Spine Rotation

At VGH, the majority of spine cases are treated on the Combined Ortho and Neurosurgical Spine service. Residents rotate though this service a total of 9 months (3 as a junior and 6 as a senior resident). Extra rotations can be arranged depending on resident interest/requirements. This rotations count towards the overall number of resident’s clinical neurosurgical in-training months/requirements.

Clinical Objectives

At the end of the rotation to the Spine Program, the resident will be able to:

  1. Describe the anatomy and embryology of the spine – including the vertebral segments, discs, joints and ligaments
  2. Describe the anatomy and physiology of the spinal cord- including vasculature, major tracts, zones, segments, and nerve roots.
  3. Describe the biomechanics of the spine – in normal and pathologic states.
  4. Spinal Cord Injury:
    • Outline the major mechanisms of injury and the pathogenesis of spinal cord injury.
    •  Classify and describe the types of bony, ligamentous and neurologic injury at each level of the spine and spinal cord.
    • List the general and associated effects of the spinal cord injury to the cardiovascular, respiratory, urological and other systems.
    • Describe all aspects of the surgical and non-surgical management of each level of spinal and spinal cord injuries, including general, urologic and respiratory care; indications for neurological decompression and indications for external and internal spinal stabilization
    • Discuss the principles of spinal stabilization – external and internal fixation; including indications, risks and benefits, and approaches
    • The delayed and chronic effects of injury to the spinal cord including pain and delayed neurological deterioration.
    • The psychological and social and family effects of spinal cord injury.
  5. Degenerative disc disease:
    • Describe the neurological syndromes of degenerative disc disease and indications for surgical management
    • Describe degenerative spinal instability and the indications for internal stabilization.
  6. Acute spinal cord compression:
    • Describe all aspects of spinal infection, general care, antibiotic management, surgical decompression and indications for stabilization.
    • Describe all aspects of acute metastatic compression and indications for surgical decompression, stabilization and adjuvant therapy.
  7. Spinal cord neoplasms:
    • Describe and manage all juxtamedullary and intramedullary neoplasms of the spinal cord.
  8. Vascular and other affections of the spinal cord.

During the rotation, all residents should fulfill the Royal College’s CanMEDS Competencies.

COMMUNICATOR:

  • Establish therapeutic relationships with patients and families.
  • Conduct, document and present history and physical exam.
  • Document operative and progress notes.
  • Perform/communicate discharge summaries appropriately
  • With appropriate supervision discuss relevant information with patients and family.
  • With appropriate supervision obtain consent for surgery
  • Share and present information with other health care providers

COLLABORATOR:

  • Work/collaborate effectively in an interdisciplinary team
  • Consult appropriately
  • Be able to work with other healthcare providers and paramedical personnel on multiple levels
  • Take part in educational activities and teaching
  • Be able to share workload and duties appropriately
  • Be able to listen and respond appropriately to concerns of other health care providers

MANAGER:

  • Effectively utilize and allocate finite resources
  • Manage own time, education and personal life for a balanced lifestyle
  • Work effectively and efficiently
  • Triage patients being able to identify spinal emergencies that require prompt and immediate management.
  • To have working knowledge and be able to manage the complete care of patients on the Neurosurgical ward.
  • To be able to delegate effectively
  • To be able to share and assign surgical cases appropriately

HEALTH ADVOCATE:

  • Recognize and respond to determinants of health in patients.
  • Respond in appropriate timely manner to these issues.
  • Contribute to overall patient well-being and outcome
  • Facilitate return of patient to community/alternate care
  • Be able to identify and provide community care/resources to support patients

SCHOLAR:

  • Participate in weekly rounds/educational activities and journal club.
  • Identify and seek out personal learning needs
  • Apply principles of critical appraisal to medical information
  • Facilitate patients, student and peer learning.
  • Contribute to development of new knowledge
  • Acquire knowledge in research methods and statistics.
  • Be involved in research projects/presentations supervised by faculty

PROFESSIONAL:

  • To foster collegial relationships with staff and residents, neuroscience nurses and other allied health professionals
  • To develop through observation and practical experience professional tactics for effective, honest discussion with patients and families with respect to challenging issues including delivery of grave diagnoses, withdrawal of care and disclosure of medical error.
  • Exhibit appropriate professional behaviors in practice, including honesty, integrity, commitment, compassion, timeliness, respect and altruism
  • Show appropriate respect for opinions of other health care providers
  • 5)Be able to appraise and identify own limits with respect to knowledge and patient care, and when to ask for assistance and consult effectively.

Understand and have a working knowledge of ethics in context of clinical care

Technical Objectives

In addition to the above knowledge objectives, the following technical objectives should be learned.

  1. External immobilization – including skull tongs, traction, halo fixation and all external orthoses.
  2. All manners of decompression of the spinal cord.
  3. All procedures for neurological complication of degenerative disc disease
  4. All procedures for neoplasms, vascular and other conditions of the spinal cord.
  5. Internal Stabilization including anterior and posterior cervical fixation, placement of thoracic and lumbar pedicle screws, use of various fixative rods and basic fusion techniques.

 

Academic Activities

When assigned to the spine service, the following rounds are available for participation:

  • Spine Rounds
  • Spine Clinics & Brenda and David Mclean Integrated Spine Clinics at the Blusson Spinal Cord Centre: These are multidisciplinary clinics run by neurosurgical and orthopaedic spine surgeons as well as physiatry and generalist/chiropractor. They occur though out the week and residents while they are on the spine service are expected to attend the clinics with the staff surgeon they are assigned. A resident will attend 1-2 clinics per week.
  • Spine Journal club: Hosted by one of the attending faculty at their home on an approximately monthly basis throughout the academic year. A relevant topic is selected, and papers assigned to each resident for review and discussion. These papers are pre-circulated and the residents are expected to attend the Journal Club having reviewed the papers to be discussed. All residents are invited to attend.