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Miembros GEER

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Iberian Course Diploma 2017

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

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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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. 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: 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: Rheumatoid Diseases

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 CO to C2 complex.
• Plan appropriate treatment for CO to C2 and sub-axial rheumatic neck problems.
• Appraise current evidence regarding outcome and prognosis

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: 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 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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