AANS/CNS Spine Section
@spinesection
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Official twitter account for the AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves
Joined March 2011
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Contraindications to cervical traction:
- Atlantooccipital dissociation
- Three column extension injury in Ankylosing Spondylitis
or DISH
- Hangman's Fracture type III
- Skull fracture
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How would you manage this 50-year-old man who presented to the ER after a fall from a roof with neck pain? He's neurologically normal.
A- single level ACDF
B- posterior long segment fusion
C- circumferential fusion
D- Halo-vest
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How would you treat this non-displaced type II odontoid fracture in a 54 yr old man who presented with neck pain following a bicycle accident?
a- rigid collar bracing
b- crown halo vest
c- anterior odontoid screw
d- posterior c1/2 fusion/arthrodesis
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25 M presents to the ED as a C4 ASIA B after an ATV accident. What are your considerations as far as surgical timing, traction, surgical plan, steroids, & early trach / peg?
#neurosurgery
#spine
#orthopedics
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A 5 yr old M was a restrained passenger in a high speed MVC. He was taken for an emergent ex lap for a small bowel injury. Several days later, he c/o severe back pain upon moving & standing. What is the pathology & does it need to be treated with surgery?
@PedsSection
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Congratulations to all of the neurosurgery applicants who matched today! This is a landmark achievement for your career!
To those that did not match today, keep your head held high! Use this as motivation to make yourself even stronger for 2023. 🦾
#neurosurgery
#match2022
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60-year-old woman with known breast Ca presenting with severe upper neck pain. Her KPS is 80 and her prognosis is > 2years. In addition to chemo/radiation. How would you manage this?
A- Rigid collar
B- Halovest
C- Reduce then C1-C2 fusion
D- Reduce then OC- fusion
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A 24 yr old F was in a high speed MVC. She presented with urinary retention, B/L foot drop (2/5), & severe mechanical back pain. How would you classify this fracture and what would your treatment be?
#neurosurgery
#orthopedics
@spinesection
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Case: 30 yr old man presented with quadriplegia following a MVA. CT showed atlantooccipital dislocation/dissociation. How would you treat?
A-Rigid collar
B-Crown halo-vest
C-Traction to realign then occipitocervical fusion
D-No traction, occipitocervical fusion
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We are very proud of our member leaders Dr Khoi Than and Dr Ali Baaj for becoming Active Fellows of the
@SRS_org
. Congratulations!
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87 yo s/p MVC ~ 6 months ago with dens fracture. In collar, no pain, no deficit. Repeat CT today shows no bony union, flex ex with minimal displacement. Pt is a surgical candidate and would rather surgery than collar. What would you do?
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Spine Classics: Francis Denis’s 1983 paper introducing the three-column classification system of thoracolumbar fractures is amongst the most cited works in spinal disorders.
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A 47 yr old F presents to the ED with worsening gait imbalance, LLE weakness, and urinary retention. Relevant images are below. What is your ddx and how would you treat this patient?
#neurosurgery
#spine
#orthopedics
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Save the date for the 2023 AANS / CNS
@spinesection
meeting in Miami!
@AANSNeuro
@CNS_Update
#neurosurgery
#orthopedics
#spine
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A 78 year old man presenting with upper neck pain and progressive quadriparesis. How would you treat?
A- Post decompression
B- Post decompression & C1/2 fusion
C- Post decompression & OC fusion
D- Posterior C1/2 fusion
E- Anterior odontoidectomy and posterior fusion
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How would you managed this 79 yr old female with RA and osteoporosis who presents with progressive quadriparesis?
A- Anteriorly (ACDF or corpectomy)
B- Post decompression & fusion
C- 360
D- Laminoplasty
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Case posted recently. 54 yr old man suffered a bicycle accident. Non-displaced type II odontoid fx tx with 3 m of rigid collar bracing. F/U CT. Still has neck pain. Next step?
a-Continue rigid collar bracing
b-Ant odontoid screw
c-Post C1/2 fusion
d-Fibrous union f/u prn
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#Spinesection
new member of the week: Dr. Kingsley O. Abode-Iyamah of Mayo Clinic-Florida. He is a world class complex spine and deformity neurosurgeon!
