Scientific Program

Day 1 :

Keynote Forum

Stylianos Kapetanakis

Assistant Professor, Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece.

Keynote: The role of Full-Endoscopic Spine Surgery in Lumbar Disc Herniation surgical treatment: Routine and complex cases

Time : 09:30-10:00

Biography:

Dr. Kapetanakis is an Orthopaedic Surgeon-Spine Surgeon and Assistant Professor of Anatomy in Democritus University of Thrace, Greece. He has his expertise in Minimally Invasive Spine Surgery (MISS) and is the director of South East Endoscopic Spinal Center in European Interbalkan Medical Hospital in Thessaloniki, having performed more than 450 such surgical operations to date. He actively participates to conformation and development of MISS by enriching medical literature with his original research. After years of teaching and performing the innovative MISS techniques, he is established as one of the primary representatives of MISS in Europe. 

Abstract:

Statement of the Problem: Lumbar Disc Herniation (LDH) represents a frequent spine disorder in clinical practice. Conservative treatment constitutes the first step in the therapeutic strategy. Nevertheless, the failure of conservative management imposes surgical intervention. Full-Endoscopic Lumbar Discectomy (FELD) is considered as a beneficial alternative over the current gold standard, conventional microdiscectomy (CD). FELD may be applied by transforaminal or interlaminar route, being associated with preservation of normal anatomy and lesser perioperative morbidity over CD. Aim of this concentrative analysis is to delineate the role of Transforaminal Full-Endoscopic Discectomy (TFED) in miscellaneous clinical scenarios of LDH.

Methodology: 460 patients with LDH were prospectively studied. Recorded comorbidities included Parkinson Disease (PD) in 15 patients and morbid obesity in 20 patients. 45 patients were operated for a Recurrent LDH (RLDH) after CD, whereas 150 patients featured Lateral Recess Stenosis (LRS). 230 patients featured no comorbidities. All patients were subjected to TFED. Clinical evaluation was performed preoperatively and at 6 weeks and 3, 6 and 12 months postoperatively. Visual Analogue Scale for Leg and Back Pain (VAS-LP and VAS-BP), Oswestry Disability Index (ODI) and Short-Form 36 (SF-36) Questionnaire for Health-Related Quality of Life (HRQoL) analysis were appropriately implemented.

Findings: VAS and ODI featured a significant amelioration (p<0.05) 12 months postoperatively in patients with PD. Furthermore, VAS-LP and VAS-BP parameters were considerably improved at the same interval for patients with RLDH, morbid obesity and LRS. Regarding HRQoL, all distinct aspects of SF-36 were, in general, demonstrated to be remarkably enhanced 12 months postoperatively in all patient groups. 

Conclusions: Despite recorded differentiations between the groups, TFED was concluded to be related to improved postoperative functional outcomes in various clinical conditions that may co-exist with LDH. Our analysis indicates that TFED represents a feasible and efficacious alternative in different clinical occasions, where CD conduction may be harmful.

Keynote Forum

Akhil Chhatre

Director of Spine Rehabilitation, The Johns Hopkins University, Baltimore, USA

Keynote: Non-surgical management of Failed Back Syndrome

Time : 10:00-10:30

Biography:

Akhil Chhatre is an assistant professor of Physical Medicine and Rehabilitation and Neurological Surgery at the Johns Hopkins University School of Medicine. He is the Director of Spine Rehabilitation at Johns Hopkins. He sees and treats adults with a wide range of Spinal Diseases and Disorders, including Neck and Low Back Pain, Lumbar and Cervical Degenerative Disease, Scoliosis, Spinal Stenosis, Facet Joint Disease, Whiplash Syndrome, Sacroiliac and Appendicular Skeletal Joint Disease, and Peripheral Neuropathy. He has a special interest in helping patients regain function and reduce pain using non-surgical techniques and performing pain-reducing medicinal procedures, including steroid injections, nerve blocks and radiofrequency denervation. He received his medical degree from the University of Missouri School Of Medicine and completed his residency in Physical Medicine and Rehabilitation at the University of Kansas Medical Center School Of Allied Health. He performed his fellowship in Interventional Spine and Sports Medicine at the University of Pennsylvania. Previously, he worked as an Interventional Spine and Sports fellow at the Hospitals of the University of Pennsylvania after completing a residency in Physical Medicine & Rehabilitation at the University of Kansas Medical Center. He is also a member of the American Academy of Physical Medicine & Rehabilitation, the International Spine Intervention Society, and the North American Spine Society.

Abstract:

There is a large population of patients who have undergone some type of spinal surgical intervention with or without revision and complaints of persistent pain. They are given a label of failed back surgery and offered little hope or answers as to their pain generators, the chance of improvement, or sustainable lifestyle options. We will discuss during this talk the pathophysiology, realistic expectations, and treatment options. 

