trauma and emergency spine surgery – past, present and ... · park inn by radisson kraków hotel...
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3rd EUROSPINE Spring Speciality Meeting
Trauma and Emergency Spine Surgery – Past, Present and Future12–13 May 2016 • Park Inn by Radisson, Kraków, Poland
www.eurospinemeeting.comwww.eurospine-spring.com
FINal PROgRaMME
in collaboration with
© 160067831/Stoker-13 • shutterstock.com
© 91660142 l tomeyk l Fotolia.com
Executive Committee
President AssistantTreasurer MeetingCouncilMichaelOgon,Austria MarcoTeli,Italy StavrosStavridis,Greece
VicePresident PastPresident ResearchCouncilMargaretaNordin,France HalukBerk,Turkey BjörnRydevik,Sweden
Secretary PastSecretary MembershipCouncilThomasR.Blattert,Germany EverardMunting,Belgium ChristophSiepe,Germany
TreasurerandStakeholderCouncil EducationCouncilFinnBjarkeChristensen,Denmark JörgFranke,Germany
Organisation and ExhibitionConventusCongressmanagement&MarketingGmbHMs.NadiaAl-HamadiCarl-Pulfrich-Strasse107745Jena,GermanyPhone+4936413116-315Fax +49 3641 31 16 [email protected]
Administrative und Scientific SecretariatEUROSPINE,theSpineSocietyofEuropec/oMs.JudithReichertSchildSeefeldstrasse168610Uster-Zürich,SwitzerlandPhone +41 44 994 14 04Fax +41 44 994 14 [email protected]
MembershipMs.ConnySchmutzerMobile+4369911727376schmutzer@eurospine.org
EducationMs.LetiziaLamartinaMobile+41786387522lamartina@eurospine.org
Contact Information
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Table of Contents
WelcomeMessageoftheMeetingHosts ................................................................................ 5
RoomOverview ........................................................................................................................ 6
ScientificProgramme ProgrammeOverview ........................................................................................ 7 Thursday,12May2016 ...................................................................................... 9 Friday,13May2016 ........................................................................................... 15
Sponsors&Exhibitors•IndustryWorkshop ........................................................................... 21
GeneralInformation RegistrationandCongressInformation ............................................................. 24 UsefulCountryInformation ............................................................................... 26 NetworkingProgramme .................................................................................... 27 VenueandMobilityinKraków ........................................................................... 28
ChairsandSpeakers ListofInvitedFaculty ......................................................................................... 30 GuidelinesforChairsandSpeakers ................................................................... 31
Abstracts .................................................................................................................................. 33
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Welcome Message of the Meeting Hosts
Dearcolleaguesandfriends,
Welcome,wearereallyhappythatyouarehereforthisspecialisttraumaspinemeetinginthisbeautifulcityofKraków.
Itisauniqueandintimate,morepersonaleventthanourlargerAnnualMeeting.Wehavequalitytimefordiscussionrelatedtotheprogrammecontentswhichincludeabstracts,keynotes,debatesandcasediscussions.Englishmaynotbeyourfirstlanguagebutthatappliestomostofus,soplease,wewanttohearyourvoiceandopinions.
ThereisauniqueflavourtoEUROSPINE,thehealthcareenvironmentisdifferenttootherpartsoftheworld.Weareagrowinganddevelopingorganisationreflected inourexpandingmembershipandactivities.Thismeeting inKrakówbuildsonourportfolioof resourcesavailable formembers.Theemphasishereisonnetworkingforyou.WewouldloveyoutocometothedinnerontheThursdaywhichisafuneventinthehistoriccity.
Discussionandinteractioniswhenwelearnmost,andwewantyoutohavetake-homeknowledge,skillsandattitudethatenhanceyourprofessionalpractice.
Krakówisacrackingvenueforthiscrackingmeeting!
PhilipJ.Sell ThomasR.BlattertHost Co-host
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Room Overview
AddressParkInnbyRadissonKrakówHotelul.MonteCassino230-337Kraków,Polandwww.parkinn.com
Catering
Check-In
Industry
Plenary Hall andSpeakers‘ PreviewCentre (Alfa)
1 DePuy Synthes (Zuchwil/CH)2 Globus Medical, Inc (Audubon/US)3 VP Valeant Sp. z o. o. Sp. J. (Warsaw/PL)
AlfaPlenary Hall
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ES Booth
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Scientifi c ProgrammeOverview
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Programme Overview
Thursday, 12 ,yadirFyaM 13 May
aflAaflA
09:00–09:15 54:90–00:90emocleW
09:15–10:15 QuickFires
Cervical Spine p. 16
p. 10 09:45–10:45
10:15–10:45 QuickFire Debates
Case Based Podium Discussion
Cervical Trauma – Jumped Facets p. 17
03:21–51:1103:21–51:11
Upper Cervical Spine enipSamuarT Trauma in Elderlies
p. 11 17
00:41–03:2100:41–03:21
Lunch hcnuLpohskroW Break
p. 22
00:61–00:4103:51–00:41
Acute Trauma citoropoetsOeraC Burst Fractures
p. 12
p. 19
16:00–17:30
Key Lectures
p. 13
from 20:00
Official Congress Dinner
p. 27
p.. 11
p.
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Scientifi c ProgrammeThursday, 12 May 2016
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Thursday, 12 May 2016
09:00–09:15 Welcome and Introduction Room: Alfa Chairs: Michael Ogon, Vienna, Austria; Philip J. Sell, Leicester, UK
09:00 WelcomeandintroductiontoEUROSPINE Michael Ogon, EUROSPINE President Vienna,Austria
09:07 Abriefhistoryofspinaltrauma Philip J. Sell, Meeting Host Leicester,UK
09:15–10:15 Cervical Spine Room: Alfa Chairs: Michael Ogon, Vienna, Austria; Philip J. Sell, Leicester, UK
1 CERVICALSPINECLEARANCE–STATES-OF-THE-ART Dennis E. Dominguez, Michaël Moeri, Guillaume Racloz Geneva University Hospitals, Geneva, Switzerland
2 ODONTOIDSYNCHONDROSISFRACTUREINCHILDREN–REPORTOF6CASES WITHSPECIALREFERENCETOPARTIALODONTOIDECTOMYINANIRREDUCIBLE ATLANTOAXIALDISLOCATION Abolfazl Rahimizadeh, Reza Mollahousaini, Abdol Hadi Daneshi Pars Advanced & Minimally Invasive Research Centre, Affiliated to Iran University of Medical Sciences, Tehran, Iran
3 COMPARISON OF FUSION RATES BETWEEN ROD-BASED LAMINAR CLAW HOOKANDPOSTERIORCERVICALSCREWCONSTRUCTSINTYPEIIODONTOID FRACTURES Andrzej Maciejczak, Wolan-Nieroda Andzelina, Katarzyna Jablonska-Sudol Rzeszow University, Neurosurgery Tarnow, Poland
4 COMPARISON OF FUSION RATES BETWEEN ROD-BASED LAMINAR CLAW HOOKANDPOSTERIORCERVICALSCREWCONSTRUCTSINTYPEIIODONTOID FRACTURES–SURGICALREPAIROPTIONSOFTYPE IIDENSFRACTURES IN ELDERLYPATIENTSBASEDONTHELITERATUREREVIEWANDOWNCASES Wojciech Glinkowski Baby Jesus Clinical Hospital, Department of Orthopaedics and Traumatology of Locomotor System (Spine Unit); Medical University of Warsaw, Department of Medical Informatics and Telemedicine, Warsaw, Poland
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5 MINIMAL INVASIVE LAG SCREW OSTEOSYNTHESIS FOR HANGMAN’S FRACTURES
Jan-Philip Zeden, Dirk Thomas Pillich, Henry Werner Siegfried SchroederJan-Uwe MüllerGreifswald University Hospital, Clinic and Polyclinic for Neurosurgery, Greifswald, Germany
6 CLINICAL ACCURACY OF AN INTRAOPERATIVE 3D CT-BASED NAVIGATION SYSTEM(O-ARM)ASSISTEDCERVICALPEDICLESCREWPLACEMENT
Nobuyuki ShimokawaDepartment of Neurosurgery, Tsukazaki Hospital, Himji City, Japan
10:15–10:45 Case Based Podium Discussion • Cervical Trauma – Jumped Facets Room: Alfa
Case presentation Matti Scholz, Frankfurt, Germany
Evidence Zdenek Klezl, Derby, UK
Case solution Matti Scholz, Frankfurt, Germany
Discussion
10:45–11:15 COFFEE BREAK IN THE EXHIBITION AREA
11:15–12:30 Upper Cervical Spine Trauma Room: Alfa Chairs: Stavros Stavridis, Thessaloniki, Greece; Everard Munting, Biez, Belgium
11:15 Anatomy and imaging of vertebral artery Alberto Zerbi, Milan, Italy
11:30 Keynote Lecture • Vertebral artery injury Thomas R. Blattert, Schwarzach, Germany
11:55 Atlas fractures – Case based podium discussion Case presentation Matti Scholz, Frankfurt, Germany Evidence Zdenek Klezl, Derby, UK Case solution Matti Scholz, Frankfurt, Germany
Discussion
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12:00–14:00 EuSSAB Meeting Room: Gamma Christoph Siepe, Member Council Chair and EuSSAB Representatives (upon invitation only)
12:30–14:00 Industry Lunch Workshop Room: Alfa see page 22
14:00–15:30 Trauma Care Room: Alfa Chairs: Charles Greenough, Middlesbrough, UK Andrzej Maciejczak, Tarnow, Poland
Measurement of blood flow and spinal decompression Marios Papadopoulos, London, UK
14:30–15:30 Acute Trauma Care
7 THETIMINGOFSURGERYINACUTESPINALCORDINJURY–SURVEYSTUDYGrzegorz Miekisiak, Wojciech Szymanski, Pawel Jarmuzek, Dariusz LatkaDepartment of Neurosurgery, Specialist Medical Centre, Polanica-Zdroj, Poland
