at overt and aggressive anterior column infections presenting as discitis or osteomyelitis. These are often identified by the presence of red flags, but not always. It is important to remain aware that serious medical conditions do slip through the red flag screen. The case studies are those that I have seen myself in recent years.
  • The second lesson looks at the MRI finding of endplate changes referred to as Modic changes. Modic changes may be caused by a low grade, low virulence infection as proposed by Hanne Albert and co-workers, or may be non-responsive to a long course of antibiotics, which means that we simply don’t know whether this is a resistant infection or whether the Modic changes have some other cause. Of course, it must be noted that not all cases with Modic changes are symptomatic.
  • There is a third lesson that has a quite different focus. This topic is dear to my heart and concerns the sudden onset severe low back pain case that presents to the Emergency Department. A significant proportion of these cases do not have acute disc prolapses, fractures or infections, but have acute anterior column disorders that present with sudden onset deformities or annular tears. Best management of these cases involves the material from the course on mechanical discogenic pain.\

There are three case study videos in this course. 

  • One presents with concerns about possible cauda equina symptoms. 
  • There is a case study of management of an acute lateral shift where various management techniques are used that were not seen in the case study seen is the mechanical discogenic pain course. 
  • There is another case study of anterior column pathology in a young man that is not reversible.
  • There is a video of my colleague Dr Charles Aprill discussing provocation discography and demonstrating the technique at three levels in the lumbar spine. 
  • There is a short video demonstrating the movement of disc material during flexion and extension over a variety of age groups using cadaver specimens.

There is a quiz to test your understanding of the material.

*Prerequisite - First Activities and Introduction Course, Principles of Clinical Diagnosis Course and Radicular Syndrome Course.

 Study time: 5 hrs (approx.)

Duration: 30 days
Price: NZ$98.00