Keynote Forum

Walid Ismail Attia

Director, Spine Fellowship Program Departments of Neurosurgery/Spine Surgery National Neuroscience Institute, King Fahad Medical City Riyadh, Kingdom of Saudi Arabia.

Keynote: Managing Hardware to revise complex spine cases; would the O-Arm and Neuronavigation be a magic wand in the hands of the surgeon or just a burden?

Time : 11:00-11:30

Biography:

Dr Walid Ismail El Shahat Aly Attia has received his PhD in Neurosurgery from Shinshu University School of Medicine during the period of 2003. Currently, he is working as Consultant in Departments of Neurosurgery/ Spine Surgery in National Neuroscience Institute, King Fahad Medical City. He has successfully completed his Administrative responsibilities. His research has included Microvascular pathology, cervical kyphotic deformity, Minimally invasive surgery. Based on this research and fellowship training he has received several awards and honors, such as: Recipient of the Outstanding Graduation award (top 30 graduates) in the Republic High School Diploma examination, the Egyptian Ministry of Education. 1986 and Recipient of the Outstanding Graduation award and Honors, Tanta University Faculty of Medicine (4th on class of 320 graduates) 1992. He is serving as an editorial member of several reputed journals like Journal of Medicine and Medical Science, Journal of Psychiatry and Neuroscience, Journal of Clinical and Experimental and many more. He has authored approximately 8-9 research articles and 7 books.
 

Abstract:

Purpose: The type and extent of surgeries carried out for complex spine disorders still lacks evidence-based medicine proof. It is up to the health care providers sound judgement and expertise to do what is needed for the patient. This is even worse for revision spine surgeons. Surgical challenges include yet not limited to; removal of misplaced or displaced hardware near vital structures, decompression near vital vascular or neural structures, decompression at a blind angle, and difficult trajectories for instrumentation and re-instrumentation. The use of intraoperative CT-quality O-arm, and neuronavigation are still tested as aiding tools in such operative modalities.
Methods: We randomly selected 10 cases of complex spine modalities that were operated upon in the years 2013- 2018 in our institute by the author to be included in this retrospective study. Cases include traumatic spinal fractures, infective, inflammatory, benign and malignant neoplasms affecting different parts of the spinal column. All of them had technical challenges regards misplaced hardware and re-instrumentation. All had undergone a combination of decompression and instrumentation of different modalities and/or bone grafting. In all cases the Medtronic O-arm and Medtronic StealthStation were used as intraoperative mapping tools.
Results: Intraoperative navigation tools were so useful in securing safe hardware removal, adequate neural decompression, neural and vascular tissue safety together with tough bony purchases of the hardware from the first and only trial of application. Intraoperative CT taken by the o-arm was a useful confirmatory intraoperative test for final proper hardware placement. A group of technical problems have been faced. All are studied in some details.
Conclusion: The intraoperative use of the O-arm and stealthStation is very useful in different modalities of revision complex spine surgeries. Some technical problems were addressed and studied. A learning curve is mandatory to feel comfortable with that technology.

  • Spinal Rehabilitation and Nursing Care
Location: Marriott Executive Apartments Al Jaddaf
Speaker

Chair

Peter Fritzell

Spine Surgeon, Futurum Academy for Health and Care, Jönköping, Sweden.

Session Introduction

Peter Fritzell

Spine Surgeon, Futurum Academy for Health and Care, Jönköping, Sweden.

Title: 1. Spine surgery discussion with the patient; The "Dialogue support – A prediction tool based on data from the Swedish national quality spine register
Speaker
Biography:

Abstract:

Peter Fritzell

Spine Surgeon, Futurum Academy for Health and Care, Jönköping, Sweden.

Title: 2. Cost and Health Outcomes Patterns in Patients Treated With Spinal Cord Stimulation Following Spine Surgery - A Register Based Study
Speaker
Biography:

Abstract:

  • Treatment of Spinal Disorders
Location: Marriott Executive Apartments Al Jaddaf
Speaker

Chair

Said Osman

Founder, Sky Spine Endoscopy Institute Frederick, MD 21702, United States.

Session Introduction

Jiaquan Luo

Associate Professor The First Affiliated Hospital of Gannan Medical University Ganzhou, Jiangxi - China.

Title: Incidence of dysphagia of zero-profile spacer versus cage-plate after anterior cervical discectomy and fusion A meta-analysis
Biography:

Abstract:

Pranaw Kumar

International Training Fellow, Royal Preston Hospital, Preston, United Kingdom.