8 ADELAYOFLESSTHAN7HBETWEENINJURYANDSURGICALDECOMPRESSION REPRESENTS THE BEST THEORETICAL CUT-POINT FOR SIGNIFICANT NEUROLOGICRECOVERYINPATIENTSWITHTRAUMATICCERVICALSCI Marko Jug, Nataša Kejžar, Miloši Vesel, Matej Cimerman, Fajko F. Bajrović Department of Traumatology, UMC Ljubljana, Slovenia
9 TURNINGADVERSITYINOPPORTUNITY Philip J. Sell University Hospitals of Leicester, UK
10 VERTEBRALFRACTURESHEALINGASSESSMENTMETHODS–THEREVIEW Wojciech Glinkowski, Jerzy Narloch
Baby Jesus Clinical Hospital, Spine Unit, Department of Orthopaedics and Trau-matology, Warsaw, Poland Chair and Department of Orthopaedics and Traumatology of Locomotor System, Centre of Excellence “TeleOrto”, Medical University of Warsaw, Baby Jesus Clinical Hospital, Warsaw, Poland
11 VERTEBRAL COLUMN FRACTURE TREATMENT IN CHILDREN AND ADOLESCENTS
Aleksander Szwed, Maciej Koban, Tadeusz BilnickiPomeranian Medical University in Szczecin, Poland
Discussion
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15:30–16:00 COFFEE BREAK IN EXHIBITION AREA
16:00–17:30 Key Lectures Room: Alfa Chair: Philip J. Sell, Leicester, UK
16:00 A cord injury, the vital early care Charles Greenough, Middlesborough, UK 20 mins Discussion 10 mins
16:30 Autologous bulbar olfactory ensheathing cells… Something to consider in very specific cases? Pawel Tabakow, Wroclaw, Poland 20 mins Discussion 20 mins
17:10 The natural history of cord injury and the challenge of improving on natural history Wagih El Masri, Keele, Staffordshire, UK 15 mins Discussion 5 mins
17:30 Conclusion
20:00 Official Congress Dinner (at own expense) see page 27
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Scientifi c ProgrammeFriday, 13 May 2016
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Friday, 13 May 2016
09:00–09:45 QuickFires Room: Alfa Chairs: Marco Teli, Liverpool, UK; Marios Papadopoulos, London, UK
QF1GUILLAIN-BARRESYNDROMEFOLLOWINGSPINALFUSIONFORTHORACIC VERTEBRALFRACTURE Dong Wuk Son Pusan National University Yangsan Hospital, South Korea
QF2UNSTABLECERVICALSPINEINJURYINPATIENTWITHNEGATIVECTSPINE: CASEREPORT Ashraf Dower, Johnny Efendy, Renata Abraszko Department of Neurosurgery, Liverpool Hospital, Sydney, Australia
QF3ANTERIORVERSUSPOSTERIORAPPROACHINTREATMENTOFUNILATERAL CERVICALDISLOCATIONS Marek Paciak, Adam Pala, Micha Biaek Wojewódzki Szpital Chirurgii Urazowej, Piekary l skie, Poland
QF4A“TWITTERTIP“SIMPLEAIDTOSPINEFUSIONBONEGRAFTING INLESS THAN90WORDS Philip J. Sell University Hosptials of Leicester, UK
QF5DIFFERENCEBETWEENMINORTRAUMATICANDNON-TRAUMATICOSTEO POROTICVERTEBRALCOMPRESSIONFRACTURES Daisuke Umebayashi, Yu Yamamoto, Yasuhiro Nakajima, Masahito Hara Inazawa Municipal hospital, Inazawa, Japan
QF6COMPLICATIONSANDOUTCOMEOFPATIENTSWITHLIVERCIRRHOSIS (CHILD-PUGHSTAGESB&C)AFTERSPINALINSTRUMENTATION Ramazan Dalkilic, Christian Ewald, Rolf Kalff University Hospital of Jena, Germany
QF7ANTERIOR LUMBAR DISCECTOMY AND FUSION IN ACUTE INCOMPLETE CAUDAEQUINASYNDROME Yma Markmann, Andrew Clarke Royal Devon and Exeter Hospital, Exeter, UK
Discussion
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09:45–10:45 QuickFire Debates Room: Alfa
09:45 QuickFire Debate 1 TREATMENTOFTHORACO-LUMBARA3/A4FRACTURESWITHOUTNEUROLOGY Leader Charles Greenough Vote Pro Wojciech Glinkowski I always operate Contra Grzegorz Miekisiak I never operate
10:15 QuickFire Debate 2 FUSIONINTHORACO-LUMBARA3/A4FRACTURESWITHOUTNEUROLOGY Leader Frank Kandziora Vote Pro Charles Greenough I always fuse Contra Philip J. Sell I never fuse
10:30 QuickFire Debate 3 IMPLANT REMOVAL IN THORACO-LUMBAR A3/A4 FRACTURES WITHOUT NEUROLOGY Leader Marco Teli Vote Pro Stavros Stavridis I remove routinely Contra Philip J. Sell I do not remove routinely
10:45–11:15 COFFEE BREAK IN THE EXHIBITION AREA
11:15–12:30 Spine Trauma in Elderlies Room: Alfa Chairs: Frank Kandziora, Frankfurt, Germany; Tomasz Potaczek, Zakopane, Poland
Osteoporotic fractures (Spine Tango data) Everard Munting, Biez, Belgium
11:30–12:30 Aging/Navigation
13 SPINALTRANSPEDICULARINSTRUMENTATIONWITHPMMAAUGMENTATION OFFRACTUREDVERTEBRAASTHEEQUIVALENTOFCOMBINEDANTERIOR POSTERIOR360INSTRUMENTATION
Wojciech GlinkowskiBaby Jesus Clinical Hospital, Department of Orthpaedics and Trauamtology of Locomotor System (Spine Unit); Medical University of Warsaw, Department of Medical Informatics and Telemedicine, Warsaw, Poland
14 DOUBLEBALLOONVERTEBRALKYPHOPLASTY(BKP)–ANEWTECHNOLOGYFOR EXTENDEDINDICATIONSINVERTEBRALFRACTURETREATMENT
Frank Hertel, Ardian Hana, Nitish Vidal Gunness, Christophe Berthold, Wolfram SchrecklingerNational Service of Neurosurgery, Centre Hospital of Luxembourg, Luxembourg Joline Company, Hechingen, Germany
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15 DOES THE QUANTITY OF CEMENT LEAK INTO THE DISC FOLLOWING ‚ BALLOONKYPHOPLASTYINFLUENCETHEPROGRESSIONOFDEGENERATIVE DISCDISEASEANDTHEOCCURRENCEOFADJACENTVERTEBRALFRACTURES?
Bakur Jamjoom, Sanjay Patel, Raj Bommireddy, Zdenek KlezlDepartment of Trauma and Orthopaedics Royal Derby Hospital, Derby, UK
16 RECENTSPINALSURGERYUSINGNAVIGATIONSYSTEMFORSPINALINJURY Nobuyuki Shimokawa Spine Centre, Tsukazaki Hospital, Himeji, Japan
17 NAVIGATION-ASSISTED SURGERY FOR OSTEOPOROTIC INSUFFICIENCY FRACTURESOFTHESACRUM–TECHNICALNOTEANDOWNRESULTS Thomas R. Blattert, Horst Balling Orthopaedic Clinic Schwarzach, Germany
18 OUTCOMEOFTREATMENTOFCOCCYDYNIA Donald Buchanan, Jonathan Spilsbury Royal Orthopaedic Hospital, Birmingham, UK
12:30–14:00 LUNCH BREAK IN THE EXHIBITION AREA
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14:00–15:50 Osteoporotic Burst Fractures Room: Alfa Chairs: Thomas R. Blattert, Schwarzach, Germany Wojciech Glinkowski, Warsaw, Poland
14:00 The state of the art and the pitfalls of radiology in osteoporotic vertebral fractures Alberto Zerbi, Milan, Italy 15 mins, 5 discussions
14:20 At what age does the use of cement in spine trauma become reasonable or accepted practice? Open Discussion All Faculty
14:30 Osteoporotic burst fractures – An unsolved problem? Thomas R. Blattert, Schwarzach, Germany Case presentation
14:50 Expert opinions on how to solve this case: Marco Teli I treat it conservatively Tomasz Potaczek I do cement augmentation/plasty technique Frank Kandziora I do MISS instrumented surgery Everard Munting I do open instrumented surgery
Case solution Discussion
15:30 Keynote Lecture • Treatment of Osteoporotic Vertebral Body Fractures Thomas R. Blattert, Schwarzach, Germany
15:50 Reflection • Did we learn something? Phillip J. Sell, Leicester, UK
End/Adjourn
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Our special thanks to this year‘s sponsors and contributors:
DePuy Synthes (Zuchwil/CH)
Globus Medical, Inc. (Audubon/US)
VP Valeant Sp. z o. o. Sp. J. (Warsaw/PL)
DePuy Synthes sponsored Lunch Symposium
How to handle Complications in Spinal Trauma Surgery
Agenda• Approach complications in the anterior C-spine • Dura lesions – When do we need to repair?• Major bleeding during anterior lumbar reconstruction• Implant complications in the osteoporotic spine • Discussion
Moderator/Chairperson Invited FacultyFrank Kandziora Zdenek Klezl, Derby, UKFrankfurt, Germany Everard Munting, Biez, Belgium Matti Scholz, Frankfurt, Germany
Lunch will be provided within the plenary hall (room Alfa).
Sponsors & Exhibitors
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General Information
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Registration and Congress Information
Registration Opening TimesThecheck-inislocatedinthefoyer(firstfloor)andwillbeopenduringthefollowinghours:
Thursday,12May2016 07:30–17:30Friday,13May2016 07:30–16:00
Registration Fees
EUROSPINEMembers 250EURLate,until11May2016EUROSPINEMembers 300EUROnsite,from12May2016Non-members 500EURLate,until11May2016Non-members 550EUROnsite,from12May2016
Official Congress Dinner(seefurtherinformationonp.27)Late,until11May2016 80EUROnsite,from12May2016 90EUR
Participants’ Registration Fee includesAdmissiontoallscientificsessionsAdmission to theworkshops organised by
industrialpartnersCongressmaterials(programme,namebadge,
abstractpublication,congressbag,lanyard)AccesstotheexhibitionCoffeebreaks
PaymentPleasenotethatallonsitepaymentsneedtobemadeincash(Euro=EUR)orbycreditcard(VISA,Mastercard,AmericanExpresswillbeaccepted).Unfortunately,wecannotaccepttravellercheques,othercreditcards,eurochequesorothercurrencies.Thereisnopossibilitytoexchangecurrencyatthecongressvenue.
Registration CountersQUICKCHECK-INREGISTRATIONisforparticipantswhohaveregisteredandpaidinadvance.Pleasehaveaprint-outofthefinalinformatione-mailathandwhenapproachingthedesk.ONSITEREGISTRATIONis forparticipantswhohavenotpre-registeredand/orpaid.Pleasenotethatcongressmaterialsaresubjecttoavailabilitytoparticipantswhoareregisteringandpayingtheirfeesonsite.
