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ESTEEMED FACULTY

Jens R. Chapman, M.D. Course Co-Chair

Complex Spine Surgeon Swedish Neuroscience Institute

Seattle, Washington

Rod J. Oskouian, M.D. Course Co-Chair

Chief of Spine Director, Spine Fellowship Program

Swedish Neuroscience Institute Seattle, Washington

Amir Abdul-Jabbar, M.D.

Orthopaedic Surgeon Swedish Neuroscience Institute

Seattle, Washington

Neel Anand, M.D. Director of Spine Trauma

Cedars-Sinai Medical Center Los Angeles, California

Sigurd Berven, M.D.

Professor in Residence Chief, Spine Service

Department of Orthopaedic Surgery University of California San Francisco

San Francisco, California

Andrew Dailey, M.D. Professor of Neurosurgery

Chief of Spine Division Department of Neurosurgery

University of Utah Salt Lake City, Utah

Michael Fehlings, M.D., Ph.D.

Professor of Neurosurgery University of Toronto

Toronto, Canada

John France, M.D. Chief, Spine Service; Professor and Vice Chairman

J.W. Ruby Memorial Hospital WVU Medicine Children's

Morgantown, West Virginia

Erik Hayman, M.D. Complex Spine Surgeon

University of South Florida Tampa, Florida

Basem Ishak, M.D. Neurosurgeon

University Hospital Heidelberg Heidelberg, Germany

Andrew Jack, M.D., MSc

Complex Spine and Peripheral Nerve Surgeon Division of Neurosurgery

University of Alberta Edmonton, Alberta

Ashraf El Naga, M.D. Assistant Professor, Spine Trauma

University of San Francisco San Francisco General Hospital

San Francisco, California

Wilson Zachary Ray, M.D. Vice-Chair of Neurological Surgery

Chief of Spine Division Washington University School of

Medicine in St. Louis St. Louis, Missouri

Rick C. Sasso M.D. Professor

Chief of Spine Surgery Department of Orthopaedic Surgery

Indiana University School of Medicine Indiana Spine Group Indianapolis, Indiana

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AGENDA

7:55am Welcome, Introductions & Course Overview Jens R. Chapman, M.D. & Rod J. Oskouian, Jr., M.D.

Session 1 Upper Cervical Moderator: Rod J. Oskouian, Jr., M.D. 8am Upper Cervical Case Presentation

Rod J. Oskouian, Jr., M.D. Objectives:

• Illustrate the physiologic effects of upper cervical trauma on the spine • Identify surgical considerations in upper cervical trauma situations

8:05am Hangman’s Fractures Rick C. Sasso, M.D. Objectives:

• Define disease entity • Outline classifications and their impact on treatment • Explain indications and preferred surgical management options

8:15am Odontoid Fractures

Erik Hayman, M.D. Objectives: • Discuss the indications for surgical treatment of odontoid fractures• Present an overview of anterior odontoid screw placement as well as posterior

C1-C2 fusion 8:25am Craniocervical Trauma Andrew Dailey, M.D Objectives:

• Review the anatomy of the cranio-cervical region • Discuss surgical indications for this region of the spine • Identify anatomic considerations for the cranio-cervical region including instrumentation

considerations 8:35am Upper Cervical Discussion All Faculty Objectives:

• Explain the merits and shortcomings of upper cervical therapies in spine trauma • Describe the concepts of individualized care versus algorithm driven management

8:45am Live Demonstration Broadcast from BioSkills Lab No. 1 Side-By-Side: Posterior C1-C2 Fixation (PALM vs. Lateral Mass, Transarticular, Translaminar) Jens R. Chapman, M.D. & Rod J. Oskouian, Jr., M.D. Objectives: • Identify how to avoid complications with each technique • Demonstrate surgical procedures in the setting of spine trauma • Perform a posterior C1, C2 fixation

Each session includes a brief case presentation, an interactive panel discussion and short talks using the PechaKucha format. PechaKucha is a fast paced, timed presentation. 20 slides.

20 seconds per slide. This format allows for powerful presentations in less than 7 minutes.

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Session 2 Spinal Cord Injuries Moderator: Rick Sasso, M.D. 9:15am Spinal Cord Injury Case Presentation Andrew Jack, M.D. Objectives:

• Illustrate the physiologic effects of spinal cord trauma • Identify surgical considerations in spinal cord injury cases

9:20am State of the Art on Spinal Cord Injuries Michael Fehlings, M.D. Objectives:

• Demonstrate working knowledge of the critical features of the pathophysiology of acute spinal cord injury

• Explain the role and timing of surgical intervention for acute spinal cord injury • Discuss current and emerging translational research for spinal cord injury

9:40am Spinal Cord Injuries: Priorities Basem Ishak, M.D. Objectives:

• Identifying priorities in patients with spinal cord injury • Early surgical decompression (>24h) is the first step to better outcomes

9:50am Spinal Cord Injuries Discussion

All Faculty Objectives:

• List controversies on key subjects in spine trauma care • Explain the merits and shortcomings of specific therapies in spine trauma • Describe the concepts of individualized care versus algorithm driven management

10am Technology Update (not for CME credit) Session 3 Thoracolumbar Trauma Moderator: Neel Anand, M.D.

10:15am Thoracolumbar Trauma Case Presentation Wilson Zachary Ray, M.D. Objectives:

• Illustrate the physiologic effects of thoracolumbar trauma on the spine • Identify surgical considerations in thoracolumbar trauma situations

10:20am Thoracolumbar Injury Classification and Severity Score (TLICS) vs. AO Spine

Classification of Thoracolumbar Fractures John France, M.D. Objectives:

• Identify current classifications • Describe the new AO classification assistance

10:35am Flexion Distraction vs. Burst Injuries: Important Pointers Rick C. Sasso, M.D. Objectives:

• Outline posterior treatment options for thoracolumbar burst fractures • Recognize the limitations of posterior thoracolumbar surgery for burst fractures

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10:50am Thoracolumbar Trauma Discussion All Faculty Objectives:

• List controversies regarding thoracolumbar trauma in spine care • Explain the merits and shortcomings of specific therapies in spine trauma • Describe the concepts of individualized care versus algorithm driven management

Session 4 Geriatric Injuries Moderator: John France, M.D. 11:30am Geriatric Injuries Case Presentation Ashraf El Naga, M.D. Objectives:

• Illustrate the physiologic effects of trauma on the spine • Identify surgical considerations in trauma situations

11:35am Maximizing Pedicle Screw Fixation in Impaired Bone

Amir Abdul-Jabbar, M.D. Objectives: • Discuss current literature on augmented pedicle screws • Outline the merits and shortcomings pedicle screw fixation in impaired bone

11:45am Advances in Minimally Invasive Surgery for Spine Trauma Neel Anand, M.D. Objectives:

• Assess a fracture anatomically for MIS techniques• Apply MIS principles and techniques in spine trauma management

11:55am Decision Making in Elderly: More, Less, Palliative Care

Sigurd Berven, M.D. and Ashraf El Naga, M.D. Objectives: • Evaluate patient frailty and how it plays into clinical decision making for the geriatric spine

patient • Identify treatment considerations in the management of geriatric spine trauma

12:05pm Geriatric Injures Discussion

All Faculty Objectives: • List controversies with regard to geriatric injuries in spine trauma care • Explain the merits and shortcomings of treatments for geriatric injuries in spine trauma

11:00am Live Demonstration Broadcast from BioSkills Lab No. 2 (Not for CME Credit) Side-By-Side: Cages & Augmented Screws: Single Stage Burst Fracture Management

Percutaneous vs. Open Neel Anand, M.D. & Rod J. Oskouian, Jr., M.D.

Objectives: • Demonstrate surgical techniques • Identify how to avoid complications with both techniques • Outline how to interpret imaging

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12:45 pm Course Wrap-up Jens R. Chapman, M.D. & Rod J. Oskouian, Jr., M.D. 12:50 pm Adjourn

12:15pm Live Demonstration Broadcast from BioSkills Lab No. 3 Side-By-Side: Lumbopelvic Fixation: S2AI vs. Iliac vs. SI Screws Amir Abdul-Jabbar, M.D. & Neel Anand, M.D. Objectives:

• Evaluate when to use open vs. minimally invasive surgery • Evaluate when to use single-stage technique • Outline different fixation techniques

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Acknowledgements

The Planning Committee gratefully acknowledges support for this conference from the following:

Educational Grant DePuy Synthes Globus Medical

Medtronic SeaSpine Stryker

TheraCell

Exhibit Support Globus Medical

Integra Organogenesis

Prosydian Stryker

In-Kind Support DePuy Synthes Globus Medical

Medtronic Stryker

TheraCell

Course Planning Committee

Jens R. Chapman, M.D. Course Co-Chair

Complex Spine Surgeon Swedish Neuroscience Institute

Seattle, Washington

Rod J. Oskouian, M.D. Course Co-Chair

Chief of Spine Director, Spine Fellowship Program

Swedish Neuroscience Institute Seattle, Washington

Amir Abdul-Jabbar, M.D.

Orthopaedic Surgeon Swedish Neuroscience Institute

Seattle, Washington

Sven Frieler, M.D. Orthopaedic Surgeon

Swedish Neuroscience Institute Seattle, Washington

Linda Sahlin

Director of Education Seattle Science Foundation

Seattle, Washington

Ashley Martin Education Specialist

Seattle Science Foundation Seattle, Washington

Course Evaluation Please take a moment to complete our online evaluation, which will be emailed to you. Your feedback helps to ensure the effectiveness of this CME activity, as well as improve future educational activities. All responses are considered anonymous. https://www.surveymonkey.com/r/2020_SpineTrauma

