Spinal Instability Diagnosis & Care

Instability Parameters

MEASURING INSTABILITY

DENIS 3 Column Classification

Spine Surgery Criteria Spinal content compromise (spinal cord and/or nerves) Heart/Lung Compromise (scoliosis > 60 degrees) Infection treatment: diagnosis/definitive excision Tumor: cure/palliative Instability Fracture Degenerative Tumor

Most Common Diagnosis Requiring Spinal Surgery Degenerative Spondylolisthesis Spinal Stenosis/Cervical Myelopathy Herniated Disc with Radiculopathy Isthmic Spondylolisthesis Cervical Spine Fractures Scoliosis

Cervical Spine Anatomy

C1-C2 Anatomy

Downs Syndrome C1-C2 Instability

Occiput-C1-C2 Instability

Use of Anterior Approach For Cervical Spine Capable of correcting Ventral compression Used in Kyphotic Sagital Imbalance and Deformity Minimal Spinal Cord manipulation Large Cervical paracentral Disc Herniations Corpectomy for OPLL or multilevel cord compression Fixation of select Odontoid fractures Transoral access to C1-C2 for tumor/RA cord compression

Posterior Access Cervical Spine Decompression/Stabilization with Neutral or Lordotic Spine Alignment 360 degree stabilization (both Anterior and Posterior) Fracture Dislocation of Spine requiring reduction Cervico-thoracic junctional instability Scoliosis

Odontoid Fractures Type 3

Cervical Disc Herniation

Anterior Cervical Discectomy and Fusion

Stenosis Neutral vs. Kyphosis

Cervical Spinal Stenosis

OPLL and Corpectomy

Open Door Cervical Laminoplasty

Preservation of Motion

Spinal Cord Injury Acute

Other Fracture Patterns

Posterior Access and Fusion

Thoracic and Lumbar Spine If Spinal Cord Involved Anterior/Lateral Approach Prudent Lateral Approach Limited in Lumbar Spine by Pelvis Paraspinal Access via Muscle Splitting Approach Less Collateral Tissue Retraction/Damage Access direction is determined by canal pathology

Access to Lumbar Spine

Anterior/Pure Posterior Access

Lateral Spine Access

Isthmic Spondylolisthesis

Spondylolisthesis

Spondylolysis Repair

MINIMALLY INVASIVE ACCESS

What is MIS? Actually LIS(Least Invasive Surgery) Still Must Achieve Structural Correction Diminish Adjacent Tissue Damage Including Muscle Denervation/Vascular Compromise Encouragement of Rapid Return to Function ? Cosmetic Considerations

MIS Access Portal: ARAS Retractor

Incision size only part of the equation

Treatment of Spinal Instability Protection of Spinal Canal Neurologic Structures Preservation of Maximal Spinal Motion Improve Pain and Quality of Life Limit Adjacent Level Collateral Damage Enhance Timeline in Return to Function Create Long Term Program to Diminish Likelihood of Recurrence (Domino Effect)

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