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AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves

Monday, February 19, 2018


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AMA Opioid Task Force

Co-prescribe naloxone for high risk patients

Statement on Safe Storage and Disposal of Opioids

NREF Honor Your Mentor Funds

You trained with the best, you succeeded and your patients have benefited. Now you can show your gratitude through the Neurosurgery Research & Education Foundation (NREF) by honoring a mentor who helped you achieve success in your field.

By honoring a mentor, you are helping recognize the incredible people who have advanced neurosurgery. Each Honor Your Mentor fund has a specific purpose. Your gift will fund a research or educational endeavor in their name. This is your opportunity to acknowledge those who have established the specialty by aiding those who will follow.

To learn more about the honored spine mentors and the research they dedicate themselves to, please visit the Honor Your Mentor page for Sanford Larson, Regis Haid, Charles Kuntz, Volker Sonntag or Stewart Dunsker and donate today.

Don't see your mentor on the list? To establish a new fund, please contact Joanne Bonaminio at 847.378.0541 or via email at jmb@nref.org.

New England Journal of Medicine Article Response

The leadership of the AANS, AAOS and NASS have jointly submitted a response to the editor-in-chief of the New England Journal of Medicine regarding the articles and editorial published on the value of fusion in the surgical treatment of spondylolisthesis in the April 14, 2016 issue of the journal. Please click the link below to view the letter.


Neurologic Events After Epidural Steroid Injections

The FDA has released a risk assessment of epidural steroid injections. The assessment emphasizes that the FDA has not approved any glucocorticoid product for epidural injection.

Hence all epidural injections are considered off-label use.

A NEJM review of the announcement is available here.

Spine Section Lumbar Fusion Guidelines

Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine [Journal of Neurosurgery: Spine]

Spine Section Position Statement

AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves Updated Position Statement: Intraoperative Electrophysiological Monitoring January 2018

Intraoperative somatosensory evoked potential (SSEP) and motor evoked potential (MEP) monitoring are commonly referred to as intraoperative monitoring (IOM). There is Level I evidence that IOM is a reliable diagnostic tool for assessment of spinal cord integrity during surgery. MEPs have been shown to be superior to SSEPs in the assessment of spinal cord integrity during surgery. Intraoperative MEPs have been shown to pr;edict recovery in traumatic cervical spinal cord injury.

There is insufficient evidence (Level III) of a therapeutic benefit of IOM during spinal surgery. While IOM is generally regarded as integral to lateral spine surgery, there is insufficient evidence to support a therapeutic benefit. The cost-effectiveness of IOM has been inadequately studied.

There is no published data to suggest that IOM results in alterations of procedures, abortion of procedures, increased procedure/anesthesia time, increased procedural difficulty, or increased risk of needle-sticks for the operative team.

IOM should be performed in procedures when the operating surgeon feels that the diagnostic information is of value, such as deformity correction, spinal instability, spinal cord compression, intradural spinal cord lesions and when in proximity to peripheral nerves or roots. Spontaneous and evoked electromyography is recommended for minimally invasive lateral retroperitoneal transpsoas approaches to the lumbar spine, and may also be of utility during pedicle screw insertion.

Read the complete position statement here.

Hypothermia and Human Spinal Cord Injury: Updated Position Statement and Evidence Based Recommendations from the AANS/CNS Joint Sections on Disorders of the Spine & Peripheral Nerves and Neurotrauma & Critical Care

Scientific studies have documented a potential benefit of systemic hypothermia in animal models of acute spinal cord injury; however there remains a paucity of clinical evidence to recommend for or against the practice of either local or systemic hypothermia for acute SCI in humans. The level IV evidence suggesting the safety of modest systemic hypothermia is promising, but controlled, comparative clinical studies investigating safety and efficacy must be performed prior to the introduction of hypothermia in the routine clinical care of patients with acute SCI.


Grade I - There is insufficient evidence to recommend for or against the practice of either local or systemic therapeutic hypothermia as a treatment for acute spinal cord injury.

Grade C - There is level IV evidence based on one retrospective comparative cohort study and one prospective cohort study to suggest that systemic modest hypothermia might be applied safely to this population.

Read a the complete postition statement here.

