The NASS Podcast

The management of intramedullary spinal cord tumors remains one of the most challenging clinical problems that one encounters as a spine surgeon. Here, as part of our NASS Spinal Oncology Podcast Series, Dr. Sheng-fu Larry Lo interviews Dr. Paul McCormick and Dr. George Jallo about updates and new research on the perioperative management of these lesions, including imaging features predicting resectability, tractography, intra-operative adjuncts to guide resection, extent of resection and outcomes, and the molecular landscape of these tumors.

Moderator: Hesham Soliman, MD, MSc

Chair: Sheng-fu (Larry) Lo, MHS

George I. Jallo, MD

Paul McCormick, MD, MPH

References:

Seaman SC, Bathla G, Park BJ, Woodroffe RW, Smith M, Menezes AH, Noeller J, Yamaguchi S, Hitchon PW. MRI characteristics and resectability in spinal cord glioma. Clin Neurol Neurosurg. 2021 Jan;200:106321.

Egger K, Hohenhaus M, Van Velthoven V, Heil S, Urbach H. Spinal diffusion tensor tractography for differentiation of intramedullary tumor-suspected lesions. Eur J Radiol. 2016 Dec;85(12):2275-2280.

Mensah-Brown KG, Germi JW, Quattrone F, Maloney-Wilensky E, Lee JYK, Chen HI, Schuster JM. Use of Second Window ICG in spinal cord biopsy of a mildly contrast-enhancing lesion: Technical note and review of the literature. Neurochirurgie. 2021 Jun 5:S0028-3770(21)00161-2.

Vetrano IG, Gennari AG, Erbetta A, Acerbi F, Nazzi V, DiMeco F, Prada F. Contrast-Enhanced Ultrasound Assisted Surgery of Intramedullary Spinal Cord Tumors: Analysis of Technical Benefits and Intra-operative Microbubble Distribution Characteristics. Ultrasound Med Biol. 2021 Mar;47(3):398-407.

Forbes JA, Teschan N, Jones SH, Parry P, Simonet L, Swamy NK. Cervical corpectomy for resection of ventral intramedullary capillary hemangioma with circumferential involvement of the anterior spinal artery: case report. J Neurosurg Spine. 2018 Aug;29(2):144-149.

McCormick KL, Alexiades N, McCormick PC. Microsurgical Resection of an Intramedullary Spinal Cord Hemangioblastoma Through an Anterior Cervical Approach: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown). 2021 Jan 13;20(2):E133.

Ushirozako H, Yoshida G, Imagama S, Kobayashi K, Ando K, Ando M, Kawabata S, Yamada K, Kanchiku T, Fujiwara Y, Taniguchi S, Iwasaki H, Shigematsu H, Tadokoro N, Takahashi M, Wada K, Yamamoto N, Funaba M, Yasuda A, Hashimoto J, Morito S, Takatani T, Tani T, Matsuyama Y. Efficacy of Transcranial Motor Evoked Potential Monitoring During Intra- and Extramedullary Spinal Cord Tumor Surgery: A Prospective Multicenter Study of the Monitoring Committee of the Japanese Society for Spine Surgery and Related Research. Global Spine J. 2021 May 20:21925682211011443.

Wang YZ, Zhang YW, Liu WH, Chai RC, Cao R, Wang B, An SY, Jiang WJ, Xu YL, Yang J, Jia WQ. Spinal Cord Diffuse Midline Gliomas With H3 K27m-Mutant: Clinicopathological Features and Prognosis. Neurosurgery. 2021 May 20:nyab174.

Disclosures:

Jallo, George I.: Consulting: Johnson&Johnson (Financial, Honorarium for consulting on shunt design $1000/yr); Grants: Medtronic (C, Pediatric Fellowship support. THis is for the support of a pediatric neurosurgery fellow); Fellowship Support: Codman (C, This is support for the pediatric fellow, Paid directly to institution/employer).

Lo, Sheng-fu Larry: Nothing to Disclose  

McCormick, Paul C.: Nothing to Disclose

Soliman, Hesham : Nothing to Disclose  

Moderator Jayesh Vallabh, MD, interviews authors Rhett MacNeille, MD, and Olumide Danisa, MD, of Loma Linda University in California about their recent SpineLine article, "Hip-Spine Syndrome: Avoiding the Pitfalls."

