Spanish & Portuguese Spine Societies Course Diploma. Module 3: Spinal Deformities

PATHOGENESIS AND NATURAL HISTORY OF AIS
• Know concepts of development of AIS and subsequent implications for surgical treatment
• Describe the natural history of AIS
CLASSIFICATION AND SURGICAL INDICATIONS
• Know the pertinent classification systems and their limitations
• Understand and formulate surgical indications
• Goals of surgery for AIS
SELECTION OF FUSION LEVELS
• Use classification to determine the end limits of fusion (Lenke)
• Understand factors which may determine fusion levels such as curve flexibility, adding on etc.
• Define the lower and upper limit of instrumentation
SURGICAL STRATEGY: POSTERIOR APPROACH
• Formulate principles of surgical correction of AIS
• Understand the role of the sagittal plane in AIS and for surgical correction
• Evaluate strategic surgical options
• Recognise indications for a posterior or combined approach
SURGICAL STRATEGY: ANTERIOR APPROACH
• Differentiate between anterior release, anterior fusion and anterior instrumentation
• Select appropriate approach for procedure
• Recognise indications for anterior approach and anterior instrumentation

NEUROMUSCULAR SCOLIOSIS
• Describe the aetiology and prognostic factors associated with neuromuscular scoliosis
• Identify factors indicating progression or risk to neurological structures
• Evaluate management options
• Assess associated pulmonary and cardiac problems
CONGENITAL SPINAL DEFORMITIES
• Relate the stages of development to deformities of the spinal cord
• Select appropriate investigations
• Evaluate treatment options
HYPERKYPHOSIS (CONGENITAL, SCHEUERMANN, ANKYLOSING SPONDYLITIS…)
• Differentiate between the aetiology and prognostic factors associated with regular and angular kyphosis
• Evaluate management options
CORRECTING HYPERKYPHOSIS
• Review the spinal osteotomy options
• Explain how to correct Scheuermann kyphosis versus congenital kyphosis

SPONDYLOLISTHESIS: PATHOGENESIS AND CLASSIFICATION
• Describe the pathogenesis and causes of developmental spondylolisthesis
• Differentiate between high- and low-grade spondylolisthesis
• Know current classification systems
SPONDYLOLYSIS, LOW-GRADE OLISTHESIS
• Understand patho-anatomic features
• Know surgical indications
• Select appropriate surgical technique
HIGH-GRADE SPONDYLOLISTHESIS
• Describe the patho-anatomy of high-grade spondylolisthesis
• Differentiate between balance and unbalanced olisthesis
• Know different surgical techniques
• Understand the pros and cons of reduction vs. in situ fusion

PEDICLE SCREW GUIDANCE IN DEFORMITY
• Assess appropriate placement
• Minimise the risk of misplacement
• Balance the pros and cons of spinal navigation
• Assess the advantages and disadvantages of freehand probing
SACRO-PELVIC FIXATION
• Choose different options of sacro-pelvic fixation
• Describe surgical technique for CadLab

CAD LAB 1: ILLIO-SACRAL FIXATION: ILLIO-SACRAL SCREW PLACEMENT
• Identify key structures of the lumbo-sacral anatomy
• Identify the S1 screw entry points
• Relate anterior vascular structures and screw placement
• Prepare iliac screw holes
• Integrate safety measures and assess risks
• Place iliac instrumentation and connect to the lumbo-sacral construct
CAD LAB 2: THORACIC PEDICLE SCREW FIXATION & HYBRID SOLUTIONS
• Approach the posterior thoracic spine
• Identify anatomical screw entry points
• Anticipate the risks and pitfalls
• Perform free hand technique to prepare a screw hole
• Check integrity of screw hole by pedicle probe
• Place pedicle screw
• Prepare facet joint and place pedicle hook
• Place transverse process and lamina hooks