EXHIBITORScanpickuptheirstaffbadgesatthecheck-in.
Name BadgesParticipantswillreceivetheirnamebadgewhencollecting their congress documents. Please wearyournamebadgeduringallcongressevents,includingthenetworkingactivities.Admissiontoscientificsessionsisrestrictedtoparticipantswearingtheirbadges.Exhibitorsareentitledtoattendthescientificsessionswith2registeredstaffmembers, includingtheirowncompany’sworkshop.Please note: Participants who misplace theirbadgeneedtopayforanewone.
Name Badge Codes:
M EURO SPINE
Member EUROSPINEMemberNM Non-MemberEXH ExhibitorS Staff
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CME Points and Certi fi cate of Att endanceCMEpointsareassignedtoparticipantsperday.TocollectyourCMEpointsforyourcertificateyouneedtousetheself-scanningstationslocatednexttotheregistrationcounterandSCANTHEBARCODEonyournamebadge,eachday.Yourcertificatewillbeavailablefordownloadviaapersonallinkwhichtheorganiserswillsendyouviae-maildirectlyafterthecongress.
The scientific programme of the EUROSPINESpringSpecialityMeetinghasbeenaccreditedamaximumof11EuropeanCMEcredits(ECMEC)bytheEuropeanAccreditationCouncilforContinuingMedicalEducation(EACCME).
CateringCoffee,teaandbiscuits/fruitswillbeservedinthefoyerduringofficialcoffeebreaks.Industryworkshopsareplannedduringwhichcateringwillbeofferedtotheparticipants.
Congress LanguageThe official congress language is English. Nosimultaneoustranslationwillbeprovided.
© 63597860 l Patryk Michalski l Fotolia.com
EUROSPINE BoothEUROSPINEstaffwillbeavailableonsiteattheEUROSPINEboothinthefoyer.Boothopeninghours:
Thursday,12May2016 08:45–17:30Friday,13May2016 08:45–16:00
Exhibiti onTheexhibitorsareawaitingyouattheirboothsduringthefollowinghours:
Thursday,12May2016 08:45–17:30Friday,13May2016 08:45–16:00
InternetWiFiisavailablefreeofchargetoallparticipantswithinthemeetingarea.Network:ParkInnConferencePassword:SSM2016
Congress Staff TheConventusteamwillbeatyourserviceattheregistrationcountersandthelecturehalls.Donothesitatetoapproachthemwithqueries,theywillgladlyassistyou.TheyarerecognisablebyaConventusnamebadge.
Krakówmainmarket
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Useful Country Information
CurrencyThecurrencyusedinKrakówandintherestofPolandiszłoty.Oneeuroisabout4.2złoty.Moneycanbeexchangedatexchangebureausandbanks.Banksusuallychargeacommission,andtheexchangerateislessprofitable.Whenexchangingmoneyinanexchangebureau,payattentiontotheexchangerates.Youmayalsocomparethemwithotherofficesorwiththeratespublishedatwww.nbp.pl.The24hCFSCurrencyExchangeOfficeislocatedattheintersectionofthePawiaStreetandWorcellaStreet,infrontofGalleriaKrakówskamall.
CloakroomCoatrackswill be available in the back of thelecturehall.Noliabilitywillbetakenforlostorstolen items.
ElectricityElectricityinPolandis230V,50HzAC.Plugsocketsareroundwithtworound-pinsockets.ThereforifyouarecomingfromtheUS,UKorIrelandyouaredefinitelygoingtoneedaplugconverter.
InsuranceParticipantsareadvisedtoarrangehealthandaccident insurance prior to travelling to the congress. The organiser will not assume anyresponsibilityforaccidents,lossesordamages,as well as for delays or modifications in theprogramme,causedbyunforeseencircumstances.
No claims for the indemnification from the organisersshallariseforcontractorsorparticipantsin caseof cancellation, forany reason,of theentirecongress.
LanguagePolishistheofficiallanguageinKraków.EnglishandGermanarealsowidelyspoken.
LiabilityConventusCongressmanagemt&MarketingGmbHshallactasmediatoronlyandcannotbeheldresponsibleforanylossincurredoranydamageinflictedonpersonsorobjects irrespectiveofwhatsoevercause.Theliabilityfortransportandotherservicecompaniesshallnotbeaffectedbytheabove.Onlywrittenagreementsshallbevalid.TheplaceforjurisdictionshallbeJena(Germany).
Medical CareForeignvisitorsfromtheEuropeanUnionenjoythesamebenefitsasPoland’sresidentscoveredbythecountry’suniversalhealthinsurancewhentheycanpresenteithertheE111formissuedintheir respectivecountriesorEuropeanHealthInsuranceCard(EHIC)orareplacementcertificate.Otherforeignersareexpectedtopayforhealthcareandmedicalproceduresaswellasdentaltreatments.
Mobile PhonesPlease set yourmobilephonesandanyothermobiledevicesonsilentmodeinthesessionrooms.
Opening HoursMostofKraków’sdowntownshopsremainopenuntil19:00andbeyondonweekdays,whilesomegrocerystorestraderoundtheclock.MoststoressellalsoonSundays,usuallyuntil15:00.MostshoppingcentresinKrakówstayopenbetween10:00 and 22:00.Monday to Friday and until20:00onweekends.Bankinghoursaredifferentindifferentbanks,yetmostbranchesopenat09:00 or 10:00 and close at 18:00 or 19:00 on workdays.
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Post OfficeThemainpostofficeisabuildingofthePolishPostandislocatedatWesterplatte20.Openinghoursare:
Monday–Friday 07:30–20:30Saturday 08:00–14:00
TaxValueAddedTax(VAT)isincludedinthepriceofalmosteveryproductandserviceyoupurchaseinPoland.YoucangetVATrefundswhenyouleave the country, if you are a resident fromoutsidetheEU.
TelephonesTheinternationalphonecodeforPolandis+48andKraków+4812.
TimeKrakówislocatedintheCentralEuropeanTimeZone(CET)whichisonehouraheadofGreenwichMeanTime(GMT).
TippingTippingisnotobligatory,youcantipwhoeveryouwant to show that the servicewasgood.Theaveragetipisaround10–15%ofthecheque.
Tourist OfficesVisitorstoKrakówcanpickandchoosefromthecity’svarioustouristoffices.TheyareruneitherbytheKrakówmunicipality’sofficialFestivalBureauorbyprivatebusinessesorbytouristorganisations.
Visa RequirementsEU citizens may live and work free of anyimmigration controls. South Africans need avisafortouristvisits.NationalsofAustralia,NewZealand,CanadaandtheUSdonot,providedtheir stay is shorter than 3 months.Forfurtherinformation,pleasegotothefollowingpage:www.msz.gov.pl/en/travel_to_poland/visa/visa.
WeatherKraków has a maritime climate with warmsummersandcoolwinters.DuetotheproximitytotheTatraMountains,thereareoftenmildwindscausingtemperaturestoriserapidlyandeveninwinterreachupto20°C.Pleasecheckwww.weather.comforup-to-dateweatherforecastsinKraków.
Official Congress DinnerRestauracjaWierzynek–averyspecialvenuethattakesyouonaculinaryjourneyintimethroughPolishcustomsandtraditions.AsoneoftheoldestrestaurantsinEuropeitisaplacethatbreathesthehistoricaltraditionandroyalhistoryofKraków.Weinviteyoutojoinamemorableeveninginacosyatmospheretoenjoyasit-downmealwithcolleaguesandfriendsintheveryheartofKraków.Date Thursday,12May2016Time from20:00Location RestauracjaWierzynek RynekGłówny16,KrakówFee 80EUR/90EURMeetingpoint 18:40atthecheck-in
Networking Programme
©RestauracjaWierzynek
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Venue and Mobility in Kraków
VenueParkInnbyRadissonKrakówHotelul.MonteCassino230-337Kraków,Polandwww.parkinn.com
How to get to the Congress VenueByplane:TheStarAlliancememberairlinesarepleasedtobeappointedastheOfficialAirlineNetworkforEUROSPINESpringSpecialityMeeting2016.ToobtaintheStarAllianceConventionsPlusdiscountspleaseusetheConventionsPlusonlinebookingtoolviawww.eurospine-spring.com.
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list of Invited Faculty
Last Name, First Name City Country
Blattert,ThomasR. Schwarzach Germany
ElMasri,WagihS. Staffordshire UK
Glinkowski,Wojciech Warsaw Poland
Greenough,Charles Middlesbrough UK
Kandziora,Frank Franfurt Germany
Klezl,Zdenek Derby UK
Maciejczak,Andrzej Tarnow Poland
Miekisiak,Grzegorz Tarnow Poland
Munting,Everard Biez Belgium
Ogon,Michael Vienna Austria
Papadopoulos,Marios London UK
Potaczek,Tomasz Zakopane Poland
Scholz,Matti Frankfurt Germany
Sell,PhilipJ. Leicester UK
Stavridis,Stavros Thessaloniki Greece
Tabakow,Pawel Wroclaw Poland
Teli,Marco Liverpool UK
Zerbi,Alberto Milan Italy
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Speakers’ Preview CentreThespeakers’previewcentreislocatedinroomAlfa(plenaryhall).Staffandappropriateequipmentwillbeavailableforyoutoarrangeandpreviewyourpresentation.Thecentrewillbeopenduringthefollowinghours:
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CERVICAL SPINE
1CERVICAL SPINE CLEARANCE – STATES-OF-THE-ART
Dennis E. Dominguez, Michaël Moeri, Guillaume RaclozGeneva University Hospitals, Geneva, Switzerland
Cervicalspine(C-spine)injurycanresultinseriousneurologicalimpairmentleadingdisabilityandpoorhealth-relatedqualityoflife(HRQL).ManyvariationsexistintheclearanceofC-spineinjuriesduringblunttrauma.Currently,thereisnoconsensusdespitethedifferentrecommendationsandguidelines.However,itiswellacknowledgedthattheunnecessarywearoftheneckcollarleadstosideeffects.Atthesametime,aninadequatecollarclearancecanleadtosecondaryspineinjuriesandhigh-levelmorbidity.ThisreviewaimstooutlinethemostrelevantliteraturearoundC-spineclearanceinblunttrauma,withtheparticularaimtodevelopaclearalgorithm,whichwouldbebotheasytouseintheEDandreliable,thusminimizingtheriskofmissedC-spineinjuries.Weproceededtoapubmebsearchusingtheterms“cervical,spine,injury,clearance”from2000to2015.WeselectedarticlescontainingrelevantinformationtoanswerthethreemostcommonquestionsfaceasuspicionofC-spineinjuryinblunttraumapatientsinED.WhenshouldweremovetheC-collarandwhoneedsaradiologicalassessment?Whatkindof imagingshouldwerequest?Howtoclearobtundedpatients?Wehighlightedtwomajordecisionruleswhicharemainlyusedtoselectpatientwhoneedradiographicevaluationandthosewhocanbecleared:theCanadianC-SpineRule(CCR)andtheNationalEmergencyX-RadiographyUtilizationStudy(NEXUS).AdequateC-spinexrayC-spineandseemtofailtheidentificationof55.5%ofclinicallysignificantfractures.ThecombinationofclinicalexaminationandMultiPlanarReconstruction(MPR)CTisenoughtoexcludesignificantinjuryin99.9%ofpatient.InobtunedpatientanegativeMPRCTalonecouldnotassuretheabsenceofinjuryanddependingonthesituationMRIcouldbeobtained.However,MRIdoesnotprovideadditionalclinicallyrelevantinformationinawakepatientBasedonthelatestscientificevidence,wedevelopedanalgorithmfortheC-spineclearanceadaptedtoanUniversityHospital’ssituation.ThehighsensitivityoftheCCRpreventsmissingaC-spineinjurywhilelimitingtheamountofunnecessaryradiologicexaminations.AfterMPRCTwecansafetyexcludethegreatmajorityofcervicalspineinjuriesanditallowstheC-collarclearance,whilstavoidingsecondaryspineinjuries.Itsuseintheemergencydepartmentallowsatimeefficientandcosteffectivemanagementofblunttraumapatientwithpotentialcervicalinjury.
