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Following chapter titles and disorder names buy discount zudena 100mg online erectile dysfunction treatment home, page numbers for the corresponding text or criteria are included in parentheses buy zudena 100mg amex erectile dysfunction frequency. Note for all mental disorders due to order 100 mg zudena visa erectile dysfunction diabetes symptoms another medical condition: Indicate the name of the other medical condition in the name of the mental disorder due to cheap zudena 100 mg visa impotence used in a sentence [the medical condi­ tion]. The code and name for the other medical condition should be listed first immedi­ ately before the mental disorder due to the medical condition. Requiring support Specify if: With or without accompanying intellectual impairment. Without self-injurious behavior Specify if: Associated with a known medical or genetic condition, neuro­ developmental disorder, or environmental factor Specify current severity: Mild, Moderate, Severe Tic Disorders 307. With onset during withdrawal Psychotic Disorder Due to Another Medical Condition^ (115) Specify whether: 293. In full remission Specify severity if full criteria for a mood episode are not currently met: Mild, Moderate, Severe 301. Late onset Specify if: With pure dysthymic syndrome; With persistent major depres­ sive episode; With intermittent major depressive episodes, with current episode; With intermittent major depressive episodes, without current episode Specify current severity: Mild, Moderate, Severe 625. Without psycho­ logical stressor 316 (F54) Psychological Factors Affecting Other Medical Conditions (322) Specify current severity: Mild, Moderate, Severe, Extreme 300. Specify current severity Sleep-Related Hypoventilation (387) Specify whether: 327. Specify whether: Substance intoxication delirium^ Substance withdrawal delirium^ 292. For possible major neuro­ cognitive disorder and for mild neurocognitive disorder, behavioral disturbance cannot be coded but should still be indicated in writing. This specifier applies only to major neurocogni­ tive disorders (including probable and possible). Note: As indicated for each subtype, an additional medical code is needed for probable major neurocognitive disorder or major neurocognitive disorder. An additional medical code should not be used for possible major neurocognitive disorder or mild neurocognitive disorder. Sexually aroused by exposing genitals to prepubertal chil­ dren and to physically mature individuals 302. With successive editions over the past 60 years, it has become a standard reference for clinical practice in the mental health field. Since a complete description of the underlying pathological processes is not possible for most mental disorders, it is important to emphasize that the current diagnos­ tic criteria are the best available description of how mental disorders are expressed and can be recognized by trained clinicians. It is a tool for clinicians, an essential educational resource for students and practitioners, and a reference for researchers in the field. The information is of value to all professionals associated with various aspects of mental health care, including psychiatrists, other physicians, psychologists, social workers, nurses, counselors, forensic and legal special­ ists, occupational and rehabilitation therapists, and other health professionals. The criteria are concise and explicit and intended to facilitate an objective assessment of symptom pre­ sentations in a variety of clinical settings—inpatient, outpatient, partial hospital, consul­ tation-liaison, clinical, private practice, and primary care—as well in general community epidemiological studies of mental disorders. Finally, the criteria and corresponding text serve as a textbook for students early in their profession who need a structured way to understand and diagnose mental disorders as well as for seasoned professionals encountering rare disorders for the first time. Some symptom domains, such as depression and anxiety, involve multiple di­ agnostic categories and may reflect common underlying vulnerabilities for a larger group of disorders. Other enhancements have been introduced to pro­ mote ease of use across all settings: xli • Representation of developmental issues related to diagnosis. The change in chapter organization better reflects a lifespan approach, with disorders more frequently diag­ nosed in childhood. Also, within the text, subheadings on development and course provide descriptions of how disorder presentations may change across the lifespan. For added emphasis, these age-related factors have been added to the criteria themselves where applicable. Likewise, gender and cultural issues have been integrated into the disorders where applicable. The revised chapter structure was informed by recent research in neuroscience and by emerging genetic linkages between diagnostic groups. Genetic