Earn CME online with this streaming In-Depth Anatomy video, which provides nearly 90 minutes of lectures and cadaveric explorations of discogenic pain covering:

• The pathophysiology of "disc degeneration" (and why that term is a misnomer),
• Disc stimulation as a mechanism for the diagnosis of Internal Disc Disruption, and
• A consideration of the end plate as a cause of anterior column axial pain.

This video is intended to be viewed in its entirety in the order it is presented by the speakers. However, it you must stop viewing at any point, the stream will resume at the point where you previously paused.

Also, when you purchase access to this stream, you will also receive a document that notes the timing of each section of the video.

Copyright
Materials presented in this activity have been made available by the Spine Intervention Society for educational purposes only. We reserve all rights to such material.

Educational Objectives
Upon completion of this activity, participants should be able to:

• Describe the molecular, microscopic, macroscopic, biomechanical and imaging findings of disc age-related changes.
  Understand the pathophysiology of internal disc disruption (IDD), and that it is a distinct disease process causing discogenic pain.
  Assess the role of pathological vertebral endplate changes in clinical pain syndromes.
  Describe the role of disc stimulation (i.e., provocation discography) as the reference standard for IDD, including the imaging findings that suggest a likely diagnosis of IDD. The learner should be able to discuss the roles and limitations of the various treatment options available for IDD.

Disclosure Information
None of the other planners or faculty had relevant financial relationships with ACCME-defined ineligible companies.

Accreditation Statement
The Spine Intervention Society (SIS) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation Statement
SIS designates this live internet activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Commercial Support
No commercial support was received for this activity.

Date of Activity Release: 02/27/2021
Date of Activity Expiration: 02/26/2024

Take your interventional skills to the next level with the diagnostic confidence you’ll develop from viewing the core lectures from the Imaging Anatomy for the Spine Interventionalist course. Earn CME credit at your convenience, without any time away from your practice, viewing streamed lectures and participating in a live Q&A. Over the years SIS has refined the curriculum for this special course, designed to help you gain a greater perspective of anatomy by combining cross-sectional (MRI and CT) and projectional (fluoroscopy) techniques—helping you perform spine interventions with greater precision and safety.

BONUS 1-HOUR Q&A DISCUSSION JUST ADDED In addition to the 6 hours of this courses' streaming lectures, we now bring you a new hour-long Q&A discussion. See how our team of expert radiologists addresses a viewer's question on the risk presented by gadolinium-based contrast agents, and register to unlock the complete video set.

Imaging Techniques

• Cross Sectional Imaging and Fluoroscopic Correlation
• Contrast Media - Safety and Utility

Lumbar Spine

• Enumeration, Anatomy Basics, and Innervation
• Disc Herniations: Disc Anatomy and Nomenclature
• Foraminal Stenosis: Disc, Endplate and SAP Hypertrophs, and Degenerative Spondylolisthesis
• Spondylolysis, Space of Okada, Posterior Ligamentous Complex Inflammatory Syndrome
• Synovial Cysts
• Axial Pain: The Disc and Posterior Elements
• Neurogenic Intermittent Claudication
• Planning Lumbar TFESI Based on Imaging Anatomy

Pelvis

• Sacroiliac Joint Anatomy, Function, and Normal Imaging
• Lumbar Contrast Patterns
• Spondyloarthropathies

Cervical Spine

• Cranio-Cervical Junction and Cervicogenic Headache
• Unique Subaxial Anatomy and Innervation
• Vascular Anatomy of the Cervical Spine
• Cervical Radicular Pain: Disc Herniations and Foraminal Stenosis

Holospine and Paraspinal Nerves

• When Not to Inject: When Imaging Warns You of Excess Risk

Speakers

John A. Carrino, MD, MPH
Vice Chairman, Department of Radiology and Imaging, Hospital for Special Surgery
Professor of Radiology, Weill Cornell Medical College, Cornell University
New York, New York

Felix E. Diehn, MD
Associate Professor of Radiology, Mayo Clinic School of Medicine
Rochester, Minnesota 

Greta B. Liebo, MD
Consultant and Assistant Professor in Radiology at Mayo Clinic School of Medicine
Rochester, Minnesota

Timothy Maus, MD
Past SIS President and Professor of Radiology, Mayo Clinic School of Medicine
Kihei, Hawaii

Vinil Shah, MD
Associate Professor of Clinical Radiology, University of California, San Francisco
San Francisco, California

Copyright
Materials presented in this activity have been made available by the Spine Intervention Society for educational purposes only. We reserve all rights to such material. 

