Spine Conference Finale

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Presentation transcript:

Spine Conference Finale Scott “Sir fuse a lot” Berta May 19, 2008

Case 1

Case 1 73 yo F with a history of 4 month of severe right leg pain. 4/5 dorsiflexion on the right MRI obtained

T1 w/o T1 w/ con

DDX? Schwannoma Neurofibroma Meningioma Paraganglioma Other tumor type Intradural, extramedullary, strongly enhancing, exit our the neural foramen Schwannoma Neurofibroma Meningioma Paraganglioma Other tumor type

Surgical Plan? Approach? Stabilization? Tackle scoliosis deformity? SSEPs/MEPs/Nerve root mapping? Which nerve root is most concerning? CUSA/A-line/PRBCs/Steroids How to close huge dural defect?

J Bone Joint Surg Am. 1949 Oct;31A(4):873-8. Surgical approach to the vertebral body. Arthur A. Michele and Frederick J. Krueger

Cervical C1-2 Screws C1-C2 Entry Points

Cervical C1-2 Screws C1 Trajectory

Cervical C1-2 Screws C2 Trajectory

Cervical C1-2 Screws

Cervical Lateral Mass Magerl Entry Point 1mm Medial to Dead-Center

Cervical Lateral Mass Magerl Avoids Vertebral Artery

Cervical Lateral Mass Magerl Avoids Nerve Root

Cervical Lateral Mass Roy-Camille

C7 Pedicle Screws

The first device designed to straighten and immobilize the spine from inside the body was introduced in the early 1960's – the Harrington Rod Designed by Dr. Paul Harrington an orthopaedic surgeon in Houston Texas, it was so successful that it remained the "gold standard" for scoliosis surgery for over 20 years

Upper Thoracic Spine Entry point 3mm lateral to center of facet joint

Mid-Thoracic Spine

Mid-Thoracic Spine Intrapedicular and Extrapedicular Techniques

Mid-Thoracic Spine Be careful in cases of severe scoliosis

Lawrence Lenke, MD

Lenke Technique

1.35 Billion Dollar Award to Michelson from Medtronic The patents of Dr. Gary Michelson are considered by many to be blocking patents in the field of spine cages. Many companies might find it difficult to develop improved spine cages without infringing Dr. Michelson's early patents in this area.

Lumbar Pedicle Screws Horizontal line bisects TP Vertical line tangential to the lateral border of the SAF

Lumbar Pedicle Screws

Lumbar Pedicle Screws L4-L5: 20-30º L1-L2: 5-10º L3: 15º

Volker K. H. Sonntag, MD Pioneer of neurosurgeons using pedicle screws without orthopaedic supervision

Sacrum Entry point in inferior and lateral to the facet Medialize® ® Trademark of Scott Berta

Sacrum Head towards sacral promontory to achieve Tricortical® ® Trademark of Jon Park

Current Pioneers in Spinal Surgery

Iliac Bolts Notch cutting Entry point and trajectory: line from just above the acetabulum crossing above the sciatic notch to the PSIS

Iliac Bolts SI joint AP fluoro is used to guide the probe above the sciatic notch and the acetabulum Curved probe should start facing away from the SI joint

Iliac Bolts

Thank You Kablam!