Iberian Course Diploma 2017

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Iberian Course Diploma 2018
Madrid, Spain
13 - 17 November 2018

Module 3: Spinal Deformities (Module 3 Complete)

Dr. Rafael González
Dr. Rafael González. Spain
Dr. Jorge Mineiro
Dr. Jorge Mineiro. Portugal

Programme Module 3: Spinal Deformities Programme Module 3: Spinal Deformities

Module 3 Learning Outcomes

The delegates should be able to assess the patient history and physical examination findings in relation to decision making; analyze the use of appropriate diagnostic tools; discuss the importance of using a broad base of evidence in decision making; describe and then select the most appropriate modalities in conservative and surgical care of a spinal deformity. Finally, they should be able to discuss prevention, identification and management of complications, familiarizing themselves with the outcome assessment tools and critical analysis of treatment results.

Session 1: Principles of spinal deformity

Scoliosis: Aetiology & Prognostic Factors

  • Describe the aetiology and prognostic factors associated with
    • Idiopathic scoliosis
    • Infantile idiopathic scoliosis
    • Secondaryscoliosis


  • Differentiate between the aetiology and prognostic factors associated with regular and angular kyphosis
  • Evaluate management options for
    • Kyphosis
    • Kyphus

Clinical Assessment

  • Differentiate between functional and structural deformities
  • Take a structured approach to clinical evaluation
  • Asses skeletal maturity
  • Identify prognostic factors of progression
  • Identify rotational deformity
  • Perform a neurological assessment
  • Explain treatment strategy to patients and their families

Imaging of Deformities

  • Define the role of standard coronal and sagittal x-ray to evaluate deformity
  • Define the role of bending and traction x-rays
  • Differentiate between imaging in children and adults
  • Minimise radiation dose to patients
  • Recognise red flags, including tumours, neural tube abnormalities, connective tissue and muscular disease and their association with spinal deformity

Session 2: Conservative treatment

Casting, Bracing & Role of Rehabilitation

  • Justify the role of casting today
  • Explain the pros and cons of different types of brace treatment
  • Formulate principles of rehabilitation for patients with spine deformity
  • Define the role of halo traction as definitive or interim treatment

Session 3: Principles of surgical treatment

Pre-Operative Assessment: how to prepare for a complex case

  • Formulate a surgical plan
  • Record a comprehensive preoperative assessment
  • Consider special issues including pulmonary, cardiac, hematological, nutritional and metabolic

Positioning the Patient

  • Position patients safely
  • Explain the rationale to other team members
  • Compare the purpose of prone, lateral and supine positions

Blood Saving

  • Anticipate the factors affecting blood loss
  • Recognize trigger points for transfusion
  • Minimise the risks of homologous transfusion
  • Outline the role of erythropoietin
  • Compare the pros and cons of autologous transfusion, haemodilution, hypotensive anaesthesia, anti-fibrinolytic agents, intraoperative blood salvage

Intra-Op Monitoring

  • Select appropriate types of monitoring
  • Differentiate between SEP and MEP
  • Perform a safe and reliable wake up test
  • Recognise when a wake up test is required
  • Respond appropriately when monitoring indicates intervention required
  • Triggered EMG pedicle screw stimulation.

Pedicle Screw Guidance in Deformity

  • Assess appropriate placement
  • Minimise the risk of misplacement
  • Balance the pros and cons of spinal navigation
  • Assess the advantages and disadvantages of freehand probing

Bone Fusion

  • Identify factors influencing spinal fusions
  • Define the roles of osteoconduction and osteoinduction factors
  • Explain the physiology of bone grafting
  • Outline the risk factors associated with non-union
  • Categorise bone fusion and diagnose non union

Session 4: Principles of surgical treatment

Congenital Spinal Cord Anomalies

  • Differentiate between types of congenital spine deformity
  • Link prognostic factors with appropriate type and timing of intervention
  • Evaluate non operative, early and late operative treatment options

Congenital Spinal Deformities

  • Relate the stages of development to deformities of the spinal cord
  • Select appropriate investigations
  • Evaluate treatment options

Neuromuscular Scoliosis

  • Describe the aetiology and prognostic factors associated with neuromuscular scoliosis
  • Identify factors indicating progression or risk to neurological structures
  • Evaluate management options
  • Assess associated pulmonary and cardiac problems

Idopathic Adult Deformities

  • Identify common problems associated with adult deformity
  • Outline the progress of scoliosis through life
  • Relate appropriate monitoring strategies
  • Evaluate operative and non operative options for different age groups
  • Relate changes to sagittal /coronal imbalance

Degenerative Deformities

  • Use spino-pelvic parameters to assess degenerative deformities
  • Differentiate between idiopathic and degenerative (de novo) deformity
  • Perform clinical evaluation of sagittal balance and stenosis
  • Select appropriate investigations
  • Evaluate operative and non operative options
  • Consider comorbidities associated with age
  • Assess patient expectation

Session 5: Techniques & Strategy

End Limits of Fusion in Idiopathic Scoliosis

  • Use classification to determine the end limits of fusion (Lenke)
  • Define the lower and upper limit of instrumentation

Coronal & Sagittal Balance

  • Plan preoperative spine assessment of coronal and sagittal balance
  • Explain primary factors and compensatory mechanisms
  • Evaluate surgical options
  • Formulate an appropriate preoperative and surgical plan

Technique & Strategy: posterior approach

  • Formulate principles of surgical correction
  • Evaluate strategic surgical options
  • Recognise indications for a posterior or combined approach

Technique & Strategy: anterior approach

  • Differentiate between anterior release, anterior fusion and anterior instrumentation
  • Select appropriate approach for procedure
  • Recognise indications for
    • Anterior approach
    • Anterior instrumentation

Session 6: Osteotomies

Role & Technique of Spinal Osteotomies

  • Justify the aim of osteotomy
  • Differentiate between the different types of osteotomy
  • Relate to appropriate degree of correction
  • Select appropriate level

Session 7: Cadaver labs

Cad Lab 1: Illio-sacral Fixation: Illio-sacral screw placement

  • Identify key structures of the lumbo-sacral anatomy
  • Identify the Sl screw entry points
  • Relate anterior vascular structures and screw placement
  • Prepare iliac screw holes
  • Integrate safety measures and assess risks
  • Place iliac instrumentation and connect to the lumbo-sacral construct

Cad Lab 2: Thoracic Pedicle Screw Fixation & Hybrid Solutions

  • Approach the posterior thoracic spine
  • Identify anatomical screw entry points
  • Anticipate the risks and pitfalls
  • Perform free hand technique to prepare a screw hole
  • Check integrity of screw hole by pedicle probe
  • Place pedicle screw
  • Prepare facet joint and place pedicle hook
  • Place transverse process and lamina hooks

Endorsed by Eurospine