Spine Tango User's Manual Part I: Dictionary of Terms
Contents
1. 27 JR E 27 SURGICAL MEASURES c DECOMPRESSION RRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRREMMMEEEMMMMMMMMMMMMMMMMMMMMMMMMMM 27 FUSION REM 28 29 STABILIZATION RIGID sess eese nenas 30 STABILISATION MOTION PRESERVING seta nana 31 PERCUTANEOUS MEASURES sscssssssececsesessscececececseuesececececseeaeseeececsenaaeceeceeceeeeaeceeececsesnaaeeeeeeseseseaeeeeeesesenses 31 OTHER SURGICAL MEASURES ccsccccccccecsessssscecececeeseeeeeecececseaaececececseaaeeeeeeecseseaeceeecscsesneaeeeeececseseaeeeeeeeesenses 32 EXTENT OF SURGERY INDICATE AS sess enean 32 INTRAOPERATIVE SURGICAL COMPLICATIONS cssssssssecececessssaececececsesseaeceecceceesseaeseeececsesnsaeeeeeeeceesesaeeeeeeeeeeneas 33 SURGICAL MEASURES DURING INDEX ness stent nnns nsns stent tesa senses eee tena 33 INTRAOPERATIVE GENERAL COMPLICATIONS setate nass sess setate ganas esset naa 33 POSTOPERATIVE SURGICAL COMPLICATIONS BEFORE DISCHARGE eene 34 POSTOPERATIVE GENERAL COMPLICATIONS BEFORE DISCHARGE2. Work status not at work since op no work activity at all since surgery started partially same job any amount of activity in old job 96 fully reintegrated same professional situation as before surgery resumed work but quit again failed attempt to go back to work even if part time resumed work different job successful attempt to go back to work but in a different position has been dismissed retired since OP job loss no new occupation yet includes both age and disability pension retired before OP includes both age and disability pension housewife full time homemaker child student not yet in professional or home based work situation other specify Therapeutic goals measures Achieved Partially achieved Not achieved Tick all that apply referring to the therapeutic goals chosen in the surgery form Has to reflect the subjective impression of the surgeon i e the achievement of the goals as they were negotiated preoperatively For description see surgery form above page 37 Spine Tango User s Manual Part Dictionary of Terms Surgery 2011 and Follow up Medication Tick all that apply take note of WHO scheme of pain treatment WHO Scheme freedom from pain Opioid for moder Severe pain EE 3 non opioid adjuvant pain persisting or increasing Opioid for mild
3. 7 Type of SCOMOSIS door tt ree HE ETE EAER E epu ue ias M RE eee tup rip bae e puce Quern Re amp Predominant etiology 525 eode HE ada teet reete amp Pathological e esa aeg ete Sas Labia age esau Eee ue ERE 9 Type of pathological fracture trauma 9 Dens fracture typ mn 10 C3 ES S1 AO fracture type ere ertet at etie EESE EEEE NEAR 11 Pathological fracture due AREE E 12 Fracture Ag P Spondylolisthesis of spondylolisthesis spesis e NE eno E a 13 Grade of Spondylolistli sis 14 14 Type of mifa mmal On oni ie eee E 14 Criteria for the Classification of Acute Arthritis of Rheumatoid Arthritis American College of Y NITOTI TOIT ER EE 15 eo EDT 16 INJECTION SPCCHICAUON m 16 Affected BATH C EE m 16 remet 16 Type UEM 16 TOGO SAION m 17 Specify Of tUMOT EE 17 Repeat SUPSOTY m 17 or reason Of repeat 17 MOST SEVERELY AFFECTED SEGMENT VERTEBRAL eee n nen nennen 18 EXTENT OF TESTON M 18 ADDITIONAE PATHOL OGY 19 INO OF PREVIOUS SPINE SURGERIES
4. other specify for soondylodiscitis choose spo ndylitis AND discitis multiple choice question Tumor Type of Tumor page 16 Spine Tango User s Manual Part Dictionary of Terms Surgery 2011 and Follow up primary malignant according to the histologic classification primary benign according to the histologic classification secondary malign metastasis tumor like lesion intermediate other specify Localisation extraosseous soft tissue Tumor located in the soft tissue no osseous attendance intraosseous superficial Tumor tissue located superficial in the bone cortical osseous structures intraosseous deep Tumor tissue located deep in the bone trabecular osseous structures extraosseous extradural Tumor tissue located in the spinal canal extradural without osseous attendance extraoseous intradural Tumor tissue located in the spinal canal intradural without osseous attendance other specify Specify type of tumor p TNM histology Repeat surgery Repeated surgery because the index surgery did not reach its technical goals misplaced screw insufficient decompression non union or clinical goals the technical goals are fulfilled but the symptoms remain e g solid fusion but persistent pain Also included are elective repeat surgeries for e g metal
5. Surgery 2011 and Follow up Grade of Spondylolisthesis Meyerding Grading System for classifying slips Slips are graded on the basis of the percentage that one vertebral body has slipped forward over the vertebral body below o Grade slip indicates that 1 24 of the vertebral body has slipped forward over the body below o Grade Il indicates a 25 49 slip o Grade indicates a 50 74 slip o Grade IV indicates a 75 99 slip If the body completely slips off the body below it is classified as a Grade V slip known as spondyloptosis Reference Meyerding HW 1932 Spondylolisthesis Surg Gynecol Obstet 54 371 377 Grade 0 lysis of pars without slip Grade 0 25 slip Grade 1 25 50 slip Grade 111 50 75 slip Grade IV gt 75 slip Grade V Spondyloptosis Inflammation Type of inflammation page 14 Spine Tango User s Manual Part Dictionary of Terms Surgery 2011 and Follow up inflammatory arthritis seropositive Rheumatoid arthritis RA is an autoimmune disorder of unknown aetiology characterized by symmetric erosive synovitis and sometimes multisystem involvement Most patients exhibit a chronic fluctuating course of disease that if left untreated results in progressive joint destruction deformity disability and premature death Rheumatoid arthritis RA most commonly affects the cervical spine Tissue destruction causes instability of the atlanto