and physiological risk factors, prognostic indicators, and some putative diagnostic markers are high­ lighted in the text. Symptoms of these disorders represent a single continuum of mild to severe impairments in the two domains of social commu­ nication and restrictive repetitive behaviors/interests rather than being distinct disor­ ders. This change is designed to improve the sensitivity and specificity of the criteria for the diagnosis of autism spectrum disorder and to identify more focused treatment tar­ gets for the specific impairments identified. Bipolar and depres­ sive disorders are the most commonly diagnosed conditions in psychiatry. It was there­ fore important to streamline the presentation of these disorders to enhance both clinical and educational use. This approach will facil­ itate bedside diagnosis and treatment of these important disorders. Likewise, the explanatory notes for differentiating bereavement and major depressive disorders will provide far greater clinical guidance than was previously provided in the simple be­ reavement exclusion criterion. The new specifiers of anxious distress and mixed fea­ tures are now fully described in the narrative on specifier variations that accompanies the criteria for these disorders. The categories of substance abuse and substance dependence have been eliminated and replaced with an overarching new category of substance use disorders—with the specific substance used defining the specific disorders. Given the explo­ sion in neuroscience, neuropsychology, and brain imaging over the past 20 years, it was critical to convey the current state-of-the-art in the diagnosis of specific types of disor­ ders that were previously referred to as the "dementias" or organic brain diseases. Although the benefits of a more dimensional approach to personality disorders have been identified in previous edi­ tions, the transition from a categorical diagnostic system of individual disorders to one based on the relative distribution of personality traits has not been widely accepted. A more dimensional profile of personality trait expression is also proposed for a trait-specified approach.

Brain Res Rev 2005; 48:409– nal capsules in patients with obsessive-compulsive 419 [F] disorder buy zudena 100mg otc erectile dysfunction kya hota hai. Gabriels L zudena 100 mg cheap erectile dysfunction doctors los angeles, Cosyns P order 100mg zudena amex erectile dysfunction beat filthy frank, Nuttin B buy zudena 100 mg overnight delivery erectile dysfunction treatment in thane, Demeulemeester H, surgical treatment of obsessive-compulsive disorder, in Gybels J: Deep brain stimulation for treatment-refrac Obsessive-Compulsive Disorders: Practical Manage tory obsessive-compulsive disorder: psychopathological ment. Aouizerate B, Cuny E, Martin-Guehl C, Guehl D, Neurology 2000; 54:142–147 [G] Amieva H, Benazzouz A, Fabrigoule C, Allard M, Rougi 507. J Neurosurg 2004; 101:682–686 [D] Copyright 2010, American Psychiatric Association. Practice Guideline for the Treatment of Patients With Obsessive-Compulsive Disorder 95 521. J Anxiety Disord 2001; 15:277–285 cingulotomy for treatment-refractory obsessive-compul [G] sive disorder. Acta Psychiatr Scand 1993; impact on treatment outcome for obsessive-compulsive 87:197–207 [C] disorder. Clin Psychol Review 1995; 1:317–346 [F] lished facts and advances between 1995–2005. National Institute for Health and Clinical Excellence: atr Clin North Am 2006; 29:585–604 [F] Obsessive Compulsive Disorder: core interventions in 533. Behav Res Ther 1994; 32:79–87 with cognitive behaviour therapy and pharmacothera [G] py. Eur Arch Psychiatry Clin R: Clomipramine and exposure for obsessive-compul Neurosci 2005; 255:121–128 [C] sive rituals, I. Arch Gen Psychiatry ersbach T, Buhlmann U, Baer L: Effectiveness of cog 1992; 49:681–689 [G] nitive therapy for obsessive-compulsive disorder: an open 568. It is a complex disorder with a variety of manifestations and symptom dimensions, some of which are underrecognized. Patients can experience signifcant improvement with treatment, and some may achieve remission. Patients with severe symptoms or lack of response to frst-line therapies should be referred to a psychiatrist. It is often a en/diseases-conditions/ obsessive-compulsive to receive treatment after meeting diagnostic chronic disorder (60% to 70% of cases) and disorder. In one Incorporating motivational interviewing may increase engagement with study population, only 30. For example, taboo thoughts glutamate, dopamine, and possibly other neurochemi may be attributed to other causes or may not appear to be cals. Patients may offer clues by alluding to intrusive and inconsistent with the individual’s sense of self (ego thoughts or repetitive behaviors. Avoidance of particular dystonic), and great effort is made to resist or suppress locations or objects, excessive concerns about illness or them. They can involve contamination; repeated doubts; injury, and repetitive reassurance-seeking behavior are or taboo thoughts of a sexual, religious, or aggressive also common. Compulsions are repetitive behaviors or mental compulsive personality disorder is a separate diagnos rituals performed to counteract the anxiety caused by tic entity that is not characterized by intrusive thoughts obsessions. Rather, it is a pervasive pattern plete these actions, and the behaviors become automatic of behaviors emphasizing organization, perfectionism, over time. Presence of obsessions, compulsions, or both: Obsessions are defned by (1) and (2): 1. Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress. The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action. The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive. Note: Young children may not be able to articulate the aims of these behaviors or mental acts. The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance. Specify if: With good or fair insight: the individual recognizes that obsessive-compulsive disorder beliefs are defnitely or probably not true or that they may or may not be true. With poor insight: the individual thinks obsessive-compulsive disorder beliefs are probably true. With absent insight/delusional beliefs: the individual is completely convinced that obsessive-compulsive disorder beliefs are true. Specify if: Tic-related: the individual has a current or past history of a tic disorder. Evidence-based medical and behavior therapies comorbid diagnoses are anxiety disorders (75. Other common Because it may take weeks to months for these therapies 898 American Family Physician Patients should be assessed for suicide risk and pres ence of comorbidities throughout the course of their Table 4. Clomipramine (Anafranil), a tricyclic ally takes at least four to six weeks for patients to note antidepressant with a strong serotonergic effect, was any signifcant improvement in symptoms; it may take previously the frst-line pharmacologic treatment for 10 weeks or longer for some. However, because of concerns about its safety If medical therapy is successful, it should be continued and adverse effects, selective serotonin reuptake inhibi for at least one to two years, if not indefnitely.

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About the Author: Stuart McGill is a Professor of Spine Biomechanics and is the Chair of the Department of Kinesiology at the University of Waterloo where he has a laboratory that explores low back mechanics of both normal and injured people generic zudena 100mg with mastercard erectile dysfunction pump how do they work, and harvested tissues (where specific injuries are created and analysed) purchase 100mg zudena otc erectile dysfunction doctors in el paso tx. He has been the author of over 200 scientific journal papers that address the issues of lumbar function cheap 100 mg zudena visa erectile dysfunction prevalence, low back injury mechanisms buy discount zudena 100mg on-line erectile dysfunction drugs uk, investigation of tissue loading during rehabilitation programs, the formulation of work-related injury avoidance strategies and high performance training. As a consultant, he has provided expertise on assessment and reduction of the risk of low back injury to various government agencies, many corporations and legal firms and professional/international athletes and teams. He is regularly referred special patient cases from the medical community from around the world for opinion. It is important to keep your neck moving whilst it is recovering, as this will prevent stiffness and help you to get better faster. Alternatively, your local pharmacist will be able to recommend suitable medicines. Wrap the ice pack or heat pad in a tea towel before using, to prevent burns or scalds to your skin. You may be more comfortable if you support your lower back with a rolled up towel and sit in an upright chair. Repeat each movement up to 10 times in each direction every 1-2 hours or as your pain allows. Keeping your eyes closed, turn back so that when you open your eyes you can see the same point in front of you. Stop the exercise and let your doctor or therapist know right away if you have either of these problems: o Any change in your bowel or bladder control. Each surgeon should exercise his or her own independent judgment in the diagnosis and treatment of an individual patient, and this information does not purport to replace the comprehensive training surgeons have received. As with all surgical procedures, the technique used in each case will depend on the surgeon’s medical judgment as the best treatment for each patient. The Mobi-C Cervical Disc Prosthesis or two contiguous levels for intractable radiculopathy is implanted using an anterior approach. Patients should (arm pain and/or a neurologic defcit) with or without have failed at least 6 weeks of conservative treatment neck pain or myelopathy due to abnormality