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Neurosurgery News Summer 2017

In this issue of Neurosurgery News, specialists discuss minimally invasive sacroiliac joint fusion, role of ssep monitoring,  risk factors that increase the risk of neurological deficits following thoracolumbar spinal fusion surgery, improving the health and wellness of the neurosurgeon, and innovations in the field.

Educational objectives:

Upon completion of this activity, participants should be able to:

  • Increase resident and faculty quality of life by implementing burnout prevention.
  • Improve their self-awareness to improve a more balanced lifestyle approach to work,family, physicality and spiritual growth.
  • Improve diagnostic skills for identifying sacroiliac joint dysfunction, so that this disease process is part of the differential diagnosis of low back pain.
  • Improve their management of patients undergoing a sacroiliac joint fusion, which will improve patient outcomes.
  • Reduce incidence of position related neuropraxia with the correct utilization of intraoperative SSEP monitoring.
  • Implement safeguards for protecting position related neuropraxia in spine surgery.
  • Closely follow recommended processes for intraoperative patient positioning and procedures for SSEP monitoring, with interpretation of results of the SSEP monitoring and make appropriate corrections in patient positioning to prevent postoperative deficits.
  • Improve the growth of thoracolumbar fusion surgeries and the current indications
  • Recognize the complication rate associated with these procedures
  • Recognize the risk factors for perioperative neurological deficits associated with these surgeries

Reading Resources:

  1. Andrew J. Jager, MA; Michael A. Tutty, PhD; and Audiey C. Kao, MD, PhD, Association Between Physician Burnout and Identification With Medicine as a Calling, Mayo Clin Proc. 2016;nn(n):1-8
  2. Shanafelt TD, Mungo M, Schmitgen J, et al. Longitudinal study evaluating the association between physician burnout and changes in professional work effort. Mayo Clin Proc. 2016; 91(4):422-431.
  3. Shanafelt TD, Hasan 0, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014 [published correction appears in Mayo Clin Proc. 2016;91(2):276]. Mayo Clin Proc. 2015;90(12): 1600-1613.
  4. Nuwer MR, Dawson EG, Carlson LG, Kanim LE, Sherman JE. Somatosensory evoked potential spinal cord monitoring reduces neurologic deficits after scoliosis surgery: results of a large multicenter survey. Electroencephalogr Clin Neurophysiol. Jan 1995;96(1):6-11.
  5. Kelleher MO, Tan G, Sarjeant R, Fehlings MG. Predictive value of intraoperative neurophysiological monitoring during cervical spine surgery: a prospective analysis of 1055 consecutive patients. J Neurosurg Spine. Mar 2008;8(3):215-221.
  6. Polly, D. W., Cher, D. J., Wine, K. D., Whang, P. G., Frank, C. J., Harvey, C. F., . . . Sembrano, J. N. (2015). Randomized Controlled Trial of Minimally Invasive Sacroiliac Joint Fusion Using Triangular Titanium Implants vs Nonsurgical Management for Sacroiliac Joint Dysfunction. Neurosurgery, 77(5), 674-691. doi:10.1227/neu.0000000000000988
  7. Rudolf, L. (2012). Sacroiliac Joint Arthrodesis-MIS Technique with Titanium Implants: Report of the First 50 Patients and Outcomes. The Open Orthopaedics Journal TOORTHJ, 6(1), 495-502. doi:10.2174/1874325001206010495
  8. Zaidi, H. A., Montoure, A. J., & Dickman, C. A. (2015). Surgical and clinical efficacy of sacroiliac joint fusion: A systematic review of the literature. Journal of Neurosurgery: Spine, 23(1), 59-66. doi:10.3171/2014.10.spine14516
  9. Rajaee SS, Bae HW, Kanim LE, Delamarter RB. Spinal fusion in the United States: analysis of trends from 1998 to 2008. Spine (Phila Pa 1976) 2012;37:67-76.
  10. Deyo RA, Gray DT, Kreuter W, Mirza S, Martin BI. United States trends in lumbar fusion surgery for degenerative conditions. Spine (Phila Pa 1976) 2005;30:1441-1445; discussion 1446-1447.
  11. Goz V, Weinreb JH, McCarthy I, Schwab F, Lafage V, Errico TJ. Perioperative complications and mortality after spinal fusions: analysis of trends and risk factors. Spine (Phila Pa 1976) 2013;38:1970-1976.
  12. Cramer DE, Maher PC, Pettigrew DB, Kuntz Ct. Major neurologic deficit immediately after adult spinal surgery: incidence and etiology over 10 years at a single training institution. J Spinal Disord Tech 2009;22:565-570.

