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Minimally invasive lateral access to the lumbar spine has gained tremendous popularity. The ability to reach the anterior lumbar spine to perform interbody fusions has allowed surgeons to treat patients with a number of spinal diseases including degenerative disc disease, pseudoarthrosis, adjacent level disease, deformity, tumors and trauma. This course will cover the history, indications, surgical anatomy and techniques for safety navigating through minimal access to the lateral spine. A discussion on proper coding for the procedure will also be included, and a number of case examples will be analyzed.This course includes videotaped podium presentations in conjunction with audio and slides. A post-course evaluation will be given to help reinforce your knowledge.
This course was originally presented to a live audience at the NASS 25th Annual Meeting in Orlando, FL, on October 5, 2010, and has been adapted for online presentation.
John C. Liu, MDFaculty:
Timothy T. Davis, MD
Mark B. Dekutoski, MD
Patrick C. Hsieh, MD
Luiz H. Pimenta, MD, PhD
Gregory J. Przybylski, MD
S. Tim Yoon, MD, PhDLearning Objectives
Upon completion of this course, participants should be able to:
- Assess initial treatment of acute spinal fractures and the importance of trauma severity scores and outcome measures.
- Appreciate the pitfalls of in the treatment of acute spinal fractures in the osteoporotic spine.
- Recognize the inherent danger of acute spinal fractures when the spine is ankylosed and understand appropriate treatment techniques.
- Identify the early and late complications that result from the loss of fixation of the unstable spinal fractures.
- Distinguish the differences and cost of various stabilization techniques & the use of various biologics in acute spinal fractures.
- Welcome and Introductions (Liu)
- History and Background of Minimally Invasive Lateral Spine Access (Pimenta)
- Minimal Access Lateral Approach to Lumbar Spine: Surgical Technique (Hsieh)
- Cases Studies (Liu)
- The Lumbar Plexus and the Transpsoas Approach, An Anatomic and Neurophysiologic Review (Davis)
- Coding and Reimbursement of MIS & Direct Lateral Interbody Surgery (Przybylski)
- Lateral Interbody Spine Surgery: Complication Avoidance (Yoon)
- MAS Deformity: Minimal Access Spinal Surgery/Techniques (Dekutoski)
- Case Studies (Liu)
Continuing Medical Education (CME) Information
This activity has been planned and implemented in accordance with the Essential Areas and Standards of the Accreditation Council for Continuing Medical Education (ACCME). The North American Spine Society is accredited by the ACCME to provide continuing medical education for physicians and takes responsibility for the content, quality and scientific integrity of this CME activity.
The North American Spine Society designates this enduring material for a maximum of 3.5 AMA PRA Category 1 Credit(s)™.
Physicians should claim only the credit commensurate with the extent of their participation in the activity.
The American Medical Association has determined that physicians not licensed in the US to participate in this CME activity are eligible for AMA PRA Category 1 Credits™
This course was released on 5/13/2011, and is available for purchase through 5/12/2014.Appropriate Audience
Target audience includes spine surgeons interested in expanding their understanding and apply DLIF/XLIF in their surgical practice.Conflict of Interest Disclosure
All faculty members provided estimated dollar amounts per the NASS Disclosure Policy through the NASS online disclosure module. NASS staff then translated that information into dollar ranges for purposes of this index, as well as for presentation at the live course. These ranges are as follows:
- None: Existing relationship but no remuneration in prior calendar year
- Level A: $100 to $1000
- Level B: $1,001 to $10,000
- Level C: $10,001 to $25,000
- Level D: $25,001 to $50,000
- Level E: $50,001 to $100,000
- Level F: $100,001 to $500,000
- Level G: $500,001 to $1M
- Level H: $1,000,001 to $2.5M
- Level I: Greater than $2.5M
Davis, Timothy T.: Private Investments: Paradigm Spine (1,000 shares); Speaking and/or Teaching Arrangements: St. Jude Medical (Amount not disclosed); Trips/Travel: St. Jude Medical (Amount not disclosed); Other Office: Alpha Diagnostics (Owner).
Dekutoski, Mark B.: Royalties: Mayo Medical Ventures/Medtronic (A); Consulting: Mayo Medical Ventures/Medtronic (B); Speaking and/or teaching arrangements: Mayo Medical Ventures/Medtronic (B); Fellowship Support: AO Foundation (A).
Hsieh, Patrick C.: Speaking and/or teaching arrangements: Medtronic Sofamor Danek (B).
Liu, John C.: Consulting: Medtronic (B); Speaking and/or teaching arrangements: Medtronic (E); Fellowship Support: DePuy (D), Medtronic (D).
Pimenta, Luiz: Consulting: NuVasive (Imaging costs and provision of devices); Other: Apatech, Pioneer, Globus Medical, Impliant (Imaging costs and provision of devices).
Przybylski, Gregory J.: Stock Ownership: United Healthcare (300 shares); Private Investments: South Jersey CK Leasing (1 share); Speaking and/or teaching arrangements: DePuy Spine (B), NASS Coding Courses (B), Eli Research (B); Trips/Travel: Practicing Physicians Advisory Council to CMS (A, relationship dissolved 2009), Relative-value Update Committee of AMA (B); Board of Directors: NASS (Amount not disclosed); Scientific Advisory Board: United Health Group (B), Humana (C), DePuy Spine (B); Other Office: Eli Research Advisory Editor (B), Council of State Neurosurgical Societies (B).
Yoon, S. Tim: Royalties: Consulting: Medtronic (B), Meditech Advisors (B); Board of Directors: KASS (President); Other Office: The Spine Journal (Associate Editor); Grants: Biomet Spine (F).
Disclosures are current as of November 1, 2010.
The following hardware/software specifications must be met or exceeded to complete this course:
- Web browser and internet connection
- Computer equipped with audio output (speakers or headphones)
- Printer (to print PDF handout)
- Internet Explorer 7 or higher
- Adobe reader 7 or higher
- Microsoft Silverlight (if you do not have the program on your computer, you will be prompted to install it)
- Disable pop-ups
The material presented is made available by the North American Spine Society for educational purposes only. The material is not intended to represent the only, nor necessarily the best, method or procedure appropriate for the medical situations discussed; rather, it is intended to present an approach, view, statement or opinion of the faculty, which may be helpful to others who face similar situations. NASS disclaims any and all liability for injury or other damages to any individual attending the meeting and for all claims which may arise out of the use of the techniques demonstrated therein by such individuals, whether these claims shall be asserted by physicians or any other person.