localized or demonstrated progressive signs or symptoms to the level of the disc space and at least one of the despite nonoperative treatment prior to implantation following conditions confrmed by radiographic of the Mobi-C Cervical Disc Prosthesis. Adjacent segment degeneration was assessed A patient was considered a success at 60 months at the spinal segment immediately above and below if all of the following criteria were met: the treated levels. The fve grades are: none (0), minimal (1), defnite (2), moderate (3) or severe (4). Operating Room Setup and Patient Positioning Proper C-arm set up is critical for accurate visualization of instrument and implant positioning. Patient positioning is critical to ensure proper orientation and alignment of the device. The position should be • Prepare for C-arm use that allows cephalad and maintained throughout the surgery, and rotation of the caudad movement. Mobi-C Cervical Disc—Surgical Technique Guide 7 Surgery Approach and Procedure • Decompress the foramen bilaterally. The Mobi-C surgical approach is identical to that • Establish a normal, healthy disc height of a traditional anterior cervical discectomy and (no overstufng). However, the Mobi-C surgical • Place the implant in the center of the vertebral procedure emphasizes aspects that may difer from a bodies for optimal biomechanical success. The operating surgeon will want to: Considerations for a Two-level Surgery • Center the exposure on midline. It may distractor to open the posterior aspect of the be easier to complete the most diseased level frst disc space. Caspar pins are available sterile packed from the inferior edge of the superior vertebral body. Use midline placement of the caspar pin as a visual reference for midline device placement. The extent of decompression is left to surgeon discretion based on patient pathology and history. To prevent weakening of the endplates, use of a burr is discouraged during endplate preparation. Width gauges correspond to the 15 mm in depth and can be used to estimate trial depth. Note: the center reference point, located on the width gauge, confrms location of the vertebral midline; • Use the paddle distractor to create parallel distraction. When the desired height is obtained, lock the caspar distractor to hold distraction. Use the caspar distractor to maintain the parallel distraction achieved by the paddle distractor. The trial will • Caspar pin depth (12 mm and 14 mm) determine the fnal implant height to be used as well • Paddle distractor depth (15 mm) as implant footprint (width and depth). Trialing should Important: It is extremely important to choose a size begin with the smallest height frst (5 mm) and should that achieves complete A/P coverage. Important: Confrm the complete anterior-posterior and medial-lateral endplate coverage of the selected footprint. Mobi-C Cervical Disc—Surgical Technique Guide 13 • Release the caspar distractor to assess the tension and ft. Once released, take a lateral X-ray to validate height and depth selection and an A/P X-ray to assess central placement and width. The holes in the trial, front and side facilitate verifcation of position (center and rotation). In assessing the trial ft: • Start with a 5 mm trial (over 85% of implanted Mobi-Cs are 5 mm, rarely a 7 mm).

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The recommendations that diagnosticians give to discount 100mg zudena with visa impotence definition inability parents are likely to zudena 100mg with amex erectile dysfunction drugs south africa be distributed in multiple venues buy 100mg zudena mastercard erectile dysfunction mental treatment. It is then up to zudena 100mg generic erectile dysfunction doctors those who are responsible to plan and deliver intervention services to the child to apply the recommendations the recommendations should be detailed, address all areas of a child’s daily life and include all developmental domains. Recommendations may include for example, “the child will need to have a communication system as soon as possible to learn to express wants and needs to others,” or “the child would beneft from programs that improve social skills and opportunities with non-disabled peers. Sharing Diagnostic Information During the oral discussion with families, diagnosticians should emphasize the importance of communication and collaboration across those who are and will be helping the child and family. The diagnostician should explain to the family what a signed consent for the release of the written report means, and how they can choose to share the report with others. In particular, sharing the report with the child’s pediatrician or medical home should be encouraged. It is also important to emphasize to families that sharing the report will assist with communication and collaboration among the different service agencies and providers as they help their child and them. An evaluation determining a student’s eligibility