Aortic injury in spine surgery……What a spine surgeon needs to know

Spine surgery as we know it has changed dramatically over the past 2 decades. More patients are undergoing minimally invasive procedures. Surgeons are becoming more comfortable with these procedures, and changes in technology have led to several new approaches and products to make surgery safer for patients and improve patient outcomes. As more patients undergo minimally invasive spine surgery, more long-term outcome and complications data have been collected. The authors describe the common complications associated with these minimally invasive surgical procedures and delineate management options for the spine surgeon.

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Simulation of Dural Repair in Minimally Invasive Spine Surgery With the Use of a Perfusion-Based Cadaveric Model

Operative Neurosurgery ◽

10.1093/ons/opz041 ◽

2019 ◽

Vol 17 (6) ◽

pp. 616-621 ◽

Cited By ~ 4

Author(s):

Ian A Buchanan ◽

Elliot Min ◽

Martin H Pham ◽

Daniel A Donoho ◽

Joshua Bakhsheshian ◽

...

Keyword(s):

Spine Surgery ◽

Model Simulation ◽

Simulation Models ◽

Csf Leak ◽

Independent Practice ◽

Dural Repair ◽

Model Realism ◽

Spine Surgeon ◽

Study Participants ◽

Cadaveric Model

Abstract BACKGROUND AND IMPORTANCE In an era of curtailed work hours and concerns over achieving technical proficiency in the repertoire of procedures necessary for independent practice, many residencies have turned to model simulation as an educational adjunct. Cerebrospinal fluid (CSF) leak repair after inadvertent durotomy in spine surgery is a fundamental skillset for any spine surgeon. While primary closure with suture is not always necessary for small durotomies, larger defects, on the other hand, must be repaired. However, the dire consequences of inadequate repair dictate that it is generally performed by the most experienced surgeon. Few intraoperative opportunities, therefore, exist for CSF leak repair by trainees. OBJECTIVE To simulate dural repair in spine surgery using minimal-access techniques. METHODS A cohort of 8 neurosurgery residents was evaluated on their durotomy repair efforts in a perfusion-based cadaveric model. RESULTS Study participants demonstrated consistent improvement across trials, with a significant reduction in closure times between their initial (12 min, 7 sec ± 4 min, 43 sec) and final attempts (7 min, 4 sec ± 2 min, 6 sec; P = .02). Moreover, all trainees—irrespective of postgraduate year—were able to accomplish robust dural closures resistant to simulated Valsalva maneuvers. Participants reported high degrees of model realism and exhibited significant increases in postprocedure confidence scores. CONCLUSION Our results support use of perfusion-based simulation models as a complement to neurosurgery training, as it affords unrestricted opportunities for honing psychomotor skillsets when resident learning is increasingly being challenged by work-hour limitations and stricter oversight in the context of value-based healthcare.

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Spine surgery is kyphosing to spine surgeon

Acta Neurochirurgica ◽

10.1007/s00701-020-04258-0 ◽

2020 ◽

Vol 162 (4) ◽

pp. 967-971

Author(s):

Ezan A. Kothari ◽

Timur M. Urakov

Keyword(s):

Spine Surgery ◽

Spine Surgeon

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Incorporation of MISS in Routine Spine Practice

10.13107/bbj.2021.v02i01.011 ◽

2021 ◽

Vol 2 (1) ◽

Keyword(s):

Minimally Invasive ◽

Spine Surgery ◽

Gold Standard ◽

Functional Outcomes ◽

Standard Procedure ◽

Routine Clinical Practice ◽

Minimally Invasive Spine Surgery ◽

Steep Learning Curve ◽

Minimally Invasive Spine ◽

Spine Surgeon

Traditional open spine surgery is the gold standard procedure in spine practice. Minimally invasive spine surgery (MISS) since last two decades have tremendously improved in technique and technology improving the clinical and functional outcomes of the surgery and patients. But still MISS has steep learning curve, many challenges and hurdles to inculcate it in the routine spine practice of the surgeon who may be either a novice or even an established in spine practice. The author has tried to identify the hurdles in incorporating MISS in routine spine practice and suggested methods to overcome these hurdles to incorporate MISS in routine clinical practice. Keywords: Minimally Invasive Spine Surgery (MISS); Spine practice; Spine Surgeon.

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Principles of spine surgery

Oxford Textbook of Rheumatology ◽

10.1093/med/9780199642489.003.0092_update_002 ◽

2013 ◽

pp. 705-711

Author(s):

Jeremy Fairbank ◽

Nuno Batista

Keyword(s):

Chronic Pain ◽

Bone Strength ◽

Spine Surgery ◽

Spinal Deformity ◽

Sagittal Balance ◽

Loss Of Function ◽

Limited Role ◽

Disabled Patients ◽

Spine Surgeon

Spine surgery addresses pain, loss of function and deformity of the spine. Earlier conceptions of chronic pain have changed, but there is still a limited role for surgery to manage painful spinal pathology. Loss of function is caused by tumours, fractures and infections, all of which can be helped by surgery. Deformity is called scoliosis and/or kyphosis, and be corrected by surgery. Spinal deformity is increasingly recognized in adults as an important cause of disability, especially when there is loss of sagittal balance. Advances in anaesthesia and implant technology have allowed the spine surgeon greater opportunities to help seriously disabled patients in ways not possible 20 years ago. Fractures occur following trauma, but are also associated with impaired bone strength, particularly through osteoporosis.