Title: Abdominal Vascular Injury During Posterior Lumbar Discectomy
Biography:

Abstract:

Malcolm Pestonji

Head of Spine Unit, MGM University of Health Sciences, Mumbai, India.

Title: Transforaminal Endoscopic Spine Surgery - An evolving concept
Biography:

Abstract:

Day 2 :

Keynote Forum

Ahmed Abdulhadi Al Jishi

Neurosurgeon, Hamilton General Hospital, USA

Keynote: The Role of cervical MRI in post-traumatic cervical bilateral jumped facets: A Meta-analysis

Time : 09:30-10:00

Biography:

Abstract:

Background: Bilateral jumped facets (BJF) are serious cervical spine injuries that require reduction and surgical stabilization. Closed reduction is often performed, however, the argument of having an associated disc herniation has suggested deferred surgical treatment until MRI is done. Such an approach has been criticised for delaying cord decompression and lower the chance of recovery.

Purpose: Evaluate the impact of MRI in determining the outcome of bilateral jumped facets who requires an immediate closed reduction 

Study design: Systematic review

Patient sample: Acute posttraumatic cervical bilateral jumped facets

Outcome measures: Frankel grade at long-term follow-up

Methodology: We conducted a systematic review focusing on BJF to assess the validity of performing an MRI before closed reduction. Due to the paucity of reports, we included all retrospective and case series that described the management of each individual. In order to monitor the neurological function, we unified the neurological grades to follow Frankel grading system. The neurological state was monitored from the time of admission, post closed reduction and after surgical stabilization. The immediate neurological state after closed reduction and long term neurological outcome were the primary goals of the study, which were compared between two groups based on the event of obtaining MRI before closed reduction.

Results: A total of 56 articles were found (1973-2019) through English literature. Twenty articles were included based on inclusion criteria. A total of 203 BJF were evaluated with C6/7 and C5/6 being the most common levels of injury. Closed reduction was performed in 194 patient with no MRI scanning in 118 patients. Clinical changes in post-reduction had occurred in 7 patients (3 improved, 2 worsened, 2 transient worsenings). The long term outcome showed no significant difference in neurological function between the two groups who had closed reduction before or after the MRI (p>0.05).

Conclusion: Cervical MRI may be useful in post-traumatic BJF, however, the closed reduction should not be delayed by obtaining pre-reduction MRI. The risk of neurological worsening is low and insignificant in patients who underwent closed reduction without a pre-reduction MRI. The MRI will be helpful in immediate post reduction to assess the status of the spinal cord and the adequacy of closed reduction, especially in comatose patients.

 

Keynote Forum

Ayush Sharma

Consultant Orthopedic Spine Surgeon, Department of Orthopedic and Spine surgery, Dr. Babasaheb Ambedkar Central Railway Hospital, Mumbai, India.

Keynote: Minimally invasive surgery for degenerative lumbar pathology an institutional experience

Time : 10:00-10:30

Biography:

Abstract:

Aim: Aim of the study was to compare the functional outcome of open vs minimally invasive surgery in degenerative lumbar pathology.

Material and methods: All patients undergoing surgery for degenerative lumbar pathology were prospectively followed for one year. VAS (Visual analogue score), ODI (Oswestry Disability Index) were used to analyse the functional outcome at post-operative period day one, two weeks, One month, three months, Six months and one year. Data was divided into open and minimally invasive group ( MIS) and analysed .P value <0.05 was taken as significant .

Result: 488 patients were included in the final analysis . 164 were from MIS group and 242 underwent open surgery . TLIF was done 142 patents of which 56 (39.4%) underwent MIS TLIF .240 patients were operated for discectomy . 104 (43.3%) were from MIS group and 136(56.6%) underwent open discectomy . While pre-operative mean VAS scores were comparable for both the groups . Follow up VAS scores were significantly better for MIS group at post-operative day one(P=0.001), two weeks(P=0.001),One month(P=0.001), three months(P=0.003) and Six months. (P=0.023) . Similarly ODI scores were also significantly better for MIS group at post-operative day one(P=0.004), two weeks(P=0.001) and one months(P=0.003). No significant difference was found between one year VAS scores between the two groups (P=0.145). . Similarly ODI scores were comparable between the two groups at three months, Six months and one year . Incidence of dural tear was slightly less (14.4%) in minimally invasive group compared to open surgery (16.13%) without any significant statistical difference(p=0.698). While two cases of dual tear from open group required revision exploration and re-suturing. No cases of CSF leak during MIS procedure required operative revision.

Conclusion: Functional outcome of minimally invasive surgery for degenerative lumbar pathology are comparable with open surgery with significantly improved VAS scores up to 6 months and significantly better ODI scores up to one month for the MIS group.