Minimal Access to the Lumbar Spine
Tuesday, October 5
8:00 a.m. - 12:00 p.m.
Course Chairs
John C. Liu, MD
Description
Minimally invasive lateral access to the lumbar spine has gained tremendous popularity. The ability to reach the anterior lumbar spine to perform interbody fusions has allowed surgeons to treat patient with a number of spine disease including degenerative disc disease, pseudoarthrosis, adjacent level disease, deformity and even tumor and trauma. This course will cover the history, indications, surgical anatomy and techniques for safety navigating through this minimal access to the lateral spine. A discussion on proper coding for the procedure will also be included, and a number of case examples will also be covered.
Upon completion of this course, participants will be able to:
- Identify the indications for DLIF/XLIF
- Demonstrate understanding of the most pertnent surgical anatomy
- Apply DLIF/XLIF in deformity surgery
- Discuss complications and how to practice avoidance in DLIF/XLIF
- Describe the coding challenges currently facing surgeons.
| 8:00 a.m. |
IWelcome and Introductions |
| 8:05 |
History and Background of minimally invasive lateral spine access |
| 8:20 |
Surgical anatomy to lateral spine |
| 8:40 |
Electrophysiological Monitoring |
| 9:00 |
Cases 1 & 2/ Break |
| 9:20 |
Surgical Technique: DLIF/XLIF |
| 9:55 |
Complication Review and Avoidance |
| 10:25 |
Cases 3 & 4/ Break |
| 10:40 |
Update on MIS & Direct Lateral Interbody Fusion Coding |
| 10:50 |
Advanced Application in Deformity, Tumors, Trauma |
| 11:20 |
Case review and Final Questions |
| 12:00 p.m. |
Adjourn |
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Lumbar Interbody Fusion Technologies
Tuesday, October 5
8:00 a.m. - 12:00 p.m.
Course Chairs
Bill Mitchell, MD
Description
This workshop gives participants an overall view of the approaches for anterior and posterior interbody procedures and exposure of various interbody technologies using different metal, bone and other biocompatible materials. Open, endoscopic and laproscopic approaches will be discussed, as well as threaded, cylindrical, and impacted devices and their applications. The use of biologics specifically with the anterior column interbody devices. This workshop covers basic surgical techniques of PLIF and various modifications of ALIF, PLIF and TLIF techniques using “prepared bone grafts” and “interbody fusion devices” and consists of both didactic sessions and hands-on practice on sawbones.
Upon completion of this course, participants will be able to:
- Explain various approaches and the pitfalls of interbody surgery.
- Recognize the technical foundation relative to interbody arthrodesis.
- Identify anatomical and biomechanical principles for the interbody fusion procedures.
- Learn the basic techniques and the application of interbody fusion devices
(rectangular or cylindrical cages, and “prepared bone grafts”).
- Determine the pitfalls of surgical techniques.
- Recognize the indications, contraindications and complications associated with the interbody procedures.
| 8:00 a.m. |
Introduction |
| 8:05 |
Biomechanics of Interbody Cages
Graft and Alternatives – What Goes in the Interspace? |
| 8:20 |
Anterior Interbody Fusion |
| 8:30 |
Novel Techniques for Interbody-X-LIF & Axialif) |
| 8:45 |
TLIF – Open and MIS Technique
TLIF- Endoscopic Techniques |
| 9:00 |
Posterior Lumbar Interbody Fusion - Its Role in Spinal Reconstruction |
| 9:15 |
Complications and Salvage in Interbody Fusions |
| 9:30 |
Economics and Coding |
| 9:45 |
Questions and Answers |
| 10:15 |
Break |
| 10:30 |
Hands-on Lab with Sawbones |
| 12:00 p.m. |
Adjourn |
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Fundamentals in EBM Part I: Asking Answerable Questions, Searching the Literature and Rating the Evidence
Tuesday, October 5
8:00 a.m. - 12:00 p.m.
Course Chairs
William Watters, III, MD
Description
This half-day course provides an introduction to the fundamentals of evidence-based medicine, asking answerable clinical questions, and performing evidence-based literature searches. It also provides a brief introduction to critically appraising the literature utilizing levels of evidence to assess the quality of research studies. It is intended for NASS committee members and all other meeting attendees who wish to develop an improved understanding of EBM and how to implement EBM in their practice. This course has been developed for those with minimal or no background in evidence-based medicine who wish to acquire some facility with its fundamentals to aid in identifying appropriate evidence to address clinical questions and obtain a brief introduction to critically appraising the evidence presented.
Audience
Physician and allied health professionals in the fields of spinal care. Participating in Parts I and II would fulfill NASS committee member obligations for EBM training (with the exception of Guidelines Committee members).
Upon completion of this course, participants will be able to:
- Define evidence-based medicine, appreciating the importance of the integration of all three components in its practice: best research evidence, clinical expertise and patient values.
- Perform computer searches of electronic databases of clinical research literature.
- Evaluate clinical value of research from an evidence-based perspective.
- Apply these techniques within their practices.
Agenda
| 8:00 a.m. |
What is Evidence-Based Medicine? |
| 8:20 |
Asking Answerable Clinical Questions |
| 8:40 |
How to Complete a Thorough Literature Search |
| 9:10 |
Levels of Evidence/Types of Studies |
| 9:40 |
Selecting the Best Evidence to Review |
| 10:10 |
Break |
| 10:25 |
Introduction to Critically Evaluating the Literature |
| 12:00 p.m. |
Adjourn |
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Trauma Evaluation, Classification, Pathologic Origin &
Stabilization Options
Tuesday, October 5
8:00 a.m. - 12:30 p.m.
Course Chairs
John R. Dimar, II, MD
Charles Fisher, MD
Description
Coming Soon
Audience
Physicians, hospital personnel who need to evaluate and treat patients with spine trauma.
Upon completion of this course, participants will be able to:
- Assess initial treatment of acute spinal fractures and the importance of trauma severity scores and outcome measures.
- Appreciate the pitfalls of in the treatment of acute spinal fractures in the osteoporotic spine.
- Recognize the inherent danger of acute spinal fractures when the spine is ankylosed and understand appropriate treatment techniques.
- Recognize the early and late complications that result from the loss of fixation of the unstable spinal fractures.
- Recognize the differences and cost of various stabilization techniques & the use of various biologics in acute spinal fractures.
Agenda
| 8:00 a.m. |
Evaluation, Initial Treatment & Stabilization of The Acute Spinal Trauma Patient |
| 8:15 |
The Importance of ISS, CCI, GCS Assessment in the Acute Spine Injury Patient |
| 8:30 |
Decision Making with TLICS |
| 8:45 |
Case Presentations |
| 9:05 |
Osteoporotic Fractures Treatment Options |
| 9:20 |
Management of Pathologic Fractures Secondary to Metastatic Disease. |
| 9:35 |
Traumatic Fractures in the Ankylosed Spine |
| 9:50 |
Cases Presentations |
| 10:05 |
Break |
| 10:20 |
Treatment Options for Post Traumatic Syringomyelia |
| 10:35 |
Loss of Fixation Following Open Reduction |
| 10:50 |
Non-Unions & Malunions Following Open Reduction in the Thoracolumbar Spine |
| 11:05 |
New Developments in Spinal Cord Injury |
| 11:25 |
Cervical Spine Trauma: ER Clearance, Classification Protocols & Treatment Regimes |
| 11:40 |
What are the Instrumentation Options & Optimal Constructs for Fracture Reduction & Stabilization |
| 11:55 |
Bone Graft Options & Necessity in Spine Fractures |
| 12:10 |
Case Presentations |
| 12:30 |
Adjourn |
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Fundamentals in EBM Part II: Critically Appraising the Literature
Tuesday, October 5
1:00-5:00 p.m.
Course Chairs
William Watters, III, MD
Description
This half-day course provides education in the fundamentals of evidence-based medicine with specific focus on critically appraising the literature. The first half of the course is in didactic format, the second half will involve small group assignments to allow for practice in critiquing studies and assigning levels of evidence. It is intended for NASS committee members and others who wish to develop their skills in critically analyzing study methodologies and assigning levels of evidence to studies based upon how the studies are being utilized to answer a specific clinical question. This course has been developed for those with a basic understanding of EBM and some familiarity with use of levels of evidence to assess the strength of research studies.
Audience
Physician and allied health professionals in the fields of spinal care. Participating in Parts I and II would fulfill NASS committee member obligations for EBM training (with the exception of Guidelines Committee members).
Upon completion of this course, participants will be able to:
- Define different types of studies, their strengths and limitations.
- Determine levels of evidence and how they are applied based upon the type of clinical question being addressed.
- Identify methodological weaknesses and how these weaknesses affect assignment of levels of evidence.
- Assign levels of evidence to research studies.
- Apply these techniques in the critical appraisal of studies that impact how you plan to care for your patients.
Agenda
| 1:00 p.m. |
Introduction: Types of Studies–Strengths and Limitations |
| 1:30 |
Reviewing Studies/Assigning Levels of Evidence |
| 2:00 |
Small Group Assignment 1: Review 3 Studies/Assign Level of Evidence |
| 2:45 |
Discussion-Assignment 1 |
| 3:15 |
Break |
| 3:30 |
Small Group Assignment 2: Review 3 Studies/Assign Level of Evidence |
| 4:15 |
Discussion-Assignment 2 |
| 4:45 |
Question & Answer |
| 5:00 |
Adjourn |
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Nursing in Spine Care
Tuesday, October 5
1:00-5:00 p.m.
Description
A course for both the highly experienced nurse as well as nurses new to the field of spine, this course is designed to focus attention on the key elements in the diagnosis and treatment of spinal disorders. This is an interactive course with live surgical videos, sawbone models and demonstrations as well as informative lectures and discussions.
Upon completion of this course, participants should be able to:
- Identify anatomical structures of the spine in the clinic, hospital and operative settings.
- Differentiate normal and pathologic conditions of the cervical, thoracic and lumbar spine as well as define which radiologic procedures are most appropriate for particular spinal disorders.
- Define the role that pharmacology and interventional pain procedures play in the non- surgical management of the patient with back pain and sciatica.
- Analyze the future of spine care as technology advances at a lightening pace.
Agenda
| 1:00 p.m. |
Introduction |
| 1:05 |
Anatomical Landmarks of the Spine
-Overview of Key Concepts
-Comparison of the Clinical Model with Surgical Anatomy.
(Live Surgical Video Demonstration) |
| 1:35 |
Discussion |
| 1:45 |
Non-operative Management and Treatment of the Spine Patient
-The role of Pharmacology in the treatment of Pain
-Interventional Pain Procedures |
| 2:15 |
Discussion |
| 2:25 |
Break |
| 2:45 |
The Role of Radiology in the Diagnosis and Treatment of Spinal Disorders: What, When and Why? |
| 3:15 |
Discussion |
| 3:25 |
Emerging Spine Trends and Technology: What’s Lurking in the Future? |
| 3:55 |
Discussion |
| 4:05 |
Emerging Spine Trends and Technology: What’s Lurking in the Future? |
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Cervical Spine Stabilization
Tuesday, October 5
1:00-5:00 p.m.
Course Chairs
Chris Bono, MD
Mark Bilsky, MD
Description
Didactic discussions include: anterior and posterior instrumentation and stabilization techniques in the cervical spine, including: occipital fixation, C1-2 transarticular and C1 lateral mass/C2 pars screw fixation, anterior cervical plating techniques and lateral mass fixation and odontoid screw fixation. These techniques are taught by neurosurgical and orthopedic experts. This workshop consists of both didactic sessions and hands-on practice on sawbones.
Upon completion of this course, participants will be able to:
- Recognize anatomical landmarks for placement of various screws in the occiput and cervical spine.
- Assess X-ray and patient set-up for odontoid, transarticular and C1 lateral mass/C2 pars screws.
- Differentiate between avoidance of the vertebral artery, adjacent levels and neural structures.
| 1:00 p.m. |
Introductions |
| 1:05 |
Occipital Plate Application |
| 1:20 |
C1 Lateral Mass Screw Insertion |
| 1:35 |
C2 Isthmus/Pedicle Screw and C1-C2 Transarticular Screw |
| 1:50 |
Lateral Mass Screws C3-C6 |
| 2:05 |
C7 and T1 Pedicle Screws |
| 2:20 |
Laminoplasty with Plates |
| 2:35 |
Anterior Cervical Discectomy with Cage and Plate |
| 2:50 |
Cervical Disc Replacement |
| 3:05 |
Odontoid Screws |
| 3:20 |
Cervical Corpectomy and Strut Insertion |
| 3:35 |
Anterior Approaches for Cervicothoracic Stabilization |
| 3:50 |
Hands-on Lab with Sawbones |
| 5:00 |
Adjourn |
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Section on Spine Biologics and ResearchTuesday, October 51:00-5:00 p.m.
Description
Current concepts in the research and use of spinal biologics will be reviewed in this precourse. Pertinent topics will be covered ranging from regenerative medicine for bone repair to spinal cord injury to future solutions for disc degeneration. The format will focus on a literature review of critical analysis topics followed by critique and discussion from the world's experts in these fields.
Upon completion of this course, participants should be able to:
- Review pertinent and current literature regarding critical analysis topics of spinal biologics such as disc regeneration, bone graft substitutes for spine fusion, stem cell research in spinal cord injury, and neurostimulation for pain.
- Assess the principles behind treatment modalities for cell-based applications, growth factors, and targeting the basilovertebral nervous plexus as a source of back pain.
- Identify future directions of treatment for spinal disorders such as degenerative disc disease, bony fusion, and spinal cord injury.
Agenda
| 1:00 p.m. |
Introduction and Course Objectives |
|
Regenerative Medicine for Spinal Repair |
| 1:05 |
Stem Cells for Bone Healing |
| 1:20 |
Understanding the Nucleus and the Endplate in Disc Regeneration |
| 1:35 |
Spinal Cord Injury and Repair |
| 1:50 |
Anabolic Molecules for Bone Regeneration (not BMPs) |
| 2:05 |
Discussion |
|
Critical Analysis:
Synthetic Bone Graft Substitutes |
| 2:10 |
Overview and Evidence |
| 2:25 |
Expert Critique and Criticism |
|
Critical Analysis:
Stem Cell Enhanced Allografts |
| 2:35 |
Overview and Evidence |
| 2:45 |
Expert Critique and Criticism |
|
Critical Analysis:
Generic BMPs |
| 2:55 |
Cheap Generic and SuperBMPs are Coming |
| 3:05 |
Expert Critique and Criticism |
| 3:15 |
Discussion |
| 3:25 |
Break |
|
Critical Analysis:
Genetic Diagnostics for Scoliosis and DDD |
| 3:40 |
Overview and evidence |
| 3:50 |
Expert Critique and Criticism |
|
Critical Analysis:
RF Treatment of Basilovertebral Nervous Plexus for Treatment of DDD |
| 3:55 |
Overview and evidence |
| 4:05 |
Expert Critique and Criticism |
|
Critical Analysis: Neurostimulation for Treatment of Pain |
| 4:10 |
Overview and evidence |
| 4:20 |
Expert Critique and Criticism |
|
Critical Analysis:
Tissue regenerative solutions for Disc Degeneration |
| 4:25 |
Overview and evidence |
| 4:35 |
Expert Critique and Criticism |
| 4:40 |
Discussion |
| 5:00 |
Course Adjourns |
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