6. of cervical spinal stabilization odontoid screw Anterior cervical spinal stabilisation with odontoid screw laminar screws other Stabilisation motion preserving Translaminar facet screw fixation TLFS A posterior form of spinal stabilization specify Any measure aiming to preserve some motion of the adressed area none anterior The total disc replacement is a typical anterior motion preserving stabilization posterior Dynesis or interspinous spacers are examples for posterior motion preserving stabilization devices Specification disc replacement motion preserving stabilization by disc replacement disc arthroplasty interspinous spacer interspinous process implants dynamic stabilization system motion preserving stabilization by posterior dynamic technique other specify Percutaneous measures page 31 Spine Tango User s Manual Part Dictionary of Terms Surgery 2011 and Follow up none posterior specify facet block injection of anesthetic into the facet joints root block Nerve root block performed under image intensifier control allowing a direct application of an anti inflammatory analgesic agent to the target nerve root discography intradiscal injection provoking discogenic pain vertebroplasty Injection of cement into the fractured vertebral body for internal stabilization ky
7. page 19 Spine Tango User s Manual Part Dictionary of Terms Surgery 2011 and Follow up seronegative arthritis Seronegative arthritis is an umbrella term for various types of arthritis that have similar symptoms to rheumatoid arthritis but do not have the rheumatoid factor determining that condition in blood tests Seronegative arthritis also tends to have additional symptoms that rheumatoid arthritis does not Examples of these disorders include ankylosing spondylitis psoriatic arthritis and reactive arthritis ankylosing spondylitis M Bechterew Arthritis and osteitis deformans involving the spinal column marked by nodular deposits at the edges of the intervertebral disks by ossification of the ligaments and by bony ankylosis of the intervertebral articulations resulting in a rounded kyphosis with rigidity other specify Infection Infection specification pyogenic due to bacteria not specific parasitic due to vermin tuberculotic tuberculosis fungal due to fungi other specify Affected structures xxx spondylitis infection of the vertebrae kx discitis epidural space infection of the intervertebral disc extradural space or peridural space space within the spinal canal bony structures outside the dura matter paravertebral infection infection of the paravertebral soft tissue muscles etc
8. 2011 and Follow up decompression in front of the dural sack anterior whatever the approach anterior or posterior removal of disk or endplate osteophytes posterior decompression about the posterior aspect of the dural sack facet joint osteophytes ligamentum flavum synovial cyst Specification discectomy partial total excision of an intervertebral disk partially and total vertebrectomy partial partial resection of the vertebra vertebrectomy full complete full resection of the vertebra osteotomy resection of bone laminotomy partial resection resp opening the spinal canal through the lamina hemi laminectomy removal of one side of the vertebral lamina laminectomy facet joint resection partial facet joint resection full Removal of the posterior arch of a vertebra partial resection of the facet joints complete resection of the facet joint sequestrectomy excision of a sequester Flavectomy removal of the lig flavum flavotomy opening of the lig flavum foraminotomy bone resection widening of the foraminae laminoplasty uncoforaminotomy The laminae are reattached to preserve lumbar stability anterior cervical foraminotomy other specify Indicate the anatomical location where the structures are Fusion prepared for fusion not the route of access e g TLIF PLIF with pedicle fixation anterior and posterior n
9. g for segment L4 5 mark segment and L4 In deformity surgery Use the apex of the main curve as most severely affected segment vertebral body Extent of lesion Indicates the number of involved segments main pathology nota bene not the number of segments treated i e operated e g instrumented page 18 Spine Tango User s Manual Part Dictionary of Terms Surgery 2011 and Follow up This section offers the opportunity to list other relevant pathology pathologies multiple answers However these pathologies are not further specified Additional pathology must be different from main pathology If there is a conflict of importance choose the more severe one as main pathology none degenerative disease see above deformity see above fracture Trauma see above pathological fracture see above spondylolisthesis non see above degenerative inflammation see above infection see above tumor see above repeat surgery see above other specify No of previous spine surgeries This section allows the documentation of previous interventions on the spine at the same level or at different levels compared with the current procedure If 0 is ticked the following two questions are excluded Previous surgery at the same single answer level no The addressed level vertebra was not touched bef