#neurosurgery
# orthopedics
#spine
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70 yo with subacute, progressive myelopathy. Anterior, Posterior, Both, or something else?
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July is a fresh start for neurosurgery trainees, spine surgery fellows, and newly minted surgeons in practice. Check out this resource for lumbar fusion. Relevant review for surgeons of all levels of experience.
@spinesection
@TheJNS
#medicaleducation
#lifelonglearning
#spine
#JNS75th
Invited Review: “State of the union: a review of lumbar fusion indications and techniques for degenerative spine disease” by Patrick C. Reid, Simon Morr and Michael G. Kaiser
#FreeArticle
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#Spine
and Peripheral Nerve Section new member of the week: Dr. Brandon Smith is a peripheral nerve neurosurgeon at Duke University. He received spectacular peripheral nerve training at the University of Michigan and the Mayo Clinic.
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Case: 56 yr old m previously healthy p/w 2 w hx of low back pain and left LE radic. CT chest abd plevis unremarkable. Next step?
1-Pain management and f/u imaging
2-Percutaneous needle biopsy of L3
3-Vertebroplasty
4-Post decompression and fusion
5-Ant corpectomy and fusion
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How do you manage penetrating spinal injuries? This 25 yr old M sustained a GSW to the back (0/5 BLE strength & no BLE sensation). Is there an indication for surgery in regards to the fracture pattern and bullet fragments in the canal?
#neurosurgery
#orthopedics
#spine
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What advice would you give to a young surgeon embarking on a career in spinal surgery?
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President and Chair
@thejuansuribe
!!
I'm proud and humbled to be elected president of the American Association of Neurological Surgeons/Congress of Neurological Surgeons: Section on Disorders of the Spine.
@spinesection
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Congratulations to
@khoithanMD
for being named the new
@spinesection
Education Chair, and to
@johnhshinmd
for becoming the new
@spinesection
Media Chair! Well-deserved accomplishments for two of the most dedicated neurosurgeons to spine education.
#neurosurgery
#spine
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How would you manage this 52 year old man with upper neck pain, headaches & quadriparesis?
A-Post decompression only
B-Post decompression & duraplasty
C-OC fusion
D-OC fusion, decompression & duraplasty
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20 yr old man presented to the ER with neck pain after a fall while intoxicated. Neurological exam normal. CT showed a UNILATERAL NON-DISPLACED FACET FRACTURE. How would you tx?
a-Rigid neck collar bracing
b-ACDF
c-PSF
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This iatrogenic deformity required a circumferential correction to achieve optimized horizontal gaze
#neurosurgery
#orthopedics
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This 61 yr old M presents after a fall down several steps with severe neck pain and difficulty maintaining horizontal gaze. He has had gait imbalance for several months. No recent infxns, met w/u negative. What is your ddx & treatment plan?
#spine
#neurosurgery
#orthopedics
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#Spine
Section new member of the week! Dr. Cliff Crutcher is a new faculty member at Duke
#Neurosurgery
who focuses on adult degenerative and deformity surgery.
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CASE: 46 yr old F suffered a roll over car accident requiring extrication. Spine precautions maintained. Neurologically normal. How would you treat this fracture?
A-Neck collar
B-Anterior corpectomy/fusion
C-Posterior fusion
D-360
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This 56 yr old M w/ multiple co-morbidities has a 1 yr hx of gait imbalance and loss of dexterity. After a recent fall, he presents to the ED with worsening weakness (4/5) in all 4 ext. How would you address this cervical deformity causing severe cord compression?
#spine
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#Spinesection
member spotlight: Dr. Jamal McClendon Jr. of the Mayo Clinic, Arizona and Phoenix children’s hospital. Dr. McClendon is an assistant professor of neurological surgery and is an expert pediatric and adult scoliosis and spinal deformity surgery.
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This 45 yr old F presented with signs & symptoms of thoracic myelopathy. How do you differentiate between a dorsal arachnoid web / cyst & a ventral dural defect causing spinal cord herniation? What would your treatment plan be for this patient?
#neurosurgery
#spine
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#Spine
Section new member of the week: Dr. Lara Massie trained at Henry Ford and at Duke, and now provides superb care to the patients at Allegheny in Pittsburgh!