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2ODONTOID SYNCHONDROSIS FRACTURE IN CHILDREN – REPORT OF 6 CASES WITH SPECIAL
REFERENCE TO PARTIAL ODONTOIDECTOMY IN AN IRREDUCIBLE ATLANTOAXIAL DISLOCATIONAbolfazl Rahimizadeh, Reza Mollahousaini, Abdol Hadi Daneshi
Pars Advanced & Minimally Invasive Research Centre, Affiliated to Iran University of Medical Sciences, Tehran, Iran
PURPOSE:Toreportsixnewcasesofsynchondrosisodontoidfracturewithdisplacementwherefourwerediagnosedearlyandtwowithdelay.Thefracturecouldbereducedwithhyperextensionwithtractioninfourandopenreductionintheothertwo.BACKGROUNDHISTORY:Fracturesoftheodontoidprocessareamongthemostcommoncervicalinjuriesinpreschoolchildren,occurringatanaverageageof4years.However,theseinjuriesareinfrequentlyreportedintheliterature.Thereportsaremostlyconfinedtooneortwocases.Theseareactuallyphysealinjuriesofthebasilarsynchondrosisbetweentheodontoidprocessandthebodyoftheaxis.However,theodontoidprocessisangulatedanteriorlyinmajority.Reductionbyhyperextensionorbycranialtractionfollowedbyrigidimmobilizationresultsinahighrateofunion,inaminority,eithersufferingirreducibleatlantoaxialdislocation,inthosewithseverelyangulatedodontoidmalunion,andinmissedcasessurgeryiswarranted.MATERIALANDMETHOD:Threeboysandthreegirlsattheageof3to6yearswithodontoidsynchondrosisfracturearepresented.Fourwereadmittedshortlyafterinjuryandtheothertwo,around4monthsafterinjury.Threeoftheacutecasesweremanagedwithimmobilizationinhaloafterreduction.Theotheracuteone,anon-compliantchild,underwentprimaryC1-C2fixation.Bothneglectedoneswereassociatedwithirreducibleatlantoaxialdislocation.Oneofthesetwo,withodontoidnon-unionwasreducedwithfacetreleasingfollowedbyanewreductionmaneuverwithpolyesterbands.Thelastonewithmalunitedodontoidfracturecouldbereducedonlyafterpartialodontoidectomyviaposterioronlyapproach.FollowedbyC1-C2fixation.RESULT:All6patientsrecoveredandfusioncouldbeachieved.CONCLUSION:Wheremajorityofacutesynchondrosisodontoidfractureshealwithexternalimmobilization.Primarysurgeryhasbeenadvocatedbysometoobviatetheneedforlong-termimmobilization.Therealchallengeisinneglectedonewithaccountasmallproportionofthefractureswithfractureangulationmorethan30degreeorsignificantodontoiddisplacementwhichrequireposteriorC1-C2fixationafteralignment.Inaddition,neglectedoneswithchronicIAADrequiremorechallengingsurgery,varyingfromfacetrelease,odontoidectomyandatlantoaxialstabilizationdependingofthesubtypeofIAAD.Wewilldescribeanewformulationprotocolformanagementofirreducibleatlantoaxialdislocationwithclassificationtothreesub-types.Thisclassificationwillfacilitatepreoperativedecision-making.Furthermore,wewillshowdemonstrativeodontoidectomyviaposterioronlyapproachwhichisnotdonebefore.
3COMPARISON OF FUSION RATES BETWEEN ROD-BASED LAMINAR CLAW HOOK AND POSTERIOR
CERVICAL SCREW CONSTRUCTS IN TYPE II ODONTOID FRACTURESAndrzej Maciejczak, Wolan-Nieroda Andzelina, Katarzyna Jablonska-Sudol
Rzeszow University, Neurosurgery Tarnow, Poland
BACKGROUND:Thisstudywasaimed(i)tocomparethefusionratesofrod-basedlaminarclawhookconstructstothatofposteriorC1/C2screwconstructsinodontoidfractures,and(ii)toevaluateanycomplicationsassociatedwithclawhook/rodconstructs.Toourknowledge,nostudyincontemporaryliteraturehaspresentedtheeffectsofusingmodernrod-basedlaminarclawhooksfortreatingodontoid
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fractures.Unlikelaminarclampsfromthe1980’s,contemporarylaminarhook-rodinstrumentationsystemsprovidefarmoreeffectiveimmobilisationofthecervicalspineandallowsforbuildingreliableframe-likeconstructssimilartocervicalscrew-rodsystems.METHODS:Aretrospectivereviewofaseriesof167consecutiveodontoidfracturesfromasingle-institutionwasconductedbetween2002–2012.Theseriesincludes:43casesmanagedconservativelyand131surgically(odontoidscrew-88,Magerlstechnique-8,Harmstechnique-4,selectiveC1/C2rod-basedlaminarclawhook-23,combinationoflaminarhook/lateralmassscrews-7).Availableforfinalassessmentwere30casestreatedusingposterioratlantoaxialfusion,12usingC1/C2posteriorscrews(controlgroup),and18withrod-basedlaminarclawhooks(studygroup).Hooksweremountedbilaterallyinaclawmanneroneachindividuallaminaandwererigidlyfixedtoperpendicularrodswithatransverseconnectorwheneverfeasible.Theminimumfollow-upperiodwasoneyear.Bonyunionwasdeterminedusingcomputedtomography(CT)scan,whilestabilityatthefusionsitewasassessedusingdynamicradiograms.Fusionrateswerealsocomparedamongtheremainedsurgicalconstructsandconservativemanagementingeriatricandnon-geriatricpatients.RESULTS:Thestudygrouphadanoverallfusionrateof89%(non-geriatric93%whilegeriatricsubgroup75%)witha100%stabilityrateatthefusionsiteinallcases.Inthecontrolgroupfusionratewas100%.Therewerenomajorcomplicationsinbothcontrolandstudygroups.Fourminorcomplications,threeinthecontrolandoneinthestudygroup,werenotedin3patients.Fusionrateforodontoidscrewwas86%,and85%inconservativegroup(mainlyTypeIIIfx).CONCLUSION:Preliminaryresultsofthisstudysuggestthatlaminarclawhook-rodsystemsareusefulalternativestoposteriorscrewtechniques.Moreover,thefusionrateinnon-geriatricpatientsiscomparabletothatofposteriorscrews.Importantly,theyaredevoidofthedisadvantagesandcomplicationsposedbyscrewconstructs.Furtherstudiesarenecessarytoconfirmthesepromisingresults.
4SURGICAL REPAIR OPTIONS OF TYPE II DENS FRACTURES IN ELDERLY PATIENTS BASED ON THE
LITERATURE REVIEW AND OWN CASESWojciech Glinkowski
Baby Jesus Clinical Hospital, Department of Orthopaedics and Traumatology of Locomotor System (Spine Unit); Medical University of Warsaw; Department of Medical Informatics and Telemedicine,
Warsaw, Poland
Dens fracturesare commoncervical injuries inadvancedagedpatients. The literature shows thatmortalityrateishigh,and,therefore,treatmentoptionsshouldbewell-consideredinthishigh-riskgroup.Posteriorandanteriorapproachesareconsideredasequivalentlysuccessful.ThepresentedstudywasundertakentoreviewthetreatmentmethodsbasedontheanalysisoftheclinicalresultsofsurgicallytreatedelderlypatientswithtypeIIdensfractures.Dataof3patients(1female,twomales)over70yearstreatedfromSeptembertoDecember2015were recorded.Clinical and radiological parameterswereobtained including the typeof fracture,associatedcervicalandotherinjuries,comorbidities,symptoms,neurologicalcondition,surgicalstrategy,postoperativecourseandcomplications.Patientswereinagoodneurologicalconditionbeforesurgery(ASIAEorD).Inbothcases,surgerywasperformedatanearlystageaftertrauma(withinfivedays).Minimallyinvasiveventralscrewfixation,modifiedHarmsandMagerltechniqueswereused.Noworseningofneurologicalfunctionsimmediatelyaftertheoperationwasseen.Thecomplicationwasobservedintheminimallyinvasivelyanteriorscrewfixationcase.Screwmigrationthroughtheposteriorpharynxoccurred.Thescrewpassedthroughhedigestivetract.ThesecondsurgerywithmodifiedHarmstechniquewassuccessful.TheauthorreviewstheliteratureonthetechniquesusedfortypeIIdensfracture.ThemodifiedHarms
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techniqueconsidersposteriorarchscrewandlateralmassfixation,bothscrewsthroughtheC2archandlateralmassscrews.Magerltechniqueseemstoberelativelyquick.However,itmayrequireadditionalsmallincisionsforpercutaneousscrewpassagetoachievesteepanglefixationinacaseofthesmallposteriorincision.Anteriorscrewfixationintheosteoporoticbonemayrequirecementaugmentationtopreventscrewlooseningandmigration.TypeIIdensfracturesareacommonfractureofelderlypatients.Surgicaltreatmentcansignificantlyimprovethequalityoflifeinelderlypatientswhohavesufferedafractureofthedens.Theoneofthreesurgicaltechniquesshouldbeindividuallyselectedfortheparticularcases.