10. largest Cobb angle Minor curves may be compensatory Predominant etiology In the case of combined aetiology indicate the most prominent page 8 Spine Tango User s Manual Part Dictionary of Terms Surgery 2011 and Follow up idiopathic Arising spontaneously or from an obscure or unknown cause congenital Failure of formation failure of segmentation or mixed neuromuscular Neuropathic or myopathic conditions e g sub classification Lonstein et al Group I Double thoracic and lumbar curves Group II Large lumbar or thoraco lumbar curves degenerative de novo secondary degenerative posttraumatic Defective structure due to a trauma or fracture M Scheuermann other Scheuermann s disease Type I classical Scheuermann s is a thoracic or thoracolumbar hyperkyphosis due to wedged vertebrae developing during adolescence Atypical Scheuermann s disease Type II lumbar Scheuermann s affects the lumbar spine and or the thoracolumbar junction It is a growth disturbance of the vertebral bodies without significant wedging causing loss of lumbar lordosis or mild kyphosis specify Pathological Fracture Trauma Type of pathological fracture trauma In the case of multiple fractures with different types please use separate forms for each category if different treatment modalities are used condylar CO fracture of the oc
11. removal Type or reason of repeat surgery hardware removal Removal of Implants e g screws rods non union Failure of bony consolidation of bridge union 6 months after surgery instability Exceeded motion in a spinal segment after surgery failure to reach therapeutic goals neurocompression Therapeutic goals were not achieved with index surgery Compression of neural structures with or without neurological deficits page 17 Spine Tango User s Manual Part Dictionary of Terms Surgery 2011 and Follow up postop infection superficial Superficial infection after surgery postop infection deep Deep subfascial wound tissue infection after surgery implant malposition Incorrect position of the implant implant failure Problem due to an implant e g loosening breakage sagittal imbalance Sagittal malalignment of the spine adjacent segment pathology Comments regarding main pathology Progressive degenerative changes in the adjacent segment of the index surgery The section main pathology facilitates grouping of different pathologies If combined pathologies of equal clinical significance are present or there are special characteristics of a given pathology please comment here Most severely affected segment vertebral body segments vertebral body In segments mark cranial VB vertebral body e
12. 19 Previous surgery at the same rennen ren nennen trennen ne 19 Previous surgery at the same hospital 19 Previous treatment for main 20 h3Rig eng ce EE 20 Presence of flags for LBP patients esee eee nennen eret en eene ener enne tenete trennen 21 Occupational and societal factors 22 not matters of perception affect all workers equally eese teen rennen nenne 22 JE eU ad 22 Rv 22 SURGICAL aloe icq 22 Therapeutic BOGUS em 22 Anterior ACCESS ppe detec 23 uada M 23 Components COMPONENE descrIptiOh ioo e see dee petunt 24 Spine Tango User s Manual Part Dictionary of Terms Surgery 2011 and Follow up SUT COW Credentials cns orte te tc LU ed 24 Morbidity State s Ts Com 24 Te np e 26 NP 27 Pado E E 27 DIC NTERER O 27 Blood transfusion acte e eae diete orae cete eo eet edm LL E 27 UM T
13. Spine Tango User s Manual Part I Dictionary of Terms Surgery Version 2011 and Follow up Spine Tango T Zweig M Neukamp A Mannion C R der E Munting D Grob 1 Institute for Evaluative Research in Medicine University of Bern Switzerland 2 Orthopedic Department Kantonsspital Schwyz Switzerland 3 Spine Unit Schulthess Klinik Zurich Switzerland 4 Orthopaedic Department Clinique Saint Pierre Ottignies Belgium 5 Spine Tango Committee EuroSpine the Spine Society of Europe Spine Tango Dictionary of Terms V 2 3 April 2012 b EURO SPINE b UNIVERSITAT BERN Spine Tango User s Manual Part Dictionary of Terms Surgery 2011 and Follow up MEO NGDUNMESLO H 4 FORMA Tit 4 LEVEL OF MAIN PATHOLOGY s0 lt ccccsevscssneiececsvseuscascestsocensesccssevasecsetsescuseuseutenrsbiendoevessedntsedesesseevaveedsdstetavessecuevseuen 4 ADMISSION PA THOLOGY 4 AXDMISSION e E o C RES E E E D ttes ti 4 MAN PATHOL OGY de Em 4 SPECIFICATION OF MAIN PATHOLOGY SEE Eier uet 5 degenerative Disease ossi cem etai a etie t etos pedit les et tetas Or EORR se EXER egt D Of AE SENET AMON E 6 Deformity EE 7 deformity
14. al appearance of the patient diagnostic measures Operation is diagnostic procedure e g biopsy other specify Anterior access no anterior access transoral through oropharyngeal cavity anterolateral anterior medial approach to the cervical spine for mainly C3 Th1 Note anterior approach to the lumbar spine see retroperitoneal or transperitoneal cervicothorac anterolateral cervicothorac w sternotomy access to pathologies involving cervicothoracic the junctions with sternotomie depending on the extent localisation of the lesion thoracotomy thoracotomy to T4 T11 thoracoabdominal Extensive approach opening the thorax and retroperitoneum by taking down the diaphragm gives access to Th10 L2 retroperitoneal anterior approach to L2 S without incision of peritoneum transperitoneal extreme lateral e g XLIF anterior approach to L2 S through the peritoneal cavity lateral retroperitoneal trans psoas approach e g for XLIF extreme lateral interbody fusion other specify Posterior access no posterior midline posterior approach to the cranio cervical thoracic lumbo sacral spine paramedian paramedian incision posterolateral e g costotransversectomie page 23 Spine Tango User s Manual Part Dictionary of Terms Surgery 2011 and Follow up percutaneous percutaneous approach