#neurosurgery
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How would you tackle this case of an Ependymoma in a 37F with myelopathy? Is that tumor in the brainstem??
A) C3-5 laminectomy
B) C3-5 laminoplasty
C) Sub-occipital - C6 laminectomy + fusion
D) C2-6 laminectomy
E) C3-6 lami, C2-7 fusion
@CNS_Update
#neurosurgery
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Please join us in Miami for the WINS
@WINSneurosurge1
reception on March 18, 5-6pm, Splash 1-3
@Fontainebleau
during Spine Summit. All are welcome to this awesome networking event!
@AANSNeuro
@CNS_Update
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#Spine
Section member of the week: Dr. Rory Goodwin of Duke University is a leading expert on spinal
#oncology
.
#neurosurgery
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The Load Sharing score introduced by MacCormack in 1994 assesses the degree of comminution, apposition & deformity of thoracolumbar fractures. In general if the LSS < 6 then a posterior short segment fusion is sufficient, otherwise reconstructing the anterior column is necessary.
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#Spine
Section leadership spotlight: Our secretary is Dr. Dan Hoh of the University of Florida!
#neurosurgery
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L5 burst fractures are some of the most uncommon traumatic spinal column fractures we see in practice. Below are some case examples within the literature of the many ways they can be successfully treated. A short clip of a posterior corpectomy is shown.
#neurosurgery
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Looking forward to seeing everyone in Austin soon! There is an all-star lineup as always! Congress of Neurological Surgeons (CNS)
#spine
#neurosurgery
#orthopedics
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A 37 yr old M presents w/ 3 days of dysphagia, BUE/BLE weakness (3-4/5). MRI >> infectious process. How would you manage this patient?
1) Abx alone
2) C4/5 ACDF
3) C4/5 corpectomy
4) C4/5 corpectomy + posterior lami / fusion
5) Posterior lami
6) Posterior lami / fusion
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This 54 F is several yrs s/p C3-6 ACDF. She presents with progressively worsening myelopathic symptoms and an inability to hold her head up. She is unable to lay flat comfortably and has pronounced neck pain. EMG is neg. What is your ddx and how would you treat this pathology?
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This 32 yr old M fell 20ft from a ladder. He initially presented with a GCS 11T, but declined to a 3T over the course of a few hrs. Despite EVD placement, the patient continued with a 3T & B/L 'blown' pupils. How would you manage the P.fossa swelling & CCJ instability?
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Countdown to
@CNS_Update
2022! We're excited to see friends & colleagues this weekend in San Francisco!
A stellar lineup of spine symposia & courses to attend!
#neurosurgery
#orthopedics
#spine
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Case: 56 yr old F with a 2 m hx of progressive upper and lower extremity weakness and numbness (myelopathy). How would you proceed?
A)LP for CSF (wbc, prt, gluc, oligoclonal bands, ACE)
B)Biopsy
C)Resection
D)Decompression +/- fusion only
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#spinesection
spotlight: Dr Wilson Zachary Ray Professor of Neurological Surgery at Washington University. A world class surgeon & one of the few to treat complex spinal & peripheral nerve disorders. A surgeon-scientist funded by NIH & DOD for his research on nerve regeneration
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65 F w/1 yr of belt-line LBP, worse when standing & walking. Cannot walk distances due to leg “heaviness”. Denies radicular symptoms. + Difficulty maintaining upright posture. Can this patient have a durable outcome with a mid-line sparing lami, or is a fusion necessary?
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Nerve Transfers for Cervical Spinal Cord Injury
@ZackRayLab
@WashUNeurosurg
@AANSNeuro
@eapotts
@CAS_Spine
@JohnHShinMD
@thejuansuribe
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How do you determine whether or not a cervical laminoplasty would be an appropriate operation to offer this myelopathic 72 yr old female patient? What surgery would you offer once conservative measures are exhausted?
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Our heartfelt condolences to all whose lives were touched by the amazingly wonderful and talented Dr. Lynda Yang, a true pioneer, leader, surgeon, scholar, mentor and so much more.
It is with a heavy heart that we share the tragic and saddening news that our colleague and friend, Dr. Lynda Jun-San Yang, M.D., Ph.D., (1967-2022) has passed away. (1/5)
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How would you treat this patient with thoracic myelopathy and calcified disc herniation at T7-T8?