5MINIMAL INVASIVE LAG SCREW OSTEOSYNTHESIS FOR HANGMAN’S FRACTURES
Jan-Philip Zeden, Dirk Thomas Pillich, Henry Werner Siegfried Schroeder, Jan-Uwe MüllerGreifswald University Hospital, Clinic and Polyclinic for Neurosurgery, Greifswald, Germany
ThemanagementofdisplacedHangman’sfracturesispredominantlyconservative.Alargenumberofclinicalstudieshaveproventhesuccessofconservativetherapy.Surgicaltreatmentisreservedforcasesthatareconsideredunstableandforcasesinwhichconservativetreatmentisnotfeasible.Itisindicatedsecondarytoabsenceofbonyfusionandpseudarthrosis.ThefusionratesofsurgicallytreatedHangman’sfracturesarehigh,mainlyat100%.Bycontrast,theexternalimmobilizationinpatientswithunstablefracturesassessedinrepresentativecaseserieshavearateoftreatmentfailureinafrequencyofabout30%.Wepresentacaseseriesof15patientswhoweretreatedwithaminimallyinvasive,3Dfluoroscopicallyguidedandneuronavigateddorsallagscrewosteosynthesis.11patientswithisolatedHangman’sfracture,2patientswithcombinationofHangman’sfractureandodontoidfracturewithcombinedanteriorandposteriorlagscrewosteosynthesis.Inthecaseseriesnononunionwasobserved.Inallpatientswithacompletefollow-up,abonyfusion,anintactvertebralalignmentandnodeformitycouldbedetectedbyCTafter3months.IntheseriestherewasonedissectionofthevertebralarterydiagnosedinthepostoperativeCTangiographyrequiringtreatment,withapossibleassociationwiththesurgicalprocedure.Mobilitypreservingosteosynthesisbyparsinterarticularislagscrewsisassociatedwithlowperioperativemorbidity.Otheradvantagesoftheminimallyinvasivesurgicaltreatmentaregoodfragmentapproximation,reduceddurationofhospitalization,ashortenedtreatmentperiodandabetterqualityoflifebyavoidingexternalstabilization.Thebenefitsareoffsetbytheriskofcomplicationssuchastheinjuryofthevertebralarteries.ThesurgicaltechniqueisnotapplicableforL+EIIIinjuries,duetothelesionofthecapsularstructuresofthefacetjoints.Furtherdevelopmentandevaluationofthesurgicaltechniquecomparedtoconservativeandalternativeoperationalproceduresaredeemednecessary.
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6CLINICAL ACCURACY OF AN INTRAOPERATIVE 3D CT-BASED NAVIGATION SYSTEM (O-ARM)
ASSISTED CERVICAL PEDICLE SCREW PLACEMENTNobuyuki Shimokawa
Department of Neurosurgery, Tsukazaki Hospital, Himji City, Japan
OBJECT:Theauthorsperformedaretrospectiveclinicalstudytoevaluatethefeasibilityandaccuracyofcervicalpediclescrew(CPS)placementusinganintraoperative3DCT-basednavigationsystem(O-arm).RecentlyCPSswereinsertedpercutaneouslyusingcannulatedCPSsystemwithO-arm(CA).METHODS:Thestudyinvolved128consecutivepatientsunderwentposteriorstabilizationofthecervicalspinebetween2007and2015.89patients(453screws)weretreatedusingpreoperative3DCT-basednavigationsystem(PR),whereas39patients(310screws)weretreatedusingO-arm(OA).ScrewpositionswereclassifiedintofourgradesbasedonthepediclewallperforationsobservedonpostoperativeCT.RESULTS:TheprevalenceofperforationsinthePRgroupwas6.4%(29screws):423(93.6%),14(3.1%), 12(2.7%),3(0.6%)forGrade0(noperforation),Grade1(perforation<2mm),Grade2(perforations≥2mmbut<4mm),Grade3(perforation≥4mm),respectively.IntheOAgroup,theprevalenceofperforationswas4.2%(6screws):138(95.8%),5(3.5%),1(0.7%),0(0%)forGrades0,1,2,3respectively.IntheCAgroup,theprevalenceofperforationswas1.8%(3screws):163(98.2%),2(1.2%),0(0%),1(0.6%),respectively.NeuralorvascularcomplicationscloselyassociatedwithCPSplacementwerenotencounteredinthepresentstudy.CONCLUSIONS:O-armcanimprovetheaccuracyofCPSinsertion,grade2and3inparticular.AlthoughsevereCPSmalpositioncausesinjurytothevitalstructure,O-armandmodifiedtechniquescanreducetheriskofamalpositionofCPSandprovideincreasedsafety.
TRAUMA CARE
7THE TIMING OF SURGERY IN ACUTE SPINAL CORD INJURY – SURVEY STUDY
Grzegorz Miekisiak, Wojciech Szymanski, Pawel Jarmuzek, Dariusz LatkaDepartment of Neurosurgery, Specialist Medical Centre, Polanica-Zdroj, Poland
PURPOSE:Oneofthegreatestcontroversiesofmodernspinalsurgeryisthetimingofsurgicaltreatmentintheacutespinalcordinjury(SCI).Tothisday,despiteseveralattemptsclinicalstudieshavenotprovideddataofsufficientqualitytomakestrongrecommendations.Weconductedasurveyamongspinalsurgeonsontheirviewonthetopic.METHODS:Thequestionnairecomprisedoffiveclinicalscenarioswasdistributedamong250spinalsurgeons,membersofthePolishSocietyofSpinalSurgery.Therewerefourpossibletimeframestochoosefromineachcase,includinganoptionofnonoperativetreatment.ThescenariosweretwocasesofcompleteSCIs(ASIAA),twoincompleteSCI(ASIABandC)andonewasposttraumaticcaudaequinasyndrome.Onehundredandten(44%)responded,anddatafrom110wereincludedinthestudy.Inthisgrouptherewere65neurosurgeons45orthopedicsurgeons,eitherboardcertifiedorintraining.RESULTS:Althoughmajorityofrespondentsfavoredimmediatesurgicaltreatment,theoverallagreementamongraterswasverylow(Kappa=0.1406,95%CI=0.1337to0.1475).TherewasafullagreementincaseoftheCESandnearrandomdistributionofanswersinoneofthecompleteSCIcases.Neurosurgeonsweremorelikelytopursuitimmediatesurgicaltreatment(p<0,005).Theoldersurgeons(aged45+)weremorelikelytooperatewithin6hoursbutthedifferencewasnotsurgicallysignificant.CONCLUSIONS:Thesurveyshowsthatthereisagreatneedforcomprehensiverecommendationsconcerningthe surgical treatmentofSCI. For thispurpose,newscientificevidenceof sufficientquality shouldbeproducedastheexistingdataisscarce.
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8A DELAY OF LESS THAN 7 H BETWEEN INJURY AND SURGICAL DECOMPRESSION REPRESENTS THE
BEST THEORETICAL CUT-POINT FOR SIGNIFICANT NEUROLOGIC RECOVERY IN PATIENTS WITH TRAUMATIC CERVICAL SCI
Marko Jug, Nataša Kejžar, Miloši Vesel, Matej Cimerman, Fajko F. BajrovićDepartment of Traumatology, UMC Ljubljana, Slovenia
Werecentlyshowedthatpatientswithcervicaltraumaticspinalcordinjury(tSCI)whoundergosurgicaldecompression(SD)andinstrumentedfusionwithin8hafterinjuryhavesuperiorneurologicaloutcomesthanpatientswhoundergoSD8-24hafterinjury,withoutanyincreaseintherateofadverseeffects.HereweusedtheROC(receiveroperatingcharacteristic)curvestovisualizethequalityofthetimefrominjurytoSDwithrespecttotheneurologicalimprovementofatleast2AISgradesandtodeterminethebesttheoreticalcut-offpointforthisclassifierinthesamegroupofpatients.OnlypatientswiththeAmericanSpinalInjuryAssociation(ASIA)ImpairmentScale(AIS)gradesofAthroughCandwith MRI-confirmedspinalcordcompressionwereenrolled.TheprimaryoutcomewasthechangeinAISgradeatthe6-monthfollow-up.Ofthe48enrolledpatients,42patientsconcludedthestudy.AUC(areaunderthecurve)wasequalto0.76with95%confidenceinterval(0.57,0.94),andYoudenindexsuggestedthatthebestcut-offpointforneurologicrecoveryofatleast2AISgradesisadelaybetweeninjuryandSDoflessthan7h.Sensitivityandspecificityatthatpointwere0.75and0.7respectively.Therewere22patientsdecompressedinthefirst7hafterinjury;3patientswithSDat3h,6patientswithSDat4h,4patientswithSDat5h,5patientswithSDat6hand4patientswithSDat7hafterinjury.The95%CIshowedthattheclassifierdidstatisticallysignificantlybetterthanrandomclassification.OurresultssupporttheviewthatthetimingofSDwithin24hisassociatedwithneurologicalimprovementandsuggestadelaybetweeninjuryandSDoflessthan7hasthebesttheoreticalcut-offpointforneurologicrecoveryofatleast2AISgradesinpatientswithtSCI.
9TURNING ADVERSITY IN OPPORTUNITY
Philip J. SellOrthopaedics, University Hospitals of Leicester, UK
Acervicalfractureinthepresenceofankylosingspondylitiscanbecatastrophicandchallengingtotreat.Thechallengesofthediseasecandistractcliniciansfromtheopportunitytosafelycorrectapre-existingspinaldeformity.TwocasesoffractureinBekhterev’sdiseaseorMarie-Strümpelldiseasearepresentedwheretheprefracturelossofforwardvisionwascorrectedasaresultofthefracturetreatmentwithagratifyingimprovementinpatientoutcomeanddeformity.