15. axial segment Criteria for the Classification of Acute Arthritis of Rheumatoid Arthritis American College of Rheumatology 1 Morning stiffness Morning stiffness in and around the joints lasting at least 1 hour before maximal improvement 2 Arthritis of 3 or more joint areas At least 3 joint areas simultaneously have had soft tissue swelling or fluid not bony overgrowth alone observed by a physician The 14 possible areas are right or left PIP MCP wrist elbow knee ankle and MTP joints 3 Arthritis of hand joints At least 1 area swollen as defined above in a wrist MCP or PIP joint 4 Symmetric arthritis Simultaneous involvement of the same joint areas as defined in 2 on both sides fo the body bilateral involvement of PIPs MCPs or MTPs is acceptable without absolute symmetry 5 Rheumatoid nodules Subcutaneous nodules over bony prominences or extensor surfaces or in juxtaarticular regions observed by a physician 6 Serum rheumatoid factor Demonstration of abnormal amounts of serum rheumatoid factor by any method for which the result has been positive in 596 of normal control subjects 7 Radiographic changes Radiographic changes typical of rheumatoid arthritis on posteroanterior hand and wrist radiographs which must include erosions or unequivocal bony decalcification localized in or most marked adjacent to the involved joints osteoarthritis changes alone do not qualify
16. c damage of the dura with liquor emission vascular injury iatrogenic damage of a vessel fx spinal structures fx fracture iatrogenic fracture of osseous spinal structures e g pedicle or vertebral body other specify not documented Complications unknown or unwillingness to record them Surgical measures during index surgery measures taken because of complications occurred during surgery none suture glue suture or glueing of e g a dura lesion other Intraoperative general complications specify general complications occurring during the surgery none anaesthesiological complications during operation due to anaesthesia narcosis Cardiovascular cardiovascular complications during operation but not necessarily due to surgical intervention Pulmonary pulmonary complications during operation but not necessarily due to surgical intervention thrombembolism thrombosis embolism Intraoperative clot formation thrombus in a blood vessel that breaks loose and is carried by the blood stream to plug another vessel e g in the leg kidneys lungs pulmonary embolism brain stroke or gastrointestinal tract death death during the operation other not documented Complications unknown or unwillingness to record them page 33 Spine Tango User s Manual Part Dictionary of T
17. cipital condyle Classification Type l I und III CO0 C1 dissociation atlanto occipital dissociation C1 fracture fracture of C1 C1 2 Instability instability between C1 and C2 C2 dens fracture specify dens fractures type C2 other fracture C2 fractures excluding dens fractures soft tissue injury neck Whiplash injury post traumatic cervicalgia without demonstratable tissue lesions by Xrays or MRI fracture C3 L5 S 1 specify AO fracture type page 9 Spine Tango User s Manual Part Dictionary of Terms Surgery 2011 and Follow up sacrum fracture fracture os sacrum other specify Specify according to the classification Anderson and d Alonzo Dens fracture type l Type I I Upper dens oblique Ill 896 Type Il Base of dens transverse 5996 Type III Body of axis facets 3396 Reference Anderson LD D Alonzo RT 1974 Fractures of the odontoid process of the axis JBJS A 56 8 1663 1674 page 10 Spine Tango User s Manual Part Dictionary of Terms Surgery 2011 and Follow up Specify according the AO classification spine fracture BE C3 L5 S1 AO fracture type A1 I I A2 A3 endplate impaction wedge impaction corpus collaps 2 2 2 3 sagittal split coronal split pincer fracture 3 2 incomplete burst burst split comp
18. co lumbo sacral including T12 lumbar and 1 lumbar L1 L5 lumbo sacral including L5 and S1 sacral 1 S5 Os Number of levels in the section has priority Pathology from 0 upper cervical Pathology from C0 C6 mid lower cervical Admission Pathology Admission date of admission format Day Month Year DD MM Y YY Y days are counted 00001 5 24001 Main pathology single answer same as stage 1 surgery This item is only on the surgery staged 2011 form page 4 If yes excludes specification of main pathology Spine Tango User s Manual Part Dictionary of Terms Surgery 2011 and Follow up degenerative disease Pathology without apparent changes other than those due to aging deformity Clinically relevant scoliosis or deviation of sagittal alignment more than two segments fracture trauma Fracture or discoligamentous injury as sequelae of trauma pathological fracture spondylolisthesis non Fracture dislocation due to pathologic conditions of bone tumor osteoporosis etc Vertebral slippage including segmental rotational degenerative displacement inflammation Pathology due to rheumatic diseases e g RA ankylosing spondylitis psoriasis etc infection Affection due to microorganisms tumor Includes paravertebral soft tissue bone and neurogenic tumo