Access the article here.

Disclosures:

Danisa, Olumide A.: Board of Directors: Musculoskeletal Transplantation Foundation (B, Paid directly to institution/employer); Consulting: Spineart (B); Royalties: Globus Medical (E); Trips/Travel: American Board of Orthopaedic Surgeons (B).

MacNeille, Rhett : Nothing to Disclose  

Vallabh, Jayesh : Nothing to Disclose

Key: A: $100-$1,000; B: $1001-$10,000; C: $10,001-$25,000; D: $25,001-$50,000; E: $50,001-$100,000; F: $100,001- $500,000; G: $500,001-$1M; H: $1,000,001- $2.5M; I: $2.5M+

How has the COVID-19 pandemic impacted your practice? What changed for you and your care team during social distancing phase? What changed for you and your care team after social distancing requirements lapsed? Join Section on Spine Oncology members John H. Shin, MD, Iliya Laufer, MD and Jacob Buchowski, MD, MS as they discuss their experiences over the past 18 months with moderator Matthew Goodwin, MD, PhD, FACSM.

Disclosures:

Buchowski, Jacob M.: Device or Biologic Distribution Group (Physician-Owned Distributorship): Globus Medical (E), K2M (C), Wolters Kluwer Health (A); Fellowship Support: AOSpine North America (E, Paid directly to institution/employer), OMeGA (D, Paid directly to institution/employer).

Goodwin, Matthew L.: Consulting: Augmedics (A, Outside 12-Month Requirement), JBJS Classroom (A); Fellowship Support: AOSpine (Salary), NREF (Salary); Royalties: Kendall Hunt (B); Stock Ownership: ROM3 (200 Shares, Outside 12-Month Requirement, Paid directly to institution/employer).

Laufer, Ilya: Consulting: BrainLab (A), DePuy Synthes (B), Globus (B), Medtronic (C), Spine Wave (B).

Shin, John H.: Consulting: Carbofix (None), DePuy (B), Medtronic (A), NuVasive (B).

Key: A: $100-$1,000; B: $1001-$10,000; C: $10,001-$25,000; D: $25,001-$50,000; E: $50,001-$100,000; F: $100,001- $500,000; G: $500,001-$1M; H: $1,000,001- $2.5M; I: $2.5M+

When signals are lost during surgical correction of complex spinal deformities, one available tool for localizing the site of injury is the dynamic spinal cord mapping technique. This valuable technique has gained popularity largely due to Dr. Lenke’s work in popularizing it for this purpose. In this episode, Dr. Lenke is interviewed about how he uses this technique, what information it provides, and how it influences his surgical strategy.

Featuring:

Richard Vogel, PhD, DABNM

Lawrence Lenke, MD

Disclosures:

Vogel, Richard: Board of Directors: American Board Of Neurophysiologic Monitoring (Nonfinancial, Examiner for Board), American Society Of Neurophysiological Monitoring (Nonfinancial, President of the Society (2019-2020)); Other: Nuvasive (Salary); Speaking and/or Teaching Arrangements: Neurophysiology Services Australia (None); Trips/Travel: North American Spine Society (Travel Expense Reimbursement), University Of Sydney (Travel Expense Reimbursement).

Lenke, Lawrence G.: Consulting: Abryx (B), EOS TECHNOLOGY (None), Medtronic (F); Grants: Fox Family Foundation (A), Scoliosis Research Society (D, Paid directly to institution/employer); Other: AOSpine (D, Paid directly to institution/employer), Broadwater (B); Research Support (Staff and/or materials): Adult Symptomatic Lumbar Scoliosis (B, Paid directly to institution/employer), Complex CADS ISSG (E, Paid directly to institution/employer), Confirm S2AI Screw Placement By Routine Fluoroscopy (B, Paid directly to institution/employer), EOS Imaging  (A, Paid directly to institution/employer), Fox Pediatric Spinal Deformity Study (A, Paid directly to institution/employer), Scoliosis Outcome Database Registry (A, Paid directly to institution/employer), Scoli-Risk-1 (B, Paid directly to institution/employer), Tropical Application Of Tranexamic Acid To Reduce Blood Loss In Spine Surgery (E, Paid directly to institution/employer); Royalties: Medtronic (I), Quality Medical Publishing (A); Trips/Travel: AOSpine (B), Broadwater (B).