10VERTEBRAL FRACTURES HEALING ASSESSMENT METHODS – THE REVIEW
Wojciech Glinkowski, Jerzy NarlochBaby Jesus Clinical Hospital, Spine Unit, Department of Orthopaedics and Trauamatology, Warsaw, Poland; Chair and Department of Orthopaedics and Traumatology of Locomotor System, Centre of Excellence “TeleOrto”, Medical University of Warsaw, Baby Jesus Clinical Hospital, Warsaw, Poland
Theproperfracturehealingassessmentmethodologyisdemandedaftervertebralcompressionfractures.Theassessmentmaypredictariskofdelayedunionornonunionofthesefractures.Themostfrequentlycompressivefracturesofvertebralbodiesareosteoporotic(OVCF).Theboneregenerationoccursinthevertebralbody.Thepatientandtheclinicianshouldknowwhenthefractureisunitedtoletthe
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patientreturntopreviousactivities.Cliniciansexpectaunionfromatleastnineweeksfrominjury.However,thedecisionconcerningpatient’smobilizationisdependentonimagingconfirmation.Usually,plainradiographsareusedfortheidentificationofcallusthatcanbechallengingandinconclusiveforvertebralbodies.Theearliestobservedchangeisblurringofthefractureborders.Sclerosisfollows,asafirstsignofosteogenicactivity.Thestudywasbasedon the literature search reviewingexistingpapers concerningassessmentofvertebralfracturehealing.Imagingmodalitiesandtechniquesfocusedonthehealingprognosisanddiagnosisofunionvs.non-unionwerereviewed.Analysisoftheliteraturesuggeststhatplainradiographsremainastandardforclinicalvertebralfractureassessmentbothatadmissionand follow-up.Radiographsaredifficult toset thefinalendpointofvertebralbodyhealing.Theirabilitytoidentifynon-unionisbasedontheexistenceofintervertebralcleftandthetypeofdeformation.T1-weightedimagespredictnon-unionindiffuseintensitypattern;T2-weightedinconfinedhighanddiffuselow-intensitypatterns.High-resolutionthin-sliceCTimagesallowdepictionoftrabecularandcorticalmorphologyandprovideaquantitativeassessmentoffracturehealing.SomestudiespresentedthecomparisonofCTvs.MRIorcombinationofboth.Usually,thefractureunionisimagedwithMRIindifficultcases,usingCTasthegoldstandard.TheassessmentoftheVCFfracturehealingshouldfocusonfeaturesobservedonimagesandtheirtimesequence.ThePMMAorotheraugmentingsubstancemake thevertebralbodyregenerationassessmentobsolete.Thehealingrequiresaradiologicalassessment.MRIcorrelateswellwithCTinidentifyingvertebralfractureunionandnon-union.ProblematicorinconclusivecasesinradiographicassessmentofvertebralbodyfracturehealingrequireroutineMRIandCT.
11VERTEBRAL COLUMN FRACTURE TREATMENT IN CHILDREN AND ADOLESCENTS
Aleksander Szwed, Maciej Koban, Tadeusz BilnickiPomeranian Medical University in Szczecin, Poland
Vertebralcolumnfractureisrareinjuryamongpaediatricpatients.Themorphologyandthelocationoffracturediffersduetotheageofthepatient.Properdiagnosticprocedures,especiallyradiologicalandpropertreatmentreducenegativeeffectsoftheinjury.InthePaediatricOrthopaedicSurgeryandTraumatologyDepartmentofthePomeranianUniversityinSzczecintherewere42patientstreatedduetovertebralcolumnfractureorluxation.Patients’agevariedfrom6to18-yearsold(mean15,3yearsold).Wetreated3patientsupto9-yearsold,39-were10-yearsoldandolder.28patientsweretreatedsurgicallyand14underwentconservativetreatment.Therewerepermanentneurologicdeficitsobservedin3cases.Themostfrequentcauseoftheinjurynotedwasfallfromheight.In7patientsfracturesofvertebralcolumnoccuredinpolitraumasyndrome.3patientsunderwenttreatmentduetofractureincervicalpartofvertebralcolumn,18-inthoracicpart,21-inlumbarsection.10patientssufferedfrommultiplefractureofvertebralcolumn.InthisstudywepresentvertebralfractureexperienceofPaediatricOrthopaedicSurgeryandTraumatologyDepartmentofthePomeranianUniversityinSzczecin.Inthispublicationsweevaluatemanagementoftheinjury.Therearepointedoutpotentialdifficultiesindiagnosticprocessandcausesoffailuresinvertebralcolumnfracturestreatmentinchildrenandadolescents.
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13SPINAL TRANSPEDICULAR INSTRUMENTATION WITH PMMA AUGMENTATION OF FRACTURED
VERTEBRA AS THE EQUIVALENT OF COMBINED ANTERIOR-POSTERIOR 360 INSTRUMENTATIONWojciech Glinkowski
Baby Jesus Clinical Hospital, Department of Orthpaedics and Trauamtology of Locomotor System (Spine Unit); Medical University of Warsaw, Department of Medical Informatics and Telemedicine,
Warsaw, Poland
Theposteriorandthecombinedanterior-posteriorapproachisconsideredforthemanagementofthoracolumbarburstfractures.Thecombinedanterior-posteriorapproachmaydeliverhigherkyphoticcorrectionand improvementof vertebralheight (sagittal index).However, the combinedanterior-posteriorapproachmayleadtomorebloodloss,longersurgerytimeandapossiblehighercomplicationrate.Theaimofthisstudywastopresenttheadvantagesofposteriorspinalinstrumentationwithbonecementaugmentationoffracturedvertebrafortreatingthoracolumbarburstfracturesincasessevereosteoporosistomimickthecombinedanterior-posteriorapproach.FromJune2013toDec,2015tenpostmenopausalandmyelomarelatedosteoporoticfracturecaseswereincludedtothisstudy.Singleormorevertebralburst/compressionfracturesweretreatedusingposteriorspinalinstrumentationwithbonecementaugmentationoffracturedvertebra.Percutaneousshortsegmentfixationwasperformedatonelevelabove,onelevelbelowthefracturedvertebra.Bonecement-augmentedornonaugmentedscrewswereused.Fracturedandcollapsedvertebrawasbonecement-augmentedwithkyphoplasty,ballooningstentplacementorvertebroplastyifthespontaneousreductionoccurredontheoperatingtablebypositioningonly.Clinicalresults,radiologicalparameters,andrelatedcomplicationswereassessedpostoperativelyand6monthsaftersurgery.Nosignificantneurologicaldeteriorationorcomplicationsoccurred in thestudygroup. ThemeanpainscoreandOswestryDisabilityScorev2.1a.Noneofthepatientscomplainedofpainworseningduringthe6monthsfollowingthesurgery.Meankyphoticanglewasimprovedsignificantlyafterspinalfixation.Kyphoticangleimprovementsweremaintainedat6monthsaftersurgery.Nopatientsustainedadjacentfracturesafterbonecement-augmentedpercutaneousshortsegmentfixationduringthefollow-upperiod.Asymptomaticcementleakageintotheparavertebralareawasobservedinfrequently.Thecombinedbonecement-augmentationofthefracturedvertebrawithpercutaneoustranspedicularspinalfixationcanbeaneffectiveandsafeprocedureforosteoporoticthoracolumbarburstfractures.Bonecementaugmentationmaymimickthecombinedanterior-posteriorapproachforspinalfixationusingapercutaneoussystemforthemanagementofselectedthoracolumbarburstfracturesaccompaniedbysevereosteoporosis.
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14DOUBLE BALLOON VERTEBRAL KYPHOPLASTY (BKP) – A NEW TECHNOLOGY FOR EXTENDED
INDICATIONS IN VERTEBRAL FRACTURE TREATMENTFrank Hertel, Ardian Hana, Nitish Vidal Gunness, Christophe Berthold, Wolfram Schrecklinger
National Service of Neurosurgery, Centre Hospital of Luxembourg, Luxembourg; Joline Company, Hechingen, Germany
INTRODUCTION:BKPisanestablishedtreatmentforvertebralfractures(VF)since2decades.However,therearesomerestrictionsforconventionalBKPandthemainindicationsarewithinthetypeA1groupofVFalongtheAOclassification.Instronglydeformatedfractures(suchasvetrbraeplanae),theinflationofaconventionalballooncanleadtoaburstofthevertebralbody(lengtheningandbroadening).Furthermore,theextentionofasingleballooninpatientswithfracturedposteriorvertebralbodywallsmayleadtoacompressionofthespinalcanalorrestrictthevertebralremodellingtoaminmum.METHOD:Inthenewdoubleballoontechnology,eachballoononasinglecathetercanbeinflatedseperately.Inourpresentation,weillhowanddemonstratethetechnologybyindividualcasefilmreconstructions.RESULTS:Within2years,wetreated37patients(46vertebrae)withtypeA1.1,1.3,2.2,3.1,3.2,3.3andB1fractuesinthedorsolumbarspine(27osteoporotic,10traumatic)withthedoubleballoontechnology.Meanageofpatients59,8years(18–84).30patientsinastand-aloneprocedure,7incombinationwithastabilization.CONCLUSION:Thedoubleballoonisasafetechnologyforboth,standard,aswellasextendedindicationsofVFinthedorsolumbarspine.ItoffersadditionaltreatmentpossibilitiesforfracturesotherwisenottreatablebyBKP.Randomizedcontrolledtrialscomparingthedoubleballoontostandardproceduresarehighlyrecommended.
15DOES THE QUANTITY OF CEMENT LEAK INTO THE DISC FOLLOWING BALLOON KYPHOPLASTY INFLUENCE THE PROGRESSION OF DEGENERATIVE DISC DISEASE AND THE OCCURRENCE OF
ADJACENT VERTEBRAL FRACTURES?Bakur Jamjoom, Sanjay Patel, Raj Bommireddy, Zdenek Klezl
Department of Trauma and OrthopaedicsRoyal Derby Hospital, Derby, UK
INTRODUCTION:Balloonkyphoplastycanbecomplicatedbycementleakintothediscspacebutitsconsequenceshavenotbeenadequatelyexamined.Inthisstudyweaimtoestablishwhetherthequantityofcementleakintothediscspacehasanyinfluenceontheprogressionofdegenerationoftheaffecteddiscandwhetherthisincreasestheincidenceofadjacentvertebralfracture.METHODS:Imagestakenduringballoonkyphoplastybetween1/10/2006to31/05/2014atourhospitalwerereviewed.Outof316procedures,weidentified32affectedin26patients.ThequantityofcementleakwasgradedasI:minimal/cloud,II:20%,III:20-40%andIV:>40%ofthediscspace.ThedegenerativechangesintheaffecteddiscswereassessedatpresentationandfollowupusingtheMimuraradiographicandPuertasMRIgradingsystems.Wecomparedlowgrade(I)tothemid/highgrade(II-IV)leaksusingachisquaredtest.Wealsoreviewedbothimagingmodalitiesforadjacentvertebralfractures.RESULTS:FollowupradiographandMRIassessmentsranged6-50(median18)and6-48(median21)monthsrespectively.Themid/highgradeleaks(II-IV)wereassociatedwithsignificantlymoreradiographicscorechanges(P=0.04295)thanthelow(I).ThiswasnotthecasefortheMRIscorechanges,withequalnumbersineachgroup.Twoadjacentvertebralfractureswerealsodetectedineachgroup.CONCLUSION:Ourfindingssuggestthatmid/highgrade(II-IV)cementleakscauseanincreaseintheprogressionofdiscdegenerationwhenassessedbyradiographs,butnotMRIs.
