Spine Surgery Resident Objectives
From a clinical standpoint the junior level resident is expected to assess in an effective fashion clinical signs and symptoms associated with spinal disorders. This clinical assessment incorporates the history, neurological examination and the formulation of appropriate diagnostic modalities necessary to diagnose and treat patients with spinal ailments. Through comprehensive lectures focusing on the anatomy, radiology and biomechanics of the spine the JR will acquire the basic knowledge to achieve the aforementioned goals. In-services will expose the JR to the multitude of spinal instrumentations and their appropriate utilization, spinal orthotics, and placement of halos. In addition, the JR will be responsible in conjunction with the chief resident and the ICU team to coordinate and implement a comprehensive treatment plan for patients suffering from spinal cord injury beginning from ER management to traction, close reduction, and cardiopulmonary stabilization.
The operating room experience will consist of a gradual process understanding the basic surgical anatomy while performing lumbar and cervical discectomies and laminectomies. This step is critical since the majority of these patients have severely distorted anatomy from extensive arthritic changes. By the end of the rotation it is expected that the JR is able to perform a non instrumented decompressive procedure with minimal supervision as a stepping stool for the VA rotation.
The research experience is tailored by the individual resident. There are many resources available for the residents that explore many aspects of spine (biomechanics) and spinal cord injury related research. There is a close collaboration between the neuroscience community and the department of orthopedics enabling the resident to choose from a wide variety of research topics. Under the supervision of a laboratory mentor a focused and realistic proposal is formulated with the expectation for publication in peer review journals and presentations at national meetings.
The SR is primarily responsible for managing the pediatric service. There is considerable amount of opportunity during this year to be involved in all aspects of spine related disorders. In conjunction with the orthopedic department the SR is encouraged to participate in deformity spine cases in order to obtain a better appreciation of the physio-biomechanical forces required for corrective surgery. This knowledge acquisition translates directly to the application of corrective forces involved in degenerative scoliosis that is becoming more predominant in our patient population as well as in metastatic lesions and traumatic injuries. The SR will become more verse in managing complex craniovertebral junction abnormalities, including degenerative, congenital, acquired (traumatic or postoperative), and metastatic lesions. By the end of the rotation it is expected that the SR can effectively diagnose, formulate and implement a comprehensive treatment plan that is clinically sound and meets the expectations of the spine program.
With these skills in place the chief resident is responsible for administrating effectively and facilitating the care of patients with spinal disorders. The CR is fully independent in coordinating the aforementioned goals and is responsible for tailoring their training to meet their needs and enhance their clinical experience. The CR is the primary source for guidance to all the residents under the direct supervision of the spine attending.
Outline - Spine surgery expectations
- Anatomy: Radiological evaluation, Neuro examinations, Management of spinal cord injury
- Surgical: Laminectomy lumbar, Discectomy cervical and lumbar
- Assistant resident: Biomechanics
- Assess patients effectively and develop a plan
- Follow up with multidisciplinary approaches to spine
- Basic principles of instrumentation and biomechanical construction
- Research: Laboratory options, Presentations in meetings
- Pediatric spine care
- Craniovertebral junction instrumentation
- Master all aspects of instrumentation
- 360 approaches in the spine
- All aspect of care and surgery
Framed and Frameless Stereotaxy
The theory and practice of the use of the CRW, Leksell and frameless stereotaxy systems are taught throughout residency. These include cases where this technology is utilized for functional neurosurgery as well as for neoplasm biopsy, stereotactic craniotomy and for the placement of diagnostic electrodes for epilepsy surgery. The methods of registration and the sources of error with the use of these devices are discussed throughout residency.
The department is actively engaged in academic research in the field of functional neurosurgery. In addition to the many basic science areas of research in epilepsy, there is current NIH funding for the development of novel techniques for intraoperative navigation (5R01EB000473-04) and for the use of viral vectors encoding hGDNF for the treatment of Parkinson’s disease (5U01NS046028-02).