Key: A: $100-$1,000; B: $1001-$10,000; C: $10,001-$25,000; D: $25,001-$50,000; E: $50,001-$100,000; F: $100,001- $500,000; G: $500,001-$1M; H: $1,000,001- $2.5M; I: $2.5M+

Authors Akhil Chhatre, MD, and Laryssa Richards, DO, discuss quality improvement measures their team has implemented at Johns Hopkins with moderator Renee Rosati, DO, in this episode of Spotlight on SpineLine.

Access the article here.

Disclosures:

Chhatre, Akhil : Nothing to Disclose

Rosati , Renee Michelle: Nothing to Disclose    

Richards, Laryssa: Nothing to Disclose

Key: A: $100-$1,000; B: $1001-$10,000; C: $10,001-$25,000; D: $25,001-$50,000; E: $50,001-$100,000; F: $100,001- $500,000; G: $500,001-$1M; H: $1,000,001- $2.5M; I: $2.5M+

Use of neuromonitoring in cervical spine surgery varies significantly across the US and around the world. In some regions, multimodality neuromonitoring is used routinely for all procedures. In other regions, it’s rarely used at all. In this episode, Dr. Todd Albert is interviewed for his perspective as an orthopedic spine surgeon.

Disclosures:

Albert, Todd J.: Board of Directors: American Orthopaedic Association (Nonfinancial, Treasurer-Elect), Hospital For Special Surgery (None, Surgeon-in-Chief Emeritus and Medical Director), Scoliosis Research Society (Nonfinancial, Past President); Consulting: Nuvasive (B); Other: JP Medical Publishers (B), Saunders/Mosby- Elsevier (B), Springer (A), Thieme Medical Publishers (B); Research Support (Staff and/or materials): PCORI (D); Royalties: DePuy Synthes Spine (F); Stock Ownership: ASIP (D), Augmedics (F), Biomerix (D, 42,253 Shares), Bonovo Orthopedics (D, 85,737 Shares), Crosstrees Medical  (D,  <1%), Cytodyn Inc. (F), Gentis (D), Innovative Surgical Designs (F), InVivo Therapeutics (C, <1%. Advisory Board, Stock options.), Invuity  (C, <1%. Member of Advisory Board, stock options.), Morphogenesis (E), Paradigm Spine, LLC (F, <1%.), Physician Recommended Nutriceuticals (D), PMIG (D), Pulse Equity (F), Spinicity  (D, <1%.), Strathspey Crown (F), Surg.IO (E), Vital 5 (None, <1%. Advisory Board, Stock Holder), Zimmer Biomet  (F).

Doan, Adam: Other: Nuvasive Clinical Services  (Salary); Private Investments: Veridical RCM (D). 

Key: A: $100-$1,000; B: $1001-$10,000; C: $10,001-$25,000; D: $25,001-$50,000; E: $50,001-$100,000; F: $100,001- $500,000; G: $500,001-$1M; H: $1,000,001- $2.5M; I: $2.5M+

Moderator Jayesh Vallabh, MD, chats with NASS President Eeric Truumees, MD, about Dr. Truumees recent column in SpineLine, which outlines the differences between NASS 3 and NASS6. Dr. Truumees talks about the importance of being involved in advocacy and how your dollars are being allocated.

Disclosures:

Truumees, Eeric: Board of Directors: Seton Family of Doctors (None); Other Office: AAOS  (Editor-in-Chief of AAOS Now); Research Support (Staff and/or materials): Medtronic (C, Paid directly to institution/employer), Pfizer (E, Outside 12-Month Requirement, Paid directly to institution/employer), Relievant (F, Paid directly to institution/employer), Seikagaku Corporation (C, Paid directly to institution/employer), Stryker Spine (B, Outside 12-Month Requirement, Paid directly to institution/employer), Vertex Pharma (D, Outside 12-Month Requirement, Paid directly to institution/employer); Trips/Travel: AAOS (Travel Reimbursement (B).

