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

3. Case 1

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

9. T1 w/o
T1 w/ con

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

13. 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?

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

17. Cervical C1-2 Screws
C1-C2 Entry Points

18. Cervical C1-2 Screws
C1 Trajectory

19. Cervical C1-2 Screws
C2 Trajectory

20. Cervical C1-2 Screws

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

22. Cervical Lateral Mass Magerl
Avoids Vertebral Artery

23. Cervical Lateral Mass Magerl
Avoids Nerve Root

24. Cervical Lateral Mass Roy-Camille

25. C7 Pedicle Screws

26. 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

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

28. Mid-Thoracic Spine

29. Mid-Thoracic Spine
Intrapedicular and Extrapedicular Techniques

30. Mid-Thoracic Spine
Be careful in cases of severe scoliosis

31. Lawrence Lenke, MD

32. Lenke Technique

33. 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.

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

35. Lumbar Pedicle Screws

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

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

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

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

40. Current Pioneers in Spinal Surgery

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

42. 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

43. Iliac Bolts

44. Thank You
Kablam!