#spine
#neurosurgery
#orthopedics
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@spinesection
leadership spotlight: Dr. Khoi Than
@DukeSpine
@Dukeneurosurg
is Chair of the Media Committee and thought leader in MIS surgery, adult deformity surgery, and interbody surface technologies. Ask
@KhoiThanMD
what he thinks about PEEK.
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Congratulations to Dr Shaffrey as the 2024 AANS Cushing Award Medalist! Tremendous honor for him but also for spine surgery!
@AANSNeuro
@CNS_Update
@SRS_org
@eapotts
@JohnHShinMD
@thejuansuribe
@CheeragU
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Leadership Spotlight! Our
#Spine
Section Chair this year is Dr. Michael Steinmetz, who is also Chair of
#Neurosurgery
at the Cleveland Clinic.
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The Art in Scoliosis Surgery: It's Not All Just Measurements
Amer Samdani MD
@AANSNeuro
@eapotts
@CAS_Spine
@ZackRayLab
@JohnHShinMD
@thejuansuribe
@CNS_Update
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Congratulations to past Spine Section Chair Dr. Christopher Shaffrey on being awarded the Cushing Medal. This is AANS highest honor and is in recognition of his tremendous contributions to the field of neurosurgery!
@Dukeneurosurg
@AANSNeuro
@CNS_Update
@SRS_org
@CheeragU
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Case: 25 yr F, MVA, multiple orthopedic injuries. Neurologically normal. CT showed bilateral occipital condyle fractures type II with extension to the skull base/clivus. How would you manage it?
A- Soft collar
B- Rigid collar
C- Crown halo-vest
D- Occipitocervical fusion
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This 50 y/o F presented with chronic neck pain, and progressive right arm/hand pain in C8 distribution. She exhausted medical management. What surgery would you offer?
#spine
#neurosurgery
#orthopedics
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(1/2) Anthony DiGiorgio, DO, MHA testifying today at the United States Senate on "Reducing Paperwork, Cutting Costs: Alleviating Administrative Burdens in Health Care."
@thejuansuribe
@AANSNeuro
@KatieOrrico
@CheeragU
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The DSPN
@spinesection
meeting is in San Diego 7/28-31. This year’s Meritorious Awardee is
@DrNTheodore
from Johns Hopkins Neurosurgery. Register and book your hotel this week!
@CNS_Update
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Do you use steroids to help improve dysphagia after ACDF or arthroplasty? Here is a prospective randomized trial that shows its safe and effective to admin three doses of IV dexamethasone perioperatively.
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CENTRAL CORD CASE answer: The patient underwent early surgery with C6 corpectomy. EBM of central cord: Level III: 1- Surgery is superior to non-surgical treatment. 2- Early surgery should be considered over late surgery.
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Case: 22 year old female suffered a MVA. Neurolgically intact. CT and MRI STIR below. How would you treat?
A-Rigid collar
B-Halovest
C-C1-3 PSF
D-C2-3 ACDF
E-Osteosynthesis
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Check out our educational intraoperative videos on ! Tumor resections, C1/2 fixation, MIS techniques and more!
#neurosurgery
#orthopedics
#spine
@CNS_Update
@AANSNeuro
@EANSonline
@EANS_yns
@SRS_org
@AOSpine
@NASSspine
0
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Dr. Mike Groff
@BWHNeurosurgery
, past chair of the spine section, presents on C1-2 posterior cervical fusion techniques
@AANSNeuro
#AANS2022
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Case of the day: A 53 M presents with 1 mos of mid-back pain & 2 days of rapidly progressive paraparesis. He has a remote hx of a dog bite 4 months ago. How would you treat this case of EDA, osteo/discitis? Is upfront instrumentation necessary?
#spine
#neurosurgery
#orthopedics
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Let us all remember that June is
#ScoliosisAwarenessMonth
. This wonderful patient population often presents with some of most challenging surgical pathology. We should always strive for early detection, while ensuring specialists with expertise are involved in their care.
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#Spinesection
faculty spotlight: Dr Stephanus Viljoen of The Ohio State University. Dr Viljoen is a world class complex spine and deformity neurosurgeon who treats the full spectrum of spinal disorders using the latest technology.