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COVID-19 and the rise of virtual medicine in spine surgery: a worldwide study

European Spine Journal ◽

10.1007/s00586-020-06714-y ◽

2021 ◽

Cited By ~ 1

Author(s):

Peter R. Swiatek ◽

Joseph A. Weiner ◽

Daniel J. Johnson ◽

Philip K. Louie ◽

Michael H. McCarthy ◽

...

Keyword(s):

Medical Education ◽

North America ◽

Online Education ◽

Spine Surgery ◽

Demographic Data ◽

Academic Practice ◽

Online Platforms ◽

Comprehensive Survey ◽

Spine Surgeon ◽

Virtual Medicine

Abstract Purpose The COVID-19 pandemic forced many surgeons to adopt “virtual medicine” practices, defined as telehealth services for patient care and online platforms for continuing medical education. The purpose of this study was to assess spine surgeon reliance on virtual medicine during the pandemic and to discuss the future of virtual medicine in spine surgery. Methods A comprehensive survey addressing demographic data and virtual medicine practices was distributed to spine surgeons worldwide between March 27, 2020, and April 4, 2020. Results 902 spine surgeons representing seven global regions responded. 35.6% of surgeons were identified as “high telehealth users,” conducting more than half of clinic visits virtually. Predictors of high telehealth utilization included working in an academic practice (OR = 1.68, p = 0.0015) and practicing in Europe/North America (OR 3.42, p < 0.0001). 80.1% of all surgeons were interested in online education. Dedicating more than 25% of one’s practice to teaching (OR = 1.89, p = 0.037) predicted increased interest in online education. 26.2% of respondents were identified as “virtual medicine surgeons,” defined as surgeons with both high telehealth usage and increased interest in online education. Living in Europe/North America and practicing in an academic practice increased odds of being a virtual medicine surgeon by 2.28 (p = 0.002) and 1.15 (p = 0.0082), respectively. 93.8% of surgeons reported interest in a centralized platform facilitating surgeon-to-surgeon communication. Conclusion COVID-19 has changed spine surgery by triggering rapid adoption of virtual medicine practices. The demonstrated global interest in virtual medicine suggests that it may become part of the “new normal” for surgeons in the post-pandemic era.

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Principles of spine surgery

10.1093/med/9780199642489.003.0092 ◽

2013 ◽

Author(s):

Jeremy Fairbank ◽

Nuno Batista

Keyword(s):

Chronic Pain ◽

Bone Strength ◽

Spine Surgery ◽

Spinal Deformity ◽

Sagittal Balance ◽

Loss Of Function ◽

Limited Role ◽

Disabled Patients ◽

Spine Surgeon

Spine surgery addresses pain, loss of function and deformity of the spine. Earlier conceptions of chronic pain have changed, but there is still a limited role for surgery to manage painful spinal pathology. Loss of function is caused by tumours, fractures and infections, all of which can be helped by surgery. Deformity is called scoliosis and/or kyphosis, and be corrected by surgery. Spinal deformity is increasingly recognized in adults as an important cause of disability, especially when there is loss of sagittal balance. Advances in anaesthesia and implant technology have allowed the spine surgeon greater opportunities to help seriously disabled patients in ways not possible 20 years ago. Fractures occur following trauma, but are also associated with impaired bone strength, particularly through osteoporosis.

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Neuroendoscopy for spinal disorders: a brief review

Neurosurgical FOCUS ◽

10.3171/foc.2005.19.6.6 ◽

2005 ◽

Vol 19 (6) ◽

pp. 1-6 ◽

Cited By ~ 6

Author(s):

Eli M. Baron ◽

Howard B. Levene ◽

Joshua E. Heller ◽

Jack I. Jallo ◽

Christopher M. Loftus ◽

...

Keyword(s):

Minimally Invasive ◽

Spine Surgery ◽

Therapeutic Modality ◽

Lumbar Spine Surgery ◽

Spinal Disorders ◽

Thoracic Spinal ◽

Disc Herniations ◽

Spine Surgeon ◽

Thoracic Disc ◽

Novice Surgeon

Neuroendoscopy has grown rapidly in the last 20 years as a therapeutic modality for treating a variety of spinal disorders. Spinal endoscopy has been widely used to treat patients with cervical, thoracic, and lumbosacral disorders safely and effectively. Although it is most commonly used with minimally invasive lumbar spine surgery, endoscopy has gained widespread acceptance for the treatment of thoracic disc herniations and for anterior release and rod implantation in the correction of thoracic spinal deformity. The authors review the use of endoscopy in spine surgery and in the treatment of spinal disorders as well as in the treatment of intrathoracic nonspinal lesions. Endoscopy has some significant advantages over open or other minimally invasive techniques in that it can allow for better visualization of the lesion, smaller incision sizes with reduced morbidity and mortality, reduced hospital stays, and ultimately lower cost. In addition, spinal endoscopy allows observers and operating room staff to be more involved in each case and fosters education. Spinal endoscopy, like any novel modality, carries with it additional risks and the surgeon must always be prepared to convert to an open procedure. The learning curve for spinal endoscopy is steep and the procedure should not be attempted alone by a novice surgeon. Nevertheless, with training and experience, the spine surgeon can achieve better outcomes, reduced morbidity, and better cosmesis with spinal endoscopy, and the operating times are comparable to open procedures. As technology evolves and more experience is obtained, neuroendoscopy will likely achieve further roles as a mainstay in spine surgery.

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