19. cord them Postoperative general complications before discharge Complications appeared after index surgery but during hospitalisation Refers exclusively to complications that occur during the hospital stay of the recorded surgery none page 34 Spine Tango User s Manual Part Dictionary of Terms Surgery 2011 and Follow up anaesthesiological postoperative complications related to anaesthesia narcosis e g sore throat or swallowing problems after intubation cardiovascular Cardiovascular postoperative complications e g heart rhythm disturbances after index surgery pulmonary Pulmonary postoperative complications e g pulmonary edema with dyspnea after index surgery thrombembolism thrombosis embolism Clot formation thrombus in a blood vessel during hospitalization that breaks loose and is carried by the blood stream to plug another vessel e g in the leg kidneys lungs pulmonary embolism brain stroke or gastrointestinal tract death death after surgery related or unrelated to the intervention other specify Re intervention after index surgery Second or multiple Interventions caused by complications performed after index surgery not planned in advance during the same hospitalization none hematoma evacuation surgical evacuation of hematoma suture glue suture or glueing of any structure that was no
20. e autol bone harvested autol bone locally produced fusion material autologous bone harvested in extra location fusion material autologous bone locally produced during operation e g via spinal decompression allog bone fusion material allogeneic bone bone subst fusion material bone substitute cement fusion material cement BMP or similar bone morphogenetic protein other growth factors other specify page 29 Spine Tango User s Manual Part Dictionary of Terms Surgery 2011 and Follow up Stabilization rigid Anatomical location where implants are placed not route of access according to the 3 column model anterior and middle column count as anterior posterior column counts as posterior Middle Column Anterior Column Posterior Column anterior posterior Use of device for stabilizing the anterior middle spinal column in a rigid way e g interbody cage Use of device for stabilizing the posterior spinal column in a rigid way e g pedicle screws with rod Specification interbody stabil with cage Cage implantation between two adjacent vertebrae through an anterior OR posterior approach Usually regarded as anterior rigid stabilization anterior and middle column interbody stabil with auto allograft Stabilization between adjacent vertebrae with autogeneic or allogeneic bone graft Usually r
21. e pars interarticularis Please specify grade of spondylolisthesis other instability myelopathy Hypermobility loss of stiffness in a motion segment not spondylolisthesis caused by degenerative changes Gradual loss of nerve function caused by progressive narrowing of the spinal canal facet joint arthrosis Spondylarthrosis degenerative changes osteoarthritis of the facet joints other Any other condition that does not fit the aforementioned pathologies Deformity Type of deformity page 7 Spine Tango User s Manual Part Dictionary of Terms Surgery 2011 and Follow up scoliosis Coronal spinal curvature of at least 10 with rotation of the vertebral bodies of unknown origin Def Cobb 1948 Cobb Classifications Infantile 0 3 years IIS Juvenile 3 10 years JIS Adolescent 10 18 years AIS Adult gt 18 years onset primary degenerative or de Novo Reference Cobb J R Outline for the Study of Scoliosis Instructional Course Lectures The American Academy of Orthopaedic Surgeons Vol 5 pp 261 275 Ann Arbor J W Edwards 19488 kyphosis The Scoliosis research Society proposes to regard 10 40 degrees as the range for normal kyphosis between the upper endplate T5 and the lower endplate T12 combined scoliosis and kyphosis Type of scoliosis single curve one single curve double curve two curves Major curve curve with the
22. eese eene 34 RE INTERVENTION AFTER INDEX SURGERY ccieeeseeeeeeeeneneneeen enne eene nnnn sien ette th nn 35 Hospital Stay E 35 Ho Sereni rlt ferry rte c 36 Therapeutic goals upon discharge 36 FU FOTOS COM NH 36 Discharge date 36 LEVEL INTERVENTIONY csssssccccceceesssccecececeesessuseeececsesssaeeececseeesesuaeseceeeceenaaeceeececsesuaesesececeessaseeseeeeserses 36 FUINTER VA Es 37 WORK WELT 37 THERAPEUTIC GOALS MEASURES 37 ACHIEVED EE 37 PARTIALLY ACHIEVED 37 EM 37 MEDICATION M 38 OVERALL OUTCOME EXAMINER 38 REHABIMITA TON E 38 DECISION Em 39 COMPLICATIONS 39 page 3 Spine Tango User s Manual Part Dictionary of Terms Surgery Form Surgery 2011 and Follow up Format minimal Minimal data set all questions with white background are excluded complete Complete data set all questions must be answered Level of main pathology upper cervical C0 C2 mid lower cervical C3 C7 cervicothoracic including C7 and T1 thoracic T1 T12 thoracolumbar including T12 and L1 thora