Educational Objectives
Upon completion of this activity, participants should be able to:

• Systematically evaluate a spine imaging study and describe normal anatomy;
• Identify the specificity and sensitivity shortcomings of radiographs, CT and MRI;
• Assess normal variants that may simulate symptomatic spine disease;
• Recognize neural compressive lesions within a large spine imaging data set;
• Interpret patient radiographic findings to develop a differential diagnosis in correlation with history, physical examination, and the patient’s spine pathology;
• Explain challenges to safe injections and how to avoid pitfalls through analysis of spine imaging;
• Utilize imaging in planning transforaminal access to maximize safety and efficacy.

Speaker and Planner Disclosure Information
RELEVANT FINANCIAL RELATIONSHIPS WITH ACCME-DEFINED COMMERCIAL INTERESTS
John A. Carrino, MD, MPH
Nothing to disclose

Felix E. Diehn, MD
Nothing to disclose

Greta B. Liebo, MD
Nothing to disclose

Timothy Maus, MD
Nothing to disclose

Vinil Shah, MD
Nothing to disclose

David M. Sibell, MD
Nothing to disclose

Alison Stout, DO
Nothing to disclose

References
References are provided within the speakers presentations.

Accreditation Statement 
The Spine Intervention Society (SIS) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation Statement
SIS designates this enduring material for a maximum of 7.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Commercial Support
No commercial support was received for this activity.

Date of Activity Release: 01/08/2021
Date of Activity Expiration: 01/07/2024

Access the complete set of videos used in the SIS Bio-Skills Labs when you purchase SIS’s Lumbar and Cervical Vignettes. This is your only opportunity to learn directly from one of SIS’s founders, master interventional specialist Dr. Charles Aprill himself, as he demonstrates SIS Guidelines-based procedures on cadavers.

Lumbar Vignettes:

• Caudal Epidural Injections
• Sacroiliac Joint Injections
• S1 Transforaminal Epidural Injections
• L5/S1 Disc Access
• L5 Transforaminal Epidural Injections
• L5 Dorsal Ramus Blocks
• L4/5 Facet Joint Injections
• L4/5 Interlaminar Epidural Injections
• L4 Medial Branch Blocks
• L3/4 Disc Access
• L3 Transforaminal Epidural Injections

Cervical Vignettes:

• C7/T1 Facet Joint Injections
• C7/T1 Interlaminar Epidural Injections
• C7 Medial Branch Blocks
• C7 Sympathetic Blocks
• C6/7 and C5/6 Transforaminal Epidural Injections
• C6/7, C5/6, and C4/5 Disc Access
• C4/5/6 Medial Branch Blocks
• C3 Medial Branch and Third Occipital Nerve Blocks
• C1/2 Lateral Atlanto-Axial Joint Injections

The lumbar modules are the building blocks for all interventional pain physicians. As an SIS member*, you can purchase this educational offering and dive into these topics. For an optimal learning experience, it is highly recommended that you view the videos in order.

Topics covered in the lumbar modules are:

• Anatomy, Technique, and the Evidence Base
  • Interlaminar Epidural Injections
  • Transforaminal Epidural Steroid Injections(Supraneural)
  • Medial Branch Blocks
  • S1 Transforaminal Epidural Injections
• Lumbar Anatomy for the Pain Management Physician
• Needlecraft
• Principles of Fluoroscopy and Radiation Safety
• Steroid Preparations for Transforaminal Epidural Injections: Safety and Efficacy
• Procedural Safety: Risk Mitigation in Basic Lumbar Procedures

Copyright 
Materials presented in this activity have been made available by the Spine Intervention Society for educational purposes only. We reserve all rights to such material.

*Continual membership is expected to access the modules in your member profile.

Educational Objectives
Upon completion of this activity, participants should be able to:

• Analyze the imaging depiction of the relevant anatomy;
• Relate patient history and physical exam findings with imaging to achieve a likely diagnosis of the spinal pathology causing the patient’s pain or dysfunction;
• Describe the literature support for the efficacy of the procedures;
• Identify the risks and benefits of each procedure, as well as assessment, prevention, and treatment of potential complications;
• Apply technically correct performance of the spinal procedures using safe fluoroscopic guidance with minimal tissue injury or discomfort.