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Check out this past month’s
@TheJNS
Neurosurgical Focus edition on cervical spondylotic myelopathy.
Many fantastic articles & videos highlighting the latest advances in the treatment of CSM.
#neurosurgery
#orthopedics
#spine
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Previous post: The patient with C2 pathological fracture due to mets br ca causing instability was treated with traction to reduce the deformity and OC fusion. Her neck pain resolved following surgery. Note the reconstitution of bone at the 2 yr f/u with appropriate treatment.
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Benzel biomechanics: Implants fail at the pt of max stress. Stress is M/Z. M is the applied moment & Z is strength determined by 3rd power of diameter. If D is uniform, pt of max stress is determined by pt of max M. If D is not uniform stress is influenced by rate of change of D
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Why is it challenging to achieve a fusion at the CVJ?
1-Significant motion, especially flexion moment
2-Recipient bed for bone graft is widely separated & available space for grafting is limited
3-Cortical bone nature of the occiput
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Congratulations to the authors on this work, published online before print
@TheJNS
, analyzing factors influencing open or MIS deformity correction approaches. Take home points: Older patients -> MIS, larger curves -> open.
#neurosurgery
#orthopedics
#spine
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This 53 yr old F presented to the ED with 24 hrs of rapidly progressive tetraparesis (3/5 proximal BUE, 2/5 distal BUE, 0/5 BLE), & significant loss of sensation in all extremities. 10 days earlier, she had a C5/6 epidural injection for radiculopathy. What is your dx and plan?
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How would you treat this patient with thoracic myelopathy and large disc herniations at T8-T9, T9-T10, T10-T11, AND T11-T12?
#spine
#neurosurgery
#orthopedics
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Honored to welcome
@DKondziolkaCNS
, Editor-in-Chief of
@NeurosurgeryCNS
to Spine Summit 2023 in Miami to share his insights on publishing and spine surgery.
@CNS_Update
@AANSNeuro
@NYUneurosurgery
#neurosurgery
#orthotwitter
1
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How would you manage a VA injury? Check out this
@CNS_update
ONS video from
@BarrowNeuro
& lecture by Dr. Ames
@NeurosurgUCSF
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Nader Dahdaleh presents on optimizing finances in academic neurosurgery during the business session this morning
@spinesection
@NaderDahdaleh
@NeurosurgeryNM
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Thank you to everyone who attended and made the Spine Summit 2022 a success! See you in Miami in 2023!
#neurosurgery
#orthropedicsurgery
#spine
0
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Standalone interbody implants are increasingly utilized in the cervical spine. Are they optimal for one level only or as effective for multilevel use? Are there still indications for plating?
#spine
#neurosurgery
#orthopedics
@CNS_Update
@AANSNeuro
5
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Dysphagia is common after multilevel ACDF - what tricks/techniques do you use to mitigate against this?
#neurosurgery
@AliBaajMD
@KhoiThanMD
@JohnHShinMD
@jrasouli
@NaderDahdaleh
@SpineNeuro
@SNeurosurgS
@DrBenRodgers
@MGalganoMD
@Chicago_Spine
@martinphammd
@MartinaStippler
4- and 5-level anterior discectomy and fusion can be done, but one of the potential side effects is
#dysphagia
, read about it in new
#onlinefirst
article in
@TheJNS
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Our
@spinesection
weekly spotlight is on Hasan Zaidi MD
@hasaqd
of
@BWHNeurosurgery
@harvardmed
. Dr. Zaidi trained
@BarrowNeuro
and is Co-Director of the Brigham Spinal Deformity Program. Meet him in Vegas
@Cosmopolitan_LV
during the SpineSummit 2020 where he will moderate.
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This patient was treated with a T11 corpectomy (NSCLC) & ventral cage reconstruction, followed by resection of the T9 intradural tumor (meningioma).
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Leader spotlight: Dr John Knightly, an expert in complex spinal disorders & neurotrauma. He is the vice-chair of the Atlantic Health Institute, NJ. He was a previous president of AANS spine section & director of the ABNS. He is an honored guest awardee at spine summit 2022.
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How would you treat this patient with thoracic myelopathy? Lesion at T9-T10.
#spine
#neurosurgery
#orthopedics
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