1. Spinal Instability Diagnosis & Care

2. Instability Parameters

3. MEASURING INSTABILITY

4. DENIS 3 Column Classification

5. 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

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

7. Cervical Spine Anatomy

8. C1-C2 Anatomy

9. Downs Syndrome C1-C2 Instability

10. Occiput-C1-C2 Instability

11. 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

12. 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

13. Odontoid Fractures Type 3

14. Cervical Disc Herniation

15. Anterior Cervical Discectomy and Fusion

16. Stenosis Neutral vs. Kyphosis

17. Cervical Spinal Stenosis

18. OPLL and Corpectomy

19. Open Door Cervical Laminoplasty

20. Preservation of Motion

21. Spinal Cord Injury Acute

22. Other Fracture Patterns

23. Posterior Access and Fusion

24. 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

25. Access to Lumbar Spine

26. Anterior/Pure Posterior Access

27. Lateral Spine Access

28. Isthmic Spondylolisthesis

29. Spondylolisthesis

30. Spondylolysis Repair

31. MINIMALLY INVASIVE ACCESS

32. 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

33. MIS Access Portal: ARAS Retractor

34. Incision size only part of the equation

35. 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)

36. THANK YOU