23. egarded as anterior rigid stabilization Vertebral body replacement with auto allograft Vertebral body replacement by an auto or allograft with total or partial vertebral resection Usually regarded as anterior rigid stabilization vertebral body replacement by cage Cage implantation as vertebral body replacement with total or partial vertebral resection Usually regarded as anterior rigid stabilization page 30 Spine Tango User s Manual Part Dictionary of Terms Surgery 2011 and Follow up plates stabilisation with plates Usually regarded as anterior rigid stabilization whereby plate can be attached at anterior or lateral aspect of vertebral pedicle screws with rod Stabilisation with pedicle screws with rod A posterior form of spinal stabilization facet screws Means of posterior osteosynthesis specific to the lumbar spine The screw usually two per level crosses the facet joint 222 transarticular screws C1 C2 Stabilisation with transarticular screws through the C2 C1 joint realized by posterior approach laminar hooks with rod Stabilisation with laminar hooks with rod A posterior form of spinal stabilization pedicle hooks with rod Stabilisation with pedicle hooks with rod A posterior form of spinal stabilization lateral mass screw with rod Stabilisation with lateral mass screw with rod A posterior form
24. er s Manual Part Dictionary of Terms Surgery 2011 and Follow up ASA 4 life threatening ASA IV Individual with severe incapacitating disease Normally disease stage is poorly controlled or end stage Danger of death due to organ failure is always present Examples Organic heart disease showing marked signs of cardiac insufficiency persistent anginal syndrome or active myocarditis Advanced degrees of pulmonary hepatic renal or endocrine insufficiency ASA 5 moribund ASA V Patient who is in imminent danger of death Operation deemed to be a last resort attempt at preserving life Patient not expected to live through the next 24 hours In some cases the patient may be relatively healthy prior to catastrophic event which led to current medical condition Examples Burst abdominal aneurysma with profound shock Major cerebral trauma with rapidly increasing intracranial pressure Massive pulmonary embolus Note most of these patients require operations as a resuscitative measure with little if any anesthesia Reference Composite from different editions of the Textbook of Surgery Sabiston David C Textbook of surgery Philadelphia W B Saunders Company Technology conventional Conventional open surgery without any of the assistive devices mentioned below MISS LISS MISS minimally invasive spine surgery LISS less invasive spine surgery loops Surge
25. erms Hospital stay Surgery 2011 and Follow up Postoperative surgical complications before discharge Complications occured after index surgery but during hospitalisation Refers exclusively to complications that occur during the hospital stay of the recorded surgery none No complication occurred epidural hematoma bleeding hematoma outside dural sack but inside bony spinal canal other hematoma hematoma in other localization but related to surgery radiculopathy affection of nerve root which can lead to radicular pain weakness numbness or difficulty controlling specific muscles CSF leak pseudomeningocele motor dysfunction cerebrospinal fluid leak fistula motoric muscle dysfunction new or worse compared to preoperative sensory dysfunction sensory dysfunction new or worse compared to preoperative bowel bladder dysfunction bowel or bladder dysfunction due to iatrogenic damage new or worse compared to preoperative wound infection superficial postoperative superficial wound infection wound infection deep postoperative deep subfascial wound infection implant malposition incorrect positioning of the implant implant failure failure of the implant e g breakage wrong level surgery on the wrong level not on level of main pathology other not documented Complications unknown or unwillingness to re
26. for e g minimal invasive surgeries trans sacral e g AxiaLIF trans sacral approach also called presacral used for e g AxiaLIF trans sacral axial lumbar interbody fusion also called Percutaneous AxiaLIF anterior para axial or paracoccygeal interbody fusion other specify Components implants e g screws rods disc prosthesis with description Activate the component subform for describing article name article number and supplier without description Implants are used but not further specified component description Supplier Article Name name the company article description implant model size etc gt can be found on the Implant sticker Article No Can be found on the Implant sticker Screws and hooks for example do not have an Article N but this field has to be filled out so then put xxx Surgeon credentials specialized spine self indicated spinal fellowship completed mayority of current work focused on spinal disorders board certif orthopaedic board certified orthopaedic surgeon board certified neuro board certified neurosurgeon orthopaedic in training orthopaedic surgeon in training neuro in training neurosurgeon in training other especify ASA stands for American Society of Anaesthesiologists In Morbidity stato 1963 the ASA adopted a five step physical status classification sys
27. gery section see above achieved The surgical goals are already completely or almost completely achieved at the time of discharge partially achieved The surgical goals are only partially achieved at the time of discharge and a further improvement is needed in order to consider them as achieved not achieved The surgical goals are definitely not yet achieved at the time of discharge and a further improvement is needed in order to consider them as at least partially or even achieved FU foreseen Indicates that one or several followups in the institution were the surgery was performed are foreseen planned Discharge date format Day Month Year DD MM YYYY Follow up Level of intervention upper cervical C0 C2 mid lower cervical C3 C7 cervicothoracic Including C7 and T1 thoracic T1 T12 thoracolumbar Including T12 and L1 thoraco lumbo sacral Including T12 lumbar and 1 page 36 Spine Tango User s Manual Part Dictionary of Terms Surgery 2011 and Follow up lumbar L1 L5 lumbosacral Including L5 and 1 sacral 1 S5 Coccyx Os coccyx Number of levels in the section has priority Fixation from 0 upper cervical Fixation from 0 mid lower cervical FU interval Tick the interval closest to the respective date or use the other answer option and specify followup interval