Speaker Disclosure Information
RELEVANT FINANCIAL RELATIONSHIPS WITH ACCME-DEFINED COMMERCIAL INTEREST
Timothy Maus, MD
Nothing to disclose

David M. Sibell, MD
Nothing to disclose

OTHER DISCLOSURES
Timothy Maus, MD
Intellectual property rights: Patent filing, Mayo Clinic Ventures
Grant research support: National Institutes of Health 1R01NS100725
Position in a physician society/association: SIS Board of Directors
Travel reimbursement: Mayo Clinic, EFIC, American University of Beirut, SIS, NASS, Vanderbilt University

David Sibell, MD
Grant and research support: Sub-investigator on a clinical trial sponsored by Avanos Medical, ClinicalTrials.gov Identifier: NCT03601949
Position in a physician society/association: SIS
Travel reimbursement: SIS

References
References are provided within the speakers presentations.

Commercial Support
No commercial support was received for this activity.

Accreditation Statement
The Spine Intervention Society (SIS) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation Statement
SIS designates this enduring material for a maximum of 5.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Date of Activity Release: 01/15/2020
Date of Activity Expiration: 01/14/2023

The Cervical Core Curriculum product includes all lectures presented during SIS Cervical and Advanced Cervical Bio-skills Courses. As an SIS member*, you can purchase this educational offering and dive into these topics.

Please Note:  Because there is a significant amount of overlapping content across presentations in the two courses, the Cervical and Advanced Cervical Core Curriculum is offered at the price for a single module.  

Topics covered include:

• Anatomy, Technique, and Evidence Base
  • Third Occipital Nerve Blocks: Lateral Approach
  • Third Occipital Nerve Blocks: Posterior Approach
  • C7 Medial Branch Blocks: Lateral Approach
  • C7 Medial Branch Block: Posterior Approach
  • C3-C6 Medial Branch Blocks: Lateral Approach
  • C3-C6 Medial Branch Blocks: Posterior Approach
  • Lateral Atlanto-Axial Joint (C1-C2) Access
  • Transforaminal Epidural Steroid Injections
  • Interlaminar Epidural Steroid Injections
  • Intra-articular Facet Joint Access
  • Thoracic Transforaminal Epidural Steroid Injections
• Cervical Anatomy for the Interventional Pain Management Physician
• Advanced Cervical Anatomy and Imaging: Anatomy of the Craniocervical Junction
• Contrast Flow Patterns in Cervical Epidural Injections
• Risk Mitigation in Cervical Procedures
• Risk Mitigation in Advanced Cervical Procedures

Copyright  
Materials presented in this activity have been made available by the Spine Intervention Society for educational purposes only. We reserve all rights to such material. 

*Continual membership is expected to access the modules in your member profile.

Educational Objectives 
Upon completion of this activity, participants should be able to:

• Analyze the imaging depiction of the relevant anatomy;
• Relate patient history and physical exam findings with imaging to achieve a likely diagnosis of the spinal pathology; causing the patient’s pain or dysfunction;
• Describe the literature support for the efficacy of the procedures;
• Identify the risks and benefits of each procedure, as well as assessment, prevention, and treatment of potential complications;
• Apply technically correct performance of the spinal procedures using safe fluoroscopic guidance with minimal tissue injury or discomfort.

Speaker Disclosure Information 
RELEVANT FINANCIAL RELATIONSHIPS WITH ACCME-DEFINED COMMERCIAL INTEREST  
Allen S. Chen, MD, MPH
Nothing to disclose

Michael B. Furman, MD, MS  
Nothing to disclose 

Brad Goodman, MD 
Nothing to disclose

Timothy Maus, MD 
Nothing to disclose

Scott Naftulin, DO 
Nothing to disclose

Joshua Rittenberg, MD 
Nothing to disclose

Louis C. Saeger, MD 
Nothing to disclose

Alison Stout, DO 
Nothing to disclose 

OTHER DISCLOSURES
Allen S. Chen, MD, MPH 
Any position as a speaker/committee member: NASS, SIS
Expert witness: Cases in New Jersey, California
Travel expenses: SIS

Michael B. Furman, MD, MS 
Service as an expert witness: Malpractice Review for several law firms 
Royalties: Elsevier 
Grant and research support: Mesoblast/Cascade 
Any position in physician society/association: SIS 
Travel Reimbursement: SIS

Brad Goodman, MD
Stock ownership or investment interest in a commercial interest: Discgenics
Royalties: Elsevier
Speaker and travel reimbursement: SIS 

