Iberian Course Diploma 2019

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Iberian Course Diploma 2019
Madrid, Spain
12 - 16 November 2019

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Module 3: Spinal Deformities



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


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

Module 3 Learning Outcomes



Session 1: PRINCIPLES OF SPINAL DEFORMITY

SPINAL ALIGNMENT AND BALANCE

  • Goals of surgery in the spinal deformity continuum
  • Understand the concepts of alignment vs balance
  • Know key spino-pelvic parameters and their limitations
  • Understand the concept of spinal harmony
  • Know compensation mechanisms

CASTING, BRACING AND THE 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, paediatric and adult
  • Define the role of halo traction as definitive or interim treatment

PREOPERATIVE ASSESSMENT AND POSITIONING

  • Record a comprehensive preoperative assessment
  • Consider special issues including pulmonary, cardiac, hematological, nutritional and metabolic
  • Position patients safely
  • Explain the rationale to other team members
  • Compare the purpose of prone, lateral and supine positions

INTRAOPERATIVE 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

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.


Session 2: ADOLESCENT IDIOPATHIC SCOLIOSIS

PATHOGENESIS AND NATURAL HISTORY OF AIS

  • Know concepts of development of AIS and subsequent implications for surgical treatment
  • Describe the natural history of AIS

CLASSIFICATION AND SURGICAL INDICATIONS

  • Know the pertinent classification systems and their limitations
  • Understand and formulate surgical indications
  • Goals of surgery for AIS

SELECTION OF FUSION LEVELS

  • Use classification to determine the end limits of fusion (Lenke)
  • Understand factors which may determine fusion levels such as curve flexibility, adding on etc.
  • Define the lower and upper limit of instrumentation

SURGICAL STRATEGY: POSTERIOR APPROACH

  • Formulate principles of surgical correction of AIS
  • Understand the role of the sagittal plane in AIS and for surgical correction
  • Evaluate strategic surgical options
  • Recognise indications for a posterior or combined approach

SURGICAL 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 3: SCOLIOSIS AND KYPHOSIS

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

CONGENITAL AND EARLY ONSET SCOLIOSIS (INCLUDING GROWING RODS)

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

HYPERKYPHOSIS (CONGENITAL, SCHEUERMANN, ANKYLOSING SPONDYLITIS...)

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


Session 4: SPONDYLOLISTHESIS

PATHOGENESIS AND CLASSIFICATION

  • Describe the pathogenesis and causes of developmental spondylolisthesis
  • Differentiate between high- and low-grade spondylolisthesis
  • Know current classification systems

SPONDYLOLYSIS, LOW-GRADE OLISTHESIS

  • Understand patho-anatomic features
  • Know surgical indications
  • Select appropriate surgical technique

HIGH-GRADE SPONDYLOLISTHESIS

  • Describe the patho-anatomy of high-grade spondylolisthesis
  • Differentiate between balance and unbalanced olisthesis
  • Know different surgical technique
  • Understand the pros and cons of reduction vs. in situ fusion


Session 5: CAD LAB PREPARATION

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

SACRO-PELVIC FIXATION

  • Choose different options of sacro-pelvic fixation
  • Describe surgical technique for CadLab


Session 6: CADAVER LABS

CAD LAB 1: ILLIO-SACRAL FIXATION: ILLIO-SACRAL SCREW PLACEMENT

  • Identify key structures of the lumbo-sacral anatomy
  • Identify the S1 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


Session 7: ADULT SPINAL DEFORMITY

FROM THE DEGENERATIVE SPINE TO ADULT DEFORMITY

  • Evaluate the lumbar spine in the context of spinal deformity
  • Classify the continuum from the degenerative spine to deformity

ADULT IDIOPATHIC AND DEGENERATIVE DEFORMITIES

  • Identify common problems associated with adult deformity
  • Differentiate between idiopathic and degenerative (de novo) deformity
  • Use spino-pelvic parameters to assess degenerative deformities
  • Evaluate operative and non-operative options for different age groups
  • Consider comorbidities associated with age
  • Define surgical indications
  • Assess patient expectation

PLANNING OF SURGICAL CORRECTION

  • Formulate principles of surgical correction
  • Plan surgical correction of adult spinal deformity
  • Know current software planning tools
  • Evaluate the appropriate techniques

SPINAL OSTEOTOMIES

  • Justify the aim of osteotomy
  • Differentiate between the different types of osteotomy (focus on posterior column and pedicle subtraction osteotomies, VCR and en bloc for advanced course)
  • Technique of spinal osteotomies
  • Outcomes and complications of spinal osteotomies

ANTERIOR-POSTERIOR TECHNIQUES

  • Recognise indications for an anterior/lateral or combined with posterior approach
  • Describe the amount of correction that can be achieved with each technique
  • Know outcomes and complications of the different techniques/approach


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