28. k other and categorise Spinal Cord fiere Ye Ei e 4 i V 4 J Nucleus __ Disc Fulposus ai Hemiation Fibrosus Normal Protrusion Prolapse central stenosis Central narrowing of the spinal canal due to e g hypertrophy of the yellow ligament lig flavum or bony restriction caused by enlargement of the facet joint osteoarthrosis osteophyte formation or degenerative spondylolisthesis page 6 Spine Tango User s Manual Part Dictionary of Terms Surgery 2011 and Follow up lateral stenosis Narrowing of the lateral recess of the spinal canal caused by e g disc height decrease posterolateral disc protrusion or hypertrophy of the superior articular process foraminal stenosis Narrowing of the foramen intraforaminal stenosis with nerve root compression degenerative disc disease deformity Degeneration of the intervertebral disc Disc related pathology e g loss of height end plate modifications intra discal gas etc Changing in the disc metabolism may lead to cellular changes matrix degradation and structural damages occurring in disc degeneration Deformation of the spine due to degenerative changes e g scoliosis kyphosis Please specify type of deformity degenerative spondylolisthesis Spondylolisthesis due to degenerative changes e g vertebral slippage due to wear and tear of the facets without anatomical changes of th
29. lete burst HE 3 BR Be transv disruption disc type A post ligament Be Bh transv bicolumn flexion spondylolysis B32 hyperextension spondylolysis oy flexion distraction A B 3 3 posterior dislocation M Holla 30 09 06 hyperextension subluxation page 11 Spine Tango User s Manual Part Dictionary of Terms Surgery 2011 and Follow up C1 C2 C3 rotation B3 shear Reference F Magerl M Aebi S D Gertzbein J Harms S Nazarian 1994 A comprehensive classification of thoracic and lumbar injuries Eur Spine J 3 184 201 Pathological fracture due to osteoporosis Osteoporosis progressive systemic skeletal disease with reduced bone mineral density BMD tumor If ticked gt go to section tumor and choose type and localisation other specify Fracture age fresh fracture 1 month old fracture gt 1 12 Spine Tango User s Manual Part Dictionary of Terms Surgery 2011 and Follow up Spondylolisthesis 1 Dysplastic Spondylolisthesis Congenital malformation of the sacrum or neural arch of L5 2 Isthmic Spondylolisthesis Stress fracture elongation or acute fracture of the pars 3 Degenerative Spondylolisthesis Long standing arthritic process of the zygapophyseal joints 4 Traumatic Spondylolisthesis Neural arch fracture excl
30. on uses loops endoscope Surgeon uses endoscope page 26 Spine Tango User s Manual Part Dictionary of Terms Surgery 2011 and Follow up CASS computer assisted surgery microscope Surgeon uses microscope neuromonitoring Intraoperative neurophysiological monitoring IONM or intraoperative neuromonitoring to monitor the functional integrity of certain neural structures during surgery other specify Operation time Indicate the duration of surgery skin to skin Prophylaxis none infection antibiotic prophylaxis thrombembolism thromboembolism prophylaxis pharmacological and or compression hosiery ossification ossification prophylaxis e g with NSAIDs Blood loss Indicate the amount of blood lost Blood transfusion units Indicate the number of transfused units autologous and allogeneic Also indicate if a cell saver was used Specify the number of units cell saver The cell saver collects blood from the surgical field to a machine which separates the red blood cells from detritus washes and concentrates the red blood cells to be reinfused into the patient Surgical measures Decompression Indicate the anatomical location where decompression is performed not the route of access none page Af Spine Tango User s Manual Part Dictionary of Terms Surgery
31. onal spinal intervention decided that is not related to foreseen complications or insufficient outcome of index intervention but to a different main pathology or same main pathology at different level Complications Complications to be indicated in relation to untoward events arising since the last recorded Tango form Examples Infection after discharge will be recorded only at first FU examination Implant loosening will be reported at first FU when diagnosis is made The complication is either a new event or a remaining sequela from a previously mentioned complication That sequela may disappear at a later follow up page 39