for special education is conducted by a team of diagnosticians, including parents, and is conducted strictly for the purpose of identifying whether a child is eligible to receive special education and related services. For those with a positive screening, an autism assessment is provided at no cost to the family either through the program that conducted the initial evaluation or by one of the autism-specifc early intervention programs. In order for diagnostic assessments performed by diagnosticians outside of the Birth to Three programs to be accepted by Birth to Three, the diagnostician must be a licensed physician, clinical psychologist or clinical social worker and the assessment must meet the minimum standards of this guideline. A child may receive the diagnosis either prior to or after the referral to Birth to Three. A version especially for parents, is called Service Guideline #1: Autism Spectrum Disorder, Intervention Guidance for Parents (2011). During the course of the evaluation to determine eligibility for special education, educators and related service personnel draw upon information from a variety of sources, including parental report/answers to questionnaires, and ensure that information is documented and carefully considered. The decision about a child’s eligibility for special education is based upon a comprehensive evaluation of the child to determine if: 1) the child is a child with a disability; and 2) whether the child requires special education. The disability category of developmental delay may apply to children from age three to six years. By their sixth birthday, children who continue to require special education services must be re-evaluated to determine if a disability that requires special education continues to exist and to identify a disability category other than developmental delay. The challenge is to achieve an optimal level of collaboration and communication between the family and the educational, medical and other diagnosticians and agencies involved in the clinical diagnosis and in the determination of eligibility for special education services. Parents are central in this process and are encouraged to collaborate with the medical and educational diagnosticians involved with their child by sharing results from clinical diagnosticians with schools and to share school evaluations with their child’s clinicians. Pediatricians and other clinical providers may have other recommendations that the school district may or may not address. Archives of Diseases in and early childhood screening recommendations for Fragile X. Medical conditions in autism spectrum Achenbach System of Empirically Based Assessment. Test of Problem young children with developmental disorders in the medical Solving 3: Elementary. Temperament and sensory features of guideline for the diagnosis, evaluation, and treatment of children with autism. Journal of Autism and Developmental attention-defcit/hyperactivity disorder in children and Disorders, 42(22), 2271-2284. Bayley Scales of Infant and Toddler Development Centers for Disease Control and Prevention. MacArthur-Bates Communicative autism at age 2: Predictive validity of assessments conducted at Development Inventories (3rd ed. Obsessive compulsive Connecticut Department of Developmental Services, Connecticut disorder in adolescence: An epidemiological study. Service guideline #1: Autism the American Academy of Child and Adolescent Psychiatry, 27, spectrum disorder, intervention guidance for families. A parent’s guide to special education in and Developmental Disorders, 38, 1302-1310. Evidence-based approach to developmental Journal of Child Psychology and Psychiatry, 48(9), 932–940. Autism and sight or hearing loss: the world for people with autism spectrum disorder. European Journal of Paediatric Neurology, Anxiety and sensory over-responsivity in toddlers with autism 8, 327–332. Developmental Disabilities Research and Reviews, 16, 144 London: the Biomedical & Life Sciences Collection, Henry 153. Refections on diagnosing autism spectrum schedule—toddler module: A new module of a standardized disorders. Pediatrics, 120(5), specifying pervasive developmental disorder-not otherwise 1183-1215. Journal of Autism and Developmental Neurodevelopmental disabilities in infancy and childhood, 3rd Disorders, 43(5), 1236-1242. Development Prevalence and natural history of primary speech and language and validation of a measure of dysmorphology: Useful delay: Findings from a systematic review of the literature. American Journal of International Journal of Language & Communication Medical Genetics, Part A 146A(9),1101–1116. Symposium presented at statement: Chromosomal microarray is a frst-tier clinical the International Meeting for Autism Research, San Sebastian, diagnostic test for individuals with developmental disabilities Spain. Journal of Developmental and Behavioral practice guidelines for screening, diagnosis, and assessment.

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Are chiro Meta-analysis of Observational Studies py for subacute and chronic low-back practic tests for the lumbo-pelvic spine pain zudena 100mg visa impotence of proofreading poem. Lucas N best 100mg zudena erectile dysfunction walmart, Macaskill P cheap zudena 100 mg without a prescription erectile dysfunction doctors austin texas, Irwig L cheap 100mg zudena visa erectile dysfunction medication covered by insurance, Moran R, examination of non-specific low back Bogduk N. Spine of studies of diagnostic accuracy includ solidated Standards of Reporting Trials). J Gen Intern ton K, Golder S, Riemsma R, Woolacoot ening the Reporting of Observational Med 2012; 27:47-55. Peng B, Fu X, Pang X, Li D, Liu W, Gao of clinical examination characteristics elaboration. Manchikanti L, Singh V, Pampati V, tor of symptomatic discs and annular Press, Newcastle, 1999. Com with a meta-analysis of false-positive parison of pressure-controlled provoca search and Clinical Management. The interexam study for incidence of low back pain and scintigraphy in assessing sacroiliitis in iner reproducibility of physical examina radiological changes of lumbar spine in ankylosing spondylitis: A systematic lit tion of the cervical spine. The associa tic and therapeutic problems of back for neck pain and age-matched healthy tion between lumbar disc degeneration pain syndromes and their distribution people. J Manipulative Physiol Ther 1997; and low back pain: the influence of age, according to a colour coding system 20:468-475. J Orthop Sports Phys Ther 2000; evaluated features of spinal degenera Res Clin Rheumatol 2008; 22:471-482. Takatalo J, Karppinen J, Niinimaki J, patients with probable symptoms but Lippincott Williams & Wilkins, Philadel Taimela S, Nayha S, Mutanen P, Se negative discography. Regional anal sociated disorders: Results of the Bone T, van den Haak E, Hurwitz E. Neurosurg Clin N Am history accurate in patients with persis imaging and low back pain in adults: A 1991; 2:807-816. The initially asymptomatic cohort: Clinical parative local anaesthetic blocks in the validity of manual examination in as and imaging risk factors. Spine (Phila diagnosis of cervical zygapophysial joint sessing patients with neck pain. Best Pract Res Clin Anaes the pyrite standard: the Midas touch in Lotti G, Milano C. The ized with magnetic resonance imaging, utility of comparative local anesthet and occupational variables. Siegenthaler A, Eichenberger U, ic blocks versus placebo-controlled 2007; 16:255-266. Schmidlin K, Arendt-Nielsen L, Cura blocks for the diagnosis of cervical zyg tolo M. J Chin Med Assoc 2004; Young M, Diedrich O, Luring C, von cal changes during puberty risk factors 67:349-354. J Bone Joint Surg Xiu Fu Chong Jian Wai Ke Za Zhi 2009; Correlation between backpack weight Am 2001; 83-A:1306-1311. Kuisma M, Karppinen J, Niinimaki J, tal spinal curvatures, athletic activity, 453. Assessment sion in symptomatic low back pain pa “structural abnormalities” on magnetic of combined movements of the lumbar tients. Stud Health Technol Inform 2002; resonance imaging a contraindication spine in asymptomatic and low back 91:325-331. Spine (Phila Pa 1976) 1999; Questionnaire survey and clinical-ra Raininko R, Viikari-Juntura E, Lammin 24:1316-1321. Lack of association be lumbar spine: findings in female sub tween lumbar disc degeneration and 448. Ann Rheum Dis Watanabe K, Chiba K, Toyama Y, Fujiwara genographic analysis of the lumbar 2011; 70:1740-1745. H, Momoshima S, Nishiwaki Y, Hashi spine in male army recruits with and moto T, Takahata T. The spine in sport and veteran mili teoarthritis in a Dutch population with pain and disability. The cervical degenerative changes in women the association between cervical spine relationship between facet joint osteo with chronic neck pain affect function Spine P, Parkkola R, Aromaa M, Sillanpaa M, logical changes of cervical facet joints (Phila Pa 1976) 1986; 11:521-524. Okada E, Matsumoto M, Ichihara D, inimaki J, Ojala R, Heliovaara M, Korpe surements from radiographs. Eur J Ra Chiba K, Toyama Y, Fujiwara H, Mo lainen R, Kaikkonen K, Taimela S, Natri diol 2005; 55:415-420. A magnetic resonance imag between the grade of disc degeneration resonance imaging study. Structural, psychological, on the role of personality characteris logical prevalence of lumbar interver and genetic influences on low back and tics and psychological distress in neck tebral disc calcification in the elderly: neck pain: A study of adult female twins. Lundin O, Hellstrom M, Nilsson I, changes in the lumbar spines of middle in diastrophic dysplasia: A clinical and Sward L. Spine (Phila Pa 1976) pression, end plate abnormalities, and top athletes in four different sports: A 2004; 29:2147-2152. Disc degenera facet joint osteoarthritis, and stability of tion and associated abnormalities of A magnetic of the interpretations of lumbar spinal jections and surgical interventions: Re resonance imaging study.

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