Timothy Maus, MD 
Grant and research support: NIH 1R01NS100725-01A1; University of MN/Mayo Clinic Translational Product Development Fund 
Intellectual property rights: Patent Filing, Mayo Clinic Ventures 
Any position in physician society/association: SIS 
Speaker and Travel Reimbursement: Mayo Clinic; American University of Beirut,Cleveland Clinic; American Academy of Pain Medicine, Rutgers University, SIS

Scott Naftulin, DO 
Position in physician society/association: SIS
Speaker and travel reimbursement: SIS

Joshua Rittenberg, MD 
Position in physician society/association: SIS
Speaker and travel reimbursement: SIS

Louis C. Saeger, MD 
Advisory committees: Minnesota Department of Health
Grant and research support: Vivex, JoiMax
Position in physician society/association: Minnesota Society of Interventional Pain Physicians, Director at Large 
Marketing/promotional dinners: Boston Scientific, Nevro, StimWave 
Speaker: SIS 
Travel reimbursement: SIS, Boston Scientific

Alison Stout, DO 
Expert consultant: State Farm 
Position in physician society/association: NASS, SIS 

References
References are provided within the speakers' presentations.

Commercial Support  
No commercial support was received for this activity.

Accreditation Statement   
The Spine Intervention Society (SIS) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation Statement   
SIS designates this enduring material for a maximum of 6.75 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Date of Activity Release: 07/11/2020   
Date of Activity Expiration: 07/10/2023

The Radiofrequency (RF) Neurotomy Core Curriculum product includes all lectures presented during SIS Radiofrequency Bio-skills Courses. As an SIS member*, you can purchase this educational offering and dive into these topics. 

Topics covered include:

• Anatomy, Technique, and Evidence Base
  •      L2-4 Medial Branch RF Neurotomy
  •      L5 Dorsal Ramus RF Neurotomy
  •      Third Occipital Nerve RF Neurotomy
  •      C3-6 Medial Branch RF Neurotomy
  •      C7 Medial Branch RF Neurotomy
• Principles of RF Denervation
• Anatomy of Cervical Posterior Column Innervation
• Anatomy of Lumbar Posterior Column Innervation
• Lumbar and Cervical Medial Branch Blocks: Response and Interpretation
• Risks and Complications

Copyright   
Materials presented in this activity have been made available by the Spine Intervention Society for educational purposes only. We reserve all rights to such material. 

*Continual membership is expected to access the modules in your member profile.

Educational Objectives
Upon completion of this activity, participants should be able to:

• Analyze the imaging depiction of the relevant anatomy;
• Relate patient history and physical exam findings with imaging to achieve a likely diagnosis of the spinal pathology; causing the patient’s pain or dysfunction;
• Describe the literature support for the efficacy of the procedures;
• Identify the risks and benefits of each procedure, as well as assessment, prevention, and treatment of potential complications;
• Apply technically correct performance of the spinal procedures using safe fluoroscopic guidance with minimal tissue injury or discomfort.

Speaker Disclosure Information  
RELEVANT FINANCIAL RELATIONSHIPS WITH ACCME-DEFINED COMMERCIAL INTEREST  
Richard Bundschu, MD
Nothing to disclose

Thomas Costello, DO
Nothing to disclose

Nicholas Fuller, MD
Nothing to disclose

Michael B. Furman, MD, MS
Nothing to disclose

Kevin Martinez, MD
Nothing to disclose

Scott Naftulin, DO
Nothing to disclose

David M. Sibell, MD
Nothing to disclose

Patrick H. Waring, MD
Nothing to disclose

Frank Willard, PhD
Nothing to disclose

OTHER DISCLOSURES
Richard Bundschu, MD
Speakers Bureau: Nevro
Grant and research support: Nevro, Principal Investigator, Research; StimGenics, Principal Investigator, Research
Speaker and travel reimbursement: SIS

Thomas Costello, DO
Position in physician society/association: President American Osteopathic College of Anesthesiologists (AOCA)
Speaker and travel reimbursement: SIS; AOCA

Nicholas Fuller, MD
Stock ownership: Spinedriver 1% equity
Speaker and travel reimbursement: SIS

Michael B. Furman, MD, MS
Expense reimbursement for lecturing: SIS
Shareholder: OSS Health, York, PA
Royalties: Elsevier

Kevin Martinez, MD
Nothing to disclose

Scott Naftulin, DO
Speaker and travel reimbursement: SIS
Position in physician society/association: SIS

David M. Sibell, MD
Nothing to disclose

Patrick H. Waring, MD
Speaker and travel reimbursement: SIS

Frank Willard, PhD
Nothing to disclose

References
References are provided within the speakers' presentations.