Vallabh, Jayesh : Nothing to Disclose  

Key: A: $100-$1,000; B: $1001-$10,000; C: $10,001-$25,000; D: $25,001-$50,000; E: $50,001-$100,000; F: $100,001- $500,000; G: $500,001-$1M; H: $1,000,001- $2.5M; I: $2.5M+

In this era of evidence-based medicine, administrative claims databases are of interest because they allow us to evaluate complex questions with large numbers; but, they also have their drawbacks. Numerous studies have used these databases to examine neuromonitoring trends in the US. What have we learned from these studies, and where should future studies focus? In this episode, Section on IONM Member, Dr. John Ney, is interviewed by IONM Co-Chair Dr. Richard Vogel, for his perspective as a neurologist and health policy expert.

Disclosures:

Ney, John: Board of Directors: ASNM (A); Consulting: Ceribell  (C), Ceribell (B); Other Office: American Academy of Neurology, Medical Economics and Management Committee (Travel reimbursement).

Vogel, Richard: Board of Directors: American Board Of Neurophysiologic Monitoring (Nonfinancial, Examiner for Board), American Society Of Neurophysiological Monitoring (Nonfinancial, President of the Society (2019-2020)); Other: Nuvasive (Salary); Speaking and/or Teaching Arrangements: Neurophysiology Services Australia (None); Trips/Travel: North American Spine Society (Travel Expense Reimbursement), University Of Sydney (Travel Expense Reimbursement).

Key: A: $100-$1,000; B: $1001-$10,000; C: $10,001-$25,000; D: $25,001-$50,000; E: $50,001-$100,000; F: $100,001- $500,000; G: $500,001-$1M; H: $1,000,001- $2.5M; I: $2.5M+

Moderator Erik Westerlund, MD discusses the 2020 JAMA article, "Effect of spinal manipulative and mobilization therapies in young adults with mild to moderate chronic low back pain: a randomized clinical trial" with Literature Review authors Ryan L. McLean, BS and Jonathan N. Grauer, MD.

Access the article here.

Disclosures:

Grauer, Jonathan N.: Board of Directors: LSRS (Nonfinancial, committee/board role); Other: NASS (D).

McLean, Ryan L.: Nothing to Disclose

Westerlund, Erik: Consulting: Nuvasive (B); Research Support (Staff and/or materials): Seaspine (None, Research support); Scientific Advisory Board: Seaspine (B).

Key: A: $100-$1,000; B: $1001-$10,000; C: $10,001-$25,000; D: $25,001-$50,000; E: $50,001-$100,000; F: $100,001- $500,000; G: $500,001-$1M; H: $1,000,001- $2.5M; I: $2.5M+

Who are the different neuromonitoring societies, what role(s) do they play in patient care, where are they focusing their efforts, and what opportunities are there for inter-society collaboration? In this episode, NASS IONM Section Co-Chair, Dr. Richard Vogel, is interviewed in his role as Past-President of the American Society of Neurophysiological Monitoring (ASNM).

Disclosures:

Doan, Adam: Other: Nuvasive Clinical Services  (Salary); Private Investments: Veridical RCM (D).

Vogel, Richard: Board of Directors: American Board Of Neurophysiologic Monitoring (Nonfinancial, Examiner for Board), American Society Of Neurophysiological Monitoring (Nonfinancial, President of the Society (2019-2020)); Other: Nuvasive (Salary); Speaking and/or Teaching Arrangements: Neurophysiology Services Australia (None); Trips/Travel: North American Spine Society (Travel Expense Reimbursement), University Of Sydney (Travel Expense Reimbursement).

Key: A: $100-$1,000; B: $1001-$10,000; C: $10,001-$25,000; D: $25,001-$50,000; E: $50,001-$100,000; F: $100,001- $500,000; G: $500,001-$1M; H: $1,000,001- $2.5M; I: $2.5M+