If you do not receive the survey via email, please call (206)732-6500 or email cme@seattlesciencefoundation.org. Accreditation Seattle Science Foundation is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. AMA PRA Category 1 CreditsTM Seattle Science Foundation designates this live activity for a maximum of 4 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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Identifying and Resolving Conflicts of Interest

Purpose: The information provided addresses several requirements of the ACCME to help ensure purpose in CME activities. Everyone in a position to control the content of a CME activity must disclose all relevant financial relationships with commercial interests to the CME provider. This information must be disclosed to participants prior to the beginning of the activity. Also, CME providers must resolve current conflicts of interest prior to the educational activity. Definitions: “Financial relationships” are those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria for promotional speakers’ bureau, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, speaking and teaching, membership on advisory committees or review panels, board membership, and other activities from which remuneration is received, or expected. ACCME considers relationships of the person involved in the CME activity to include financial relationships of a spouse or partner. The ACCME defines a “commercial interest” as any entity producing, marketing, re-selling or distributing health care goods or services consumed by, or used on, patients. Among the exemptions to this definition are government organizations, non-health care related companies and non-profit organizations that do not advocate for commercial interests. Circumstances create a “conflict of interest” when an individual has an opportunity to affect CME content about products or services of a commercial interest with which he/she has a financial relationship. ACCME focuses on financial relationships with commercial interests in the 12-month period preceding the time that the individual is being asked to assume a role controlling content of the CME activity. ACCME has not set a minimal dollar amount for relationships to be significant. Inherent in any amount is the incentive to maintain or increase the value of the relationship. The ACCME defines “relevant financial relationships” as financial relationships in any amount occurring within the past 12 months that create a conflict of interest. CME Activity Planning Committee Members: I If a conflict of interest exists, the Planning Committee member must withdraw from the Planning Committee unless the conflict can be resolved. Resolution may be made by one of the following methods: (1) Peer review of CME content will be conducted at another oversight level to assure no commercial bias exists; (2) Change in focus of course so the activity does not include information related to products or services about which the planning committee member has a conflict; (3) Severing relationship(s) between the member and any related commercial interest; (4) Others to be determined by SSF CME Committee. CME Activity Presenter: When a conflict of interest exists, the Planning Committee must address the conflict by one of the following methods: (1) Review content to be presented by speaker in advance to assure content balance; (2) Change topic so the presentation is not related to products or services where a conflict exists; (3) Select a different presenter without any related commercial interest; (4) Include presentations by other faculty to provide an overall balance to the content of the course; (5) Limit or specify the sources for recommendations that the presenter can use. Each speaker is required to give a balanced, evidence-based presentation based on published research. No conclusions or recommendations without external validation may be made by a speaker with a conflict of interest.

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Faculty Disclosure Summary

The following planners and presenters (or their spouses/domestic partners) have/had a financial relationship with a commercial interest: (S = Speaker; P = Planner) Neel Anand, M.D.(S); Consultant: DePuy Synthes, Medtronic, Inc.; Scientific Advisory Board: Spinal Simplicity, Viseon, Spinal Balance, TheraCell; Royalties: Globus Medical, Elsevier; Receipt of Intellectual Property Rights/ Patent Holder: Medtronic Inc.; Ownership Interest: TheraCell Sigurd Berven, M.D. (S): Consultant: Medtronic Inc, Stryker, Globus Medical, Innovasis, Integrity, Kuros Biosciences Jens R. Chapman, M.D. (S, P): Consultant: Globus Medical; Stockholder: Renovis Surgical (wife) Andrew Dailey, M.D. (S): Consultant: ZimmerBiomet; Grant/Research Support: K2M/Stryker Michael Fehlings, M.D. (S): Consultant: Neuraxis; Grant support: CIHR, DOD, AOSpine, Rick Hansen Institute; Principal Investigator: RISCIS Trial, AOSpine Guidelines Rod J. Oskouian, Jr., M.D. (S, P): Consultant: Globus Medical, DePuy Synthes, Stryker; Grant/Research Support: AO North America; Royalties: Stryker, Globus Rick Sasso, M.D. (S): Royalty: Medtronic Inc., Saunders Elsevier; Consultant: NuVasive; Research Support: Medtronic Inc., Stryker, AO Spine, Cerapedics, Smith & Nephew, Lilly, Simplify, Orthofix The following planners and/or presenters (or their spouses/domestic partners) have/had no financial relationship with a commercial interest (S = Speaker; P = Planner) Amir Abdul-Jabbar, M.D. (S, P); Ashraf El Naga, M.D. (S); John France, M.D. (S); Erik Hayman, M.D. (S); Sven Frieler, M.D. (P); Basem Ishak, M.D. (S); Andrew Jack, M.D. (S); Wilson Zachary Ray, M.D. (S); Linda Sahlin (P); Ashley Martin (P) All planners and presenters attested that their content suggestions and/or presentation(s) will provide a balanced view of therapeutic options and will be entirely free of promotional bias. All presentations have been reviewed by a planner with no conflicts of interest to ensure that the content is evidence-based and unbiased.