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Iberian Course Diploma 2019

Module 5: Tumours & Inflammatory Disease of the Spine

 Programme Module 5: Tumours & Inflammatory Disease of the Spine

Module 5 Learning Outcomes

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Session 1: VERTEBRAL OSTEOMYLETIS

ETIOLOGY, PATHOGENESIS, ROUTES OF SPREAD

• Explain the aetiology of vertebral osteomyelitis including: bacterial, tuberculous, and fungal
• Describe the pathogenesis including venous route, arterial inoculation and iatrogenic direct extension
• Anticipate the routes of spread: vertebral body & intervertebral disc

SYMPTOMS & DIAGNOSIS

• Recognise the signs and symptoms of vertebral osteolyelitis
• Identify the risk factors (immunodeficiency etc)
• Select appropriate investigations
• Distinguish on MRl and x-ray the key features that define and contrast both pyogenic and tuberculous spinal lesions

CONSERVATIVE MANAGEMENT & INDICATIONS FOR SURGICAL TREATMENT

• Evaluate options for conservative treatment
• Compare absolute and relative indications for conservative treatment

SURGICAL MANAGEMENT OF SPINAL INFECTIONS

• Formulate a plan for infection specific treatment
• Anticipate complications
• Plan appropriate management
• Appraise current evidence concerned with spondylitis outcome and prognosis

CASE DISCUSSION

Session 2: METABOLIC BONE DISEASES

BONE DISORDERS

• Paget's disease
• Rickets
• DISH (Forestier's disease)
• Metabolic bone disease

OSTEOPOROSIS

• Outline the etiology of osteoporosis
• Diagnose osteoporosis using appropriate investigations

SURGICAL CONSIDERATIONS IN DISORDERS OF THE BONE

• Evaluate treatment options.
• Compare minimally invasive techniques including
  • vertebroplasty
  • kyphoplasty
  • vertebral body stenting

CASE DISCUSSION

Session 3: CADAVER LABS

POSTERIOR CERVICAL

• Approach the posterior cervical spine
• Identify anatomical landmarks of the occipito-cervical region
• Anticipate risks and pitfalls
• Perform lateral mass screw fixation
• Perform lamina hook fixation
• Perform C1-C2 screw osteosynthesis (Harms or Magerl)
• Insert an occipital plate

VBR: VERTEBRAL BODY REPLACEMENT (THORACIC SPINE & THORACO-LUMBAR JUNCTION)

• Approach to the anterior thoracic and thoraco-lumbar spine
• Describe the relationship between large vessels and spine
• Elevate diaphragm
• Prepare rib for strut graft
• Perform discectomy
• Perform corpectomy
• Place rib strut graft
• Place corpectomy cage

Session 4: RHEUMATOID ARTHRITIS AND ANKYLOSING SPONDYLITIS

ETIOLOGY, PATHOGENESIS, SYMPTOMS, DIAGNOSIS

• Explain the aetiology of rheumatoid disease
• Describe the pathogenesis relating rheumatoid disease and joint changes
• Recognise the signs and symptoms
• Select and interpret appropriate investigations and imaging
• Recognise signs of
  • the rheumatoid spine
  • ankylosing spondylitis

STABILIZING & CORRECTIVE SURGERY OF THE SPINE

• Describe indications for corrective surgery for ankylosing spondylitis
• Diagnose occipito-atlantoaxial complex and subaxial cervical spine
• Differentiate between horizontal and vertical atlantoaxial instability

DIAGNOSIS & TREATMENT OF THE OCCIPITO-ATLANTOAXIAL COMPLEX

• Identify the commonly used radiographic lines and measurements for the C0 to C2 complex.
• Plan appropriate treatment for C0 to C2 and sub-axial rheumatic neck problems.
• Appraise current evidence regarding outcome and prognosis

CASE DISCUSSION

Session 5: TUMOURS OF THE AXIAL SKELETON

PRIMARY BENIGN TUMOURS AND TUMOUR LIKE LESIONS; DIAGNOSIS AND MANAGEMENT

• Explain the aetiology of tumours and tumour like lesions
• Describe the pathogenesis relating to tumours and tumour like lesions
• Differentiate between primary benign tumours and tumour like lesions
• Select appropriate investigations, interpret results and stage tumour
• Evaluate treatment options
• Anticipate outcomes
• Formulate a plan for long term monitoring

SECONDARY MALIGNANT TUMOURS; DIAGNOSIS AND MANAGEMENT

• Justify the relative importance of combined tumour therapy including surgery, radiotherapy and chemotherapy.
• Evaluate surgical options and results
• Formulate a multidisciplinary management plan
• Justify the risks, benefits and impact of radiotherapy and chemotherapy.
• Evaluate surgical options
• Anticipate complications

CASE DISCUSSION

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