32. one anterior Implies an anterior interbody fusion whatever the approach anterior or posterior posterior Implies a posterior fusion whatever the approach anterior or posterior page 28 Spine Tango User s Manual Part Dictionary of Terms Surgery 2011 and Follow up Specification none interbody fusion A IF interbody fusion PLIF Interbody Fusion A IF Anterior interbody fusion of adjacent or distant vertebrae through an anterior approach A IF anterior cervical thoracic lumbar interbody fusion location defined by Level of intervention question anterior interbody fusion of adjacent or distant vertebrae through a posterior approach PLIF posterior lumbar interbody fusion interbody fusion TLIF anterior interbody fusion of adjacent or distant vertebrae through a posterior approach transforaminal lumbar interbody fusion interbody fusion XLIF anterior interbody fusion of adjacent or distant vertebrae through a far lateral approach XLIF Extreme lateral interbody fusion other interbody fusion posterolateral fusion If anterior interbody fusion types like A IF PLIF TLIF and XLIF do not apply e g with AxiaLIF posterolateral attachment of fusion material posterior fusion posterior attachment of fusion material other specify Fusion material Substance that is intended to contribute to future bony union e g BMP non
33. ore yes The same level vertebra has been addressed before partially Applies if the current procedure includes but is not limited to the previously operated segment s Previous surgery at the same hospital no A previous surgery was done elsewhere page 19 Spine Tango User s Manual Part Dictionary of Terms Surgery 2011 and Follow up yes This patient was operated in your institution already partially Applies if at least one but not all the previous interventions have been performed at the present institution Previous treatment for main multiple answers allowed pathology none No previous therapy at all surgical Surgical treatment already performed because of the same pathology 3 mon conservative 3 6 mon conservative 6 12 mon conservative Conservative treatment of the main pathology less than 3 months Conservative treatment for the main pathology for 3 6 months Conservative treatment for the main pathology for 6 12 months gt 12 mon conservative Conservative treatment for the main pathology for over 12 months Risk factors BMI Body Mass Index BMI kg m2 Weight kg Height m 2 Classification Underweight 18 5 Normal weight range 218 5 24 99 Overweight 25 29 99 Obese 30 current smoker yes regularly smoking at present no currently no
34. phoplasty Similar to vertebroplasty in the use of cement for internal stabilization of a vertebral compression fracture but by injecting the cement into a intervertebral cavity created by the insertion and inflation of a balloon epidural injections injection of e g anaesthetic corticosteroids into the epidural space other specify Other surgical measures Any other surgical procedure not matching the surgical terminology matrix given above no yes Extent of surgery indicate as Cranio caudal spinal range treated i e operated e g instrumented or decompressed from first row to second row for non contiguous segments i e 1 2 and L4 5 in one surgery document the extent of surgery from the most cranial to the most caudal segment even if there are healthy ones in between segments vertebral body from First row Indicate the most cranial segment or vertebral body of the operation to Second row Indicate the most caudal segment or vertebral body of the operation page 32 Spine Tango User s Manual Part Dictionary of Terms Surgery 2011 and Follow up Intraoperative surgical complications surgical complications occurring during the surgery none nerve root damage iatrogenic nerve root damage due to surgery spinal cord damage iatrogenic spinal cord damage due to surgery dura lesion iatrogeni
35. rs of the spine repeat surgery Any repeat surgery related to the index treatment operation other Any other condition that does not fit the aforementioned pathologies Degenerative spondylolisthesis includes by definition degenerative changes and spondylolisthesis If there is a typical degenerative spondylolisthesis e g vertebral slippage due to wear and tear of the facets without anatomical changes of the pars interarticularis tick degenerative disease as main pathology and specify as degen Spondylolisthesis If there is both degenerative spondylolisthesis and spinal stenosis you can now choose both since the Type of degeneration is multiple choice question Specification of main pathology Specify only in relation to items in the section corresponding to the chosen pathology degenerative Disease page 5 Spine Tango User s Manual Part Dictionary of Terms Surgery 2011 and Follow up Multiple answers allowed but only in relation to the main pathology These questions serve to improve the definition of Type of degeneration main pathology and to establish subgroups for later more differentiated identification disc herniation protrusion Disc material within the borders of the spinal canal either connected to the disc space bulging protrusion or separated from it sequester For further classification please tic
36. sent the equivalent of red flags for mental health and psychological problems Orange flags can include excessively high levels of distress major personality disorders post traumatic stress disorders drug and alcohol abuse addictions or clinical depression blue Focusing on Socioeconomic work factors perceived features of work or the social environment High demand low control unsupportive management style Perceived time pressure Lack of job satisfaction Work is physically uncomfortable page 21 Spine Tango User s Manual Part Dictionary of Terms Surgery 2011 and Follow up black Occupational and societal factors not matters of perception affect all workers equally Employer s rehabilitation policy deters gradual reintegration or mobility threats to financial security Qualification criteria for compensation e g where inactivity is a qualification criterion financial incentives lack of contