Iberian Course Diploma 2019

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 7: ADULT SPINAL DEFORMITY

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