Concensus statement on Vertebroplasty and Kyphoplasty

A consensus statement developed by the Society of Interventional Radiology (SIR), American Association of Neurological Surgeons (AANS), Congress of Neurological Surgeons (CNS), American College of Radiology (ACR), American Society of Neuroradiology (ASNR), American Society of Spine Radiology (ASSR), Canadian Interventional Radiology Association (CIRA), and the Society of NeuroInterventional Surgery (SNIS) was recently published in the Journal of Vascular and Interventional Radiology. Barr JD, et al. Journal of Vascular and Interventional Radiology 25:171-181, 2014. In this manuscript, the societies state their position that vertebroplasty and kyphoplasty (i.e., percutaneous vertebral augmentation) is a safe, efficacious, and durable procedure for the treatment of appropriate patients with pathologic fractures due to osteoporosis or neoplastic processes. It is stressed that these treatments must be performed in accordance with published standards. The position statement also notes that these procedures are only offered when non-operative medial therapy has not provided adequate relief or if their symptoms are significantly effecting their quality of life.

Feature spine neurosurgery video of the week:
See all videos here

Anterolateral Approach without Fixation for Resection of an Intradural Schwannoma of the Cervical Spinal Canal

NEW 2013 Guidelines for the Management of Acute Cervical Spine and Spinal Cord Injuries

AANS-CNS Spine Newsletter Spring 2015

Read a thoughtful critique to the Deyo JAMA article .
This article has identified a potential trend towards the application of more complex fusion procedures to Medicare patients who are treated with fusion as an adjunct to decompressive procedures for lumbar stenosis. However, without a clear understanding of patient selection criteria, outcomes achieved, and risk stratification, over-interpretation of such data is potentially misleading and dangerous.

Spine Section Position Statement on Electrophysiological Monitoring during Routine Spinal Surgery

Hypothermia and Human Spinal Cord Injury: Position Statement and Evidence Based Recommendations

AANS/CNS Medicare participation options for neurosurgeons

AANS/CNS Joint Section of the Disorders of the Spine and Peripheral Nerves - The First 25 Years, A Video History (login required)

Chaim's Topic of the Week: Review past topics

Position Statement

Video-Assisted Thoracic Surgery (VATS)

Thoracic spinal surgery and peripheral nerve surgery, including sympathectomy, are traditional and integral components of neurosurgical training and practice. Video-assisted thoracic surgery (VATS) of the spine is a minimally invasive technique performed by neurosurgeons for conditions traditionally treated by neurosurgery. These conditions include thoracic sympathectomy for hyperhydrosis, upper extremity complex regional pain syndromes, and thoracic spinal surgery for thoracic disc herniation, spinal tumor, spinal instability, and scoliotic deformity.

Neurosurgeons currently in training receive experience in VATS during residency and are examined for competency in the procedure and its indications by the American Board of Neurological Surgery. Neurosurgical residency programs provide opportunity for training in minimally invasive neurosurgical techniques, including VATS for sympathectomy and spinal disorders.

Mission Statement - May 01, 2016

Washington State Approves Coverage for Lumbar and Cervical Artificial Discs - Oct 17, 2008

The American Association of Neurological Surgeons and Congress of Neurological Surgeons Applaud the SPORT Study Results which Support the Benefit of Surgery in Treating Patients with Symptomatic Herniated Lumbar Discs - Nov 29, 2006

The American Board of Neurological Surgery Establishes Requirements for Maintenance of Certification - Nov 28, 2006

The AANS/CNS Section on Disorders of the Spine and Peripheral Nerves Announces the Release of the Lumbar Fusion Guidelines - An Evidenced-Based Approach to Lumbar Fusion - Nov 27, 2006

Mission Statement

To advance spine and peripheral nerve patient care through education, research and advocacy

Purpose of the Spine and Peripheral Nerves Section

To foster the use of spinal neurosurgical methods for the treatment of diseases of the spinal neural elements, the spine and peripheral nerves. To advance spinal neurosurgery and related sciences, to improve patient care, to support meaningful basic and clinical research, to provide leadership in undergraduate and graduate continuing education, and to promote administrative facilities necessary to achieve these goals.

Founders: The Section on Disorders of the Spine and Peripheral Nerves was founded at the suggestion of Albert L. Rhoton, MD in 1978 to Charles Drake, MD, President of the AANS in 1978. Also instrumental were Stewart B. Dunsker, MD and Russell Travis, MD.

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