Disclosures:

Drs. Paschel, Gandhoke, Nwachuku, Maroon, and Friedlander have reported no relevant relationships with proprietary entities producing health care goods or services.

Peter Gerszten, MD, is a consultant for Zimmer Biomet. L. Dade Lunsford, MD, is a consultant for DSMB and Insightec. He is also a stockholder in Elekta AB.

All presenters disclosure of relevant financial relationships with any entity producing, marketing, re-selling, or distributing health care goods or services, used on, or consumed by, patients is listed above.  No other planners, members of the planning committee, speakers, presenters, authors, content reviewers and/or anyone else in a position to control the content of this education activity have relevant financial relationships to disclose.

Accreditation Statement:

The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The University of Pittsburgh School of Medicine designates this enduring material for a maximum of .5 AMA PRA Category 1 Credits™. Each physician should only claim credit commensurate with the extent of their participation in the activity. Other health care professionals are awarded (0.05) continuing education units (CEU) which are equivalent to .5 contact hour.

For your credit transcript, please access our website 4 weeks post-completion at http://ccehs.upmc.edu and follow the link to the Credit Transcript page. If you do not provide the last 5 digits of your SSN on the next page you will not be able to access a CME credit transcript. Providing your SSN is voluntary.

Release Date: 5/31/2017 | Last Modified On: 5/31/2017 | Expires: 5/31/2018

Additional Resources

Presenters

Erin Paschel, PA-C

Erin Paschel, PA-C Clinical Instructor
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Peter C. Gerszten, MD, MPH, FACS

Peter C. Gerszten, MD, MPH, FACS Peter E. Sheptak Professor of Neurological Surgery
Vice Chairman, Quality Improvement
Director, Percutaneous Spine Service
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Robert M. Friedlander, MD

Robert M. Friedlander, MD On June 1, 2010, Robert Friedlander, MD, MA, became the fourth chair in the department’s history. Prior to joining the department, Dr. Friedlander was professor of neurosurgery at Harvard Medical School and vice-chairman of neurosurgery and associate director of cerebrovascular surgery at Brigham ...
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Gurpreet S. Gandhoke, MD

Gurpreet S. Gandhoke, MD Gurpreet S. Gandhoke, MD, began his neurosurgery residency at the University of Pittsburgh in July 2013. He completed his medical school and master’s degree in surgery at the University of Pune, India. He graduated from a neurosurgery residency at the King George’s Medical University in India.
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Enyinna Nwachuku, MD

Enyinna Nwachuku, MD PGY-2 Resident
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Joseph C. Maroon, MD, FACS

Joseph C. Maroon, MD, FACS Tri-State Neurosurgical Associates - UPMC
Office Address(es):
UPMC West1600 Coraopolis Heights Road
Coraopolis, PA 15108
Phone: (888) 234-4357
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L. Dade Lunsford, MD

L. Dade Lunsford, MD L. Dade Lunsford, MD is the Lars Leksell Professor and Distinguished Professor at the Department of Neurological Surgery at the University of Pittsburgh. He also is director of the Center for Image-Guided Neurosurgery at the University of Pittsburgh Medical Center and an internationally ...
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