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16RECENT SPINAL SURGERY USING NAVIGATION SYSTEM FOR SPINAL INJURY
Nobuyuki ShimokawaSpine Centre, Tsukazaki Hospital, Himeji, Japan
Significantprogresshasbeenmadeinimage-guidedsurgery(IGS)usingacomputernavigationsystemoverthelastfewdecades.IGScanbeeffectivelyappliedtospinalinstrumentationsurgery.Inthisreviewarticle,wefocusourattentiononthefeasibilityandsafetyofcurrentIGStechniquesfortraumaticspinalinjury.IGSspinalfixationwithorwithoutminimallyinvasivesurgery(MIS)techniquessuchaspercutaneousscrewplacement,balloonkyphoplasty(BKP),orvertebroplasty(VP)wasaccomplishedin80patientswithtraumaticspinalinjurybetween2007and2015.Theinjuredvertebrallevelsincludedthefollowing:cervicalspine,41;thoracicspine,22;andlumbarspine,17.NeurologicalconditionbeforeandaftersurgerywasassessedusingtheAmericanSpinalInjuryAssociationImpairmentScale(AIS).Atotalof419pedicles,lateralmass,orlaminarscrewswereplacedand399screws(95.2%)werefoundtobeplacedcorrectlybasedonpostoperativeCTscan.Although20screws(4.8%)werefoundtobeunexpectedlyplacedincorrectly,noneuralorvascularcomplicationscloselyassociatedwithscrewplacementwereencountered.NeurologicaloutcomesappearedtobeacceptableorsuccessfulbasedonAIS.IGSisapromisingtechniquethatcanimprovetheaccuracyofscrewplacementandreducepotentialinjurytocriticalneurovascularstructures.TheintegrationofMISandIGShasprovedfeasibleandsafeinthetreatmentoftraumaticspinalinjury,althoughathoroughknowledgeofsurgicalanatomy,spinalbiomechanics,andbasictechniqueremainthemostessentialaspectsforsuccessfulsurgery.
17NAVIGATION-ASSISTED SURGERY FOR OSTEOPOROTIC INSUFFICIENCY FRACTURES OF THE SACRUM:
TECHNICAL NOTE AND OWN RESULTSThomas R. Blattert, Horst Balling
Orthopaedic Clinic Schwarzach, Germany
PURPOSE:Navigation-assistedscrewfixationforosteoporoticinsufficiencyfracturesofthesacrumisanew,technicallydemandingprocedurerequiringsurgical skillsandexperience.Thepurposeof thiswork is todescribethetechniqueofnavigation-assistedscrewfixation(NSF)forosteoporoticsacralfracturesandtocomparetheresultstothoseofNSFwithadditionalsacroplasty(SP).METHODS:From02/2011-12/2015,allosteoporoticsacralfracturesindicatingsurgicaltherapyweretreatedusingnavigation-assistanceinformofNSF(I)orNSF+SP(II).SPwasperformedonlyinabsenceoftransforaminalfractures.Primaryefficacyoutcomewaspost-surgicalpainreliefdeterminedbyvisualanalogscale(VAS).Secondaryefficacyoutcomeswereproceduralaccuracycontrolledbyintra-operativeO-armvisualizationofscrew/cementpositions,anddurationofsurgery.Primarysafetyoutcomeswereprocedure-relatedmajorcomplicationsindicatingrevisionsurgery.RESULTS: Seventy-one osteoporotic sacral fractures in 36 consecutive patients were surgically treated (NSF: n=43, NSF+SP: n=28). Eleven fractures occurred unilaterally in S1, 50 fractureswere found to be bilateralinS1,10fractureswerebilateralinS2.Additionalanteriorpelvicringfractureswerefoundin9casesofNSF,and10casesofNSF+SP(p≈0.18).Pre-surgicalpain-levelsdecreaseduntildismissalonaverageby4.2(I)and5.2(II)VAS-points,respectively(p≈0.098).All77screwswerelocatedwithinsafesacralcorridors(accuracy100%).Cement-extrusionsintoneuroforaminawerenotobservedafterSP.Surgicaltimewas88±33minutes(I)and114±28minutes(II),respectively(p≈0.016).Revisionsurgeriesformalplacedscrews,bonecementextrusionorneurologicaldamagewerenotindicated.Inonecase(2.8%),subfascialhematomahadtobeevacuatedafterNSF.
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CONCLUSIONS: The study demonstrates the feasibility and safety of navigation-assisted treatment forosteoporoticsacral insufficiency fractures.Additional sacroplasty led tosignificantlyprolongedoperativetimewithoutrelevantimpactonpainrelief.Primarysafetyoutcomesweresimilarinbothgroups.
18OUTCOME OF TREATMENT OF COCCYDYNIA
Donald Buchanan, Jonathan SpilsburyRoyal Orthopaedic Hospital, Birmingham, UK
INTRODUCTION:Theresultsoftreatmentofcoccydyniaarevariable.Recentreportsshowgoodresultsfollowingcoccygectomy.Weevaluatedourresultsfollowingtreatmentofpatientswithcoccydynia.METHODS:Theauditwasregisteredwiththeclinicalgovernancedepartment.CasenotesandimagesofpatientswithcoccydyniawhoweretreatedbetweenMay2006andApril2015werereviewed.Datawasenteredonanexcelspreadsheetforanalysis.RESULTS:Therewere48patients(6malesand42females).Themeanagewas45.9(13.4to69.6)years.Thedurationofsymptomswas42.7(6to216)months.PatientwhohadagoodresponsetoMUAandinjectionandhadahypermobile,arthritic,deformedcoccyxwereconsideredforcoccygectomy.Twentypatientsimprovedandrequirednofurthertreatment,20hadtransientimprovementandlaterhadcoccygectomy,eightweredischargedtothepainclinic.Themeanageofthepatientswhohadcoccygectomywas46.2(22.1to64.6)years.Themeandurationofsymptomswas63.5(3to120)months.Sevenpatientsreportedpreviousinjuriessuchasafall,1patienthadatraumaticvaginaldelivery,12caseswereatraumaticinorigin.Allbut1ofthepatientshadagoodresponsetoMUAandinjectionpriortosurgery(1patienthadadefunctioningcolostomyseveralyearsbeforebuthadagoodresponsetococcygealinjection).Manipulationunderanaesthesiarevealedamobilecoccyxin11patients,mobileandcrepitantin3,mobileandsubluxedposteriorlyin1,antevertedin1,noMUAfindingswererecordedin3,MUAwasnotdonein1.Fourteenpatients(70%)hadgoodorexcellentpainrelief.Five(25%)hadpartialpainrelief,oneoftheserequiredarepeatcoccygealinjection,onewoundexplorationforinfectionandthreewerereferredtothepainclinic.Oneofthepatientswithapooroutcomecomplainedofapainfulscarandanothercomplainedthatthesacrumwasprominent.Theoutcomewasnotdocumentedinonepatient(5%).Therewere3woundinfections,oneoftheserequiredwoundexploration,theother2weretreatedwithantibioticsandsettledinlessthan2weeks.Meanfollowupwas26.9(7to62)months.DISCUSSION:Thisisasinglesurgeonseries.Goodresultsareconsistentwithpublishedliterature.Useofafavourableresponsetoinjection,presenceofahypermobilecoccyx,deformityandcrepitushelptodefinecriteriaforsurgery.Useofanoutcomescoringsystemwouldhelpinassessmentofoutcome.
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QUICKFIRES
QF1GUILLAIN-BARRE SYNDROME FOLLOWING SPINAL FUSION FOR THORACIC VERTEBRAL FRACTURE
Jun Seok LeePusan National University Yangsan Hospital, South Korea
Guillain-Barresyndrome(GBS)issymmetric,rapidlyprogressivepolyneuropathyofunknowncausethathasbeendescribedmostfrequentlyafternon-specificviralinfection.TherehavebeenveryfewreportsintheliteratureofGBSafterspinalsurgery.WepresentauniquecaseofGBSfollowingspinalfusionforthoracicvertebralfracture.Theaimofthisreportistoillustratetheimportanceofearlyneurologicalassessmentanddeterminingtheexactcauseofanewneurologicaldeficitthatoccursafteranoperation.Afifty-year-oldmanwasreferredtoouremergencyroombecauseofparaplegiaaftertrafficaccident.ComputedtomographyshowedtheburstfracturewithdislocationonT12andnearcompleteobstructionofspinalcanal.Emergentoperationofspinalcanaldecompressionandspinalfusionwasperformedaftersteroidmegadosetherapy.Paraplegiawasnotimprovedafteroperation.However,generalpatient’sconditionwasimproved.Hecomplainedofprickypain8daysafteroperation.Therewasnospecificfindinginabdominalcavity.Followingaday,Henotedthenumbnessinbothhandsandchestdiscomfort.Resultsofexaminationswerenormal.Inspiteofcarefulobservationwithsupportivecare,hecomplainedoftheprogressionofdyspnea.GradeIVmotorweaknessonbothupperextremitiesandbilateralfacialpalsyweredetected10days after operation.His clinical course suggests acute inflammatorydemyelinatingperipheralpolyneuropathy,BrainandcervicalspinalimagingstudyrevealednoabnormallesionsonCNS.Cerebrospinalfluidanalysis(CSFA)wasnotperformedbecauseofpostoperativebackwoundandlowreliabilityofCSFAfrominjuryofspinalcordandduramatter.Nerveconductionstudiesshowedslowingconductionvelocity,prolongedterminallatenciesandconductionblockinthemedianandulnarnerves.TheresultsofnerveconductionvelocityhighlysuggestedofGBS.Humanimmunoglobulinwasinfused.Motorpowerofbothupperextremitieswereimproved.WereportauniquecaseofGBSfollowingspinalfusionforthoracicvertebralfracture.Thiscasereinforcestheneedforneurosurgeonstomaintainawarenessofthispotentiallyreversiblecondition,GBS,thatmayariseafterspinaloperation.