Commercial Support   
No commercial support was received for this activity.

Accreditation Statement    
The Spine Intervention Society (SIS) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation Statement    
SIS designates this enduring material for a maximum of 4.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Date of Activity Release: 10/21/2020   
Date of Activity Expiration: 10/20/2023

In the fifth, and final, video of the new In-Depth Anatomy: Cervicogenic Headache series, review the anatomy critical to performing safe and effective ultrasound-guided greater occipital nerve blocks.

Explore the correlation of radiologic and cadaveric structures to interventional pain diagnosis and treatments.

Copyright
Materials presented in this activity have been made available by the Spine Intervention Society for educational purposes only. We reserve all rights to such material.

Educational Objectives
Upon completion of this activity, participants should be able to:

• Apply the anatomic relationships of relevant soft tissue, neurological, and osseous upper cervical structures to injection targets under multiplanar fluoroscopic imaging.
• Evaluate the impact of anatomic relationships on the safe performance of diagnostic and therapeutic cervical injection procedures.

Disclosure Information
RELEVANT FINANCIAL RELATIONSHIPS WITH ACCME-DEFINED COMMERCIAL INTERESTS
Alison Stout, DO
Nothing to disclose

Frank H. Willard, PhD
Nothing to disclose

Accreditation Statement
The Spine Intervention Society (SIS) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation Statement
SIS designates this live internet activity for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Commercial Support
No commercial support was received for this activity.

Date of Activity Release: 11/02/2020
Date of Activity Expiration: 11/01/2023

Earn CME credit online watching Professor Nikolai Bogduk, a founding member of the Society, author of over 150 peer-reviewed publications, and editor of the SIS Practice Guidelines, as he shares a new presentation on lumbar disc stimulation.

Gain a deeper understanding of the pathophysiology and anatomy of low back pain due to intervertebral disc and/or vertebral endplate injury to develop your clinical and diagnostic skills.

Copyright
Materials presented in this activity have been made available by the Spine Intervention Society for educational purposes only. We reserve all rights to such material.

Educational Objectives
Upon completion of this activity, participants should be able to:

• Describe the mechanisms that can result in painful disc stimulation, including internal disc disruption with pain from the annulus, vertebral end plate fracture, and Modic changes.
• Assess the etiology, biophysics, and the morphological and biochemical features of internal disc disruption.
• Identify the intellectual dilemma posed by a positive disc stimulation and the impact that this can have upon the diagnosis of patients with a painful disc.

Disclosure Information
RELEVANT FINANCIAL RELATIONSHIPS WITH ACCME-DEFINED COMMERCIAL INTERESTS

Nikolai Bogduk, MD, PhD
Nothing to disclose

Accreditation Statement
The Spine Intervention Society (SIS) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation Statement
SIS designates this live internet activity for a maximum of 0.50 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Commercial Support
No commercial support was received for this activity.

Date of Activity Release: 12/07/2020
Date of Activity Expiration: 12/06/2023

Get tips on performing C1-2 lateral articulation injections and see the anatomic foundations that underpin the procedure in the third video in the new In-Depth Anatomy: Cervicogenic Headache series. Explore the correlation of radiologic and cadaveric structures to interventional pain diagnosis and treatments.

Copyright
Materials presented in this activity have been made available by the Spine Intervention Society for educational purposes only. We reserve all rights to such material.

Educational Objectives
Upon completion of this activity, participants should be able to:

• Apply the anatomic relationships of relevant soft tissue, neurological, and osseous upper cervical structures to injection targets under multiplanar fluoroscopic imaging.
• Evaluate the impact of anatomic relationships on the safe performance of diagnostic and therapeutic cervical injection procedures.

Disclosure Information
RELEVANT FINANCIAL RELATIONSHIPS WITH ACCME-DEFINED COMMERCIAL INTERESTS
Timothy Maus, MD
Nothing to disclose

Frank H. Willard, PhD
Nothing to disclose

Joel M. Talsma, MS
Nothing to disclose

Accreditation Statement
The Spine Intervention Society (SIS) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation Statement
SIS designates this live internet activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Commercial Support
No commercial support was received for this activity.

Date of Activity Release: 10/30/2020
Date of Activity Expiration: 10/29/2023