QF2UNSTABLE CERVICAL SPINE INJURY IN PATIENT WITH NEGATIVE CT SPINE – CASE REPORT
Ashraf Dower, Johnny Efendy, Renata AbraszkoDepartment of Neurosurgery, Liverpool Hospital, Sydney, Australia
INTRODUCTION:Missedcervicalspineinjuries(CSI)areapreventablemorbidityinblunttraumapatientswithapproximately5-10%ofassociatedneurologicaldeteriorationoccuringduringtheemergencydepartment(ED)admission.1WereportonatraumapatientwhosecervicalspinewasclearedwithanormalCTcervicalspine(CT-CS)howeveranunstableCSIwasdetectedonfollow-up.CASEREPORT:A62-year-oldmaledriverinvolvedinalowspeedMVAwasbroughtinbyambulancetoourED.Duringassessmenthewasplacedinacervicalcollarforimmobilisation,andasecondarysurveyonly revealedmidline tendernessat theC1-3 region.Hewasotherwisealert,orientedandneurologicallyintact,withnootherdistractinginjuries.ACT-CSrevealednoacutecervicalspinefracturesormalalignmentandwasdeemedtobestable.Thepatientwasclinicallyclearedandthecervicalcollarwasremovedondischarge.
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At6weeks’follow-uphepresentedtoneurosurgicalfollow-upcomplainingofintermittentparaesthesiaandnumbnessinhisupperextremities.AnMRIcervicalspine(MR-CS)wasperformedwhichrevealedinjurytotheposteriorlongitudinalligament,andassociatedsubluxationattheC5/6level.AC5/6ACDFand3levelposteriorlateralmassfusion(C4/5,C5/6,C6/7)wasperformed.Thepatienthadnoresidualneurologicalsigns/symptomsat2weeks’follow-up.DISCUSSION:TheclearanceofablunttraumapatientwithanegativeCT-CSthathaspersistentneckpainonlateralflexion,ormidlinetendernessisararebutcriticalsituationandexistingprotocolsarebasedonapoorevidencebase.TheEASTpracticemanagementguidelinesforcervicalspineclearancesuggesteithercontinuingthecervicalcollarforanextendedperiodoftime,removalofthecollarafteranegativeflexion/extension(F/E)film,orfinallytheremovalofthecollarafteranegativeMR-CS.However, prolonged cervical collar usemayhavedeleterious effects and a recent comprehensivesystematicreviewoftheavailabledataonF/Efilmsinthesettingofblunttraumapatientsconcludedtheyofferedverylittleusefulinformation.Whilstearlierstudieshavenotdemonstratedanyclinicallysignificant injuriespickeduponMR-CSinthesettingofanegativeCT-CS,arecentstudysuggeststhat2.8%ofpatientsmayhaveunstableinjuriesdetectableonMRI.CONCLUSION: OurcaseoutlinestheutilityofMR-CS inanalertandneurologically intacttraumapatientwithanegativeCT-CS.
QF3ANTERIOR VERSUS POSTERIOR APPROACH IN TREATMENT OF UNILATERAL CERVICAL
DISLOCATIONSMarek Paciak, Adam Pala, Micha Biaek
Wojewódzki Szpital Chirurgii Urazowej, Piekary l skie, Poland
Unilateraldislocationsare less common thatbilateralonesandhave fewerneurological complication.Therforethisinjuryisoftenunderestimated.Butifmisdiagnosedortreatedconservativelyfortoolong,displacedinterlockedfacettcoudbefinallyirreducibleinsomeinstanceswithpersistentneckandradicularpainasaresultoffailedtreatment.Skulltractionasinitialtreatmentnotalwaysleadstoreduction.Manualreductioningeneralanesthesiacouldbeperformedwithcautionbeforesurgery.Butthismeanscouldbe insufficient becauseunilateral dislocation ismoredifficult to reduce thanbilateral one. Therefore,posteriorapproachofferspossibiltytodirectlyunblockdisplacedfacettsometimesfirstafterpartialfacettresection.Authorspreferanteriorapproachasofferingpossibilityodanteriorspinalcorddecompressionandsolidinterbodyandanteriorfusion.Butinsomecasesposteriorapproachasfirstchoicewithorwithoutsubsequentanteriordecompressionisadvisable.Analysisoftreatmentof94caseswithrespecttoclinicalsymptomsandimagingfindingsresultsinformulatinganauthorsownalgorithmoftreatmentofunilateralcervicaldislocationswithquallificationtoanterior,posteriororcombinedapproach.
QF4A “TWITTER TIP” SIMPLE AID TO SPINE FUSION BONE GRAFTING IN LESS THAN 90 WORDS
Philip J. SellUniversity Hosptials of Leicester, UK
Morselisedbonegraftcanbeawkwardtoplaceinposteriorspinalfusionsurgery.Itisparticularlyfrustratingifsmallfragmentsofgraftfallintoapreviouslydecompressedcanalandrequireextraction.Asimplequickandcheapmethodofsafedeliveryofautologousorautogenousistoutiliseastandard5mlor10mlsyringeafterremovalofthenozzle.Thegraftandapplicatorcanbepreparedforadministrationbythescrubnursepractitioner.This‘quicktip’reducesbonefragmentswithinthespinalcanal.Italsoenablesquantificationofthegraftvolume.
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QF5DIFFERENCE BETWEEN MINOR TRAUMATIC AND NON-TRAUMATIC OSTEOPOROTIC VERTEBRAL
COMPRESSION FRACTURESDaisuke Umebayashi, Yu Yamamoto, Yasuhiro Nakajima, Masahito Hara
Inazawa Municipal hospital, Inazawa, Japan
Populationagingiscontinuinginallovertheworld,especiallyinJapan.Therefore,osteoporotic-relatedfractureshasbecomeanincreasinglycommonproblem.Osteoporoticvertebralcompressionfractures(OVCF)occurwithorwithoutminortrauma.However,thedifferenceintheclinicalcourseofminortrauma-orientedOVCFandnon-traumaticOVCFhasnotbeenclarified.Furthermore,thereisnoconsensusastowhetherminortrauma-orientedOVCFornon-traumaticOVCFistheoptimalcandidateforpercutaneousvertebroplasty(PVP).Inthisstudy,wedescribetheresultsofaretrospectivestudydesignedtoevaluatethedifferenceoftwotypesofOVCF.Patientsover65yearswithacuteOVCFandhospitalizedforseverebackpainwereenrolled.Majortraumaincludingfalloffinjuryandtrafficaccidentwereexcluded.Theprimaryoutcomewaspainreliefwhichisrecognizedastheabilitytoambulate.Bonemineraldensitywasusedtoanalyzetheextentofosteoporosis.Asaresult,patientsweredividedintofourgroups,minortrauma-orientedOVCFwithorwithoutPVP,non-traumaticOVCFwithorwithoutPVP.Here,comparingthesefourgroups,wereportthecharacteristicsofthesegroupsandtheoptimaltreatmentforeachgroup.
QF6COMPLICATIONS AND OUTCOME OF PATIENTS WITH LIVER CIRRHOSIS (CHILD-PUGH STAGES B & C)
AFTER SPINAL INSTRUMENTATIONRamazan Dalkilic, Christian Ewald, Rolf Kalff
University Hospital of Jena, Germany
OBJECTIVE:WiththisstudywewanttoshareourexperienceandoutcomewithpatientswithlivercirrhosisChild-PughstagesBandCafterinstrumentedspinesurgery.Wealreadyknowthatpatientswith cirrhosis (Child-PughB&C) are high-risk patients due to their coagulation problems, higherinfectionrisk,aswellasosteopenia.METHOD:Between2006and2013wehaveoperatedon12patientswithlivercirrhosis(Child-PughB&C)andspinalfractures(spontaneousandtraumatic).Allthesepatientunderwentinstrumentedspinalsurgery.Thisretrospectivestudyisbasedonthepatients’conditions,intra-andpostoperativecomplications,andthepatientoutcomescores.RESULTS:Thestudygroupcomprised12cirrhoticpatients(9malesand3females).Theaverageagewas59years(±26).Theaveragelengthofstaywas36days(±27).3(25%)patientswereadmittedwithneurologicaldeficitswithhypoaesthesia,3(75%)patientswereadmittedwiththoracolumbarpain.Onepatientwasstabilisedwithwirecerclageduetodensfracture,6patientsunderwentdorsoventralinstrumentation,andin5patientsweperformedonlyposteriorfusionduetothoracicandlumbarvertebralbodyfractures.5(41.6%)patientsexperiencedpostoperativematerialdislocation.Oneofthesepatientsufferedpostoperativeparaparesisand4(33.3%)ofthisgrouphadtobere-operatedonduetopostoperativeepiduralbleeding.4ofthepatientshadpostoperativewoundinfections(33.3%)andoneofthembecameseptic.Postoperativepainreductionwasachievedinonlytwopatients.6ofthecohortrequiredup-titrationoftheirpainmedicationpostoperativelyandonepatienthadpermanentparaparesis.Onepatientdiedpostoperativelyduetodrasticallyderangedcoagulation.Theoverallcomplicationratewasabout83.3%.CONCLUSION: Inourexperience, inmostofpatientswith livercirrhosis(Child-PughstagesB&C)wewereunabletoimprovetheneurologicalorpainsituationwithspinalinstrumentation.Theriskofneurologicalcomplicationsandinfectionsaremarkedlyhigherinpatientswithcirrhosis.Thesepatientsrequirein-depthandindividualisedevaluationbeforeundergoingspinesurgerywithinstrumentation.
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QF7ANTERIOR LUMBAR DISCECTOMY AND FUSION IN ACUTE INCOMPLETE CAUDA EQUINA
SYNDROMEYma Markmann, Andrew Clarke
Royal Devon and Exeter Hospital, Exeter, UK
Isanterior lumbardiscectomyand fusion (ALDF) incasesof recurrent lumbardischerniationwithpreviousperformedposteriordecompressivesurgeryanacceptableemergencyprocedure?Thiscasereportstudiesthreepatientsthatunderwentemergencyanteriorlumbardiscectomyandfusion.Allthreepatientssufferedfromacuteincompletecaudaequinasyndromeduetoare-recurrentdischerniation.RecoveryandoutcomewasverygoodinallofthepatientsandleadstotheconclusionthatALDFisindeedalegitimatesurgicaloptionintheurgenttreatmentofacutecaudaequinasyndromecasesthatmeetspecificcriteriaincludingrecurrentdischerniationwithpreviousposteriorrevisionsurgery.
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EUROSPINE 20165–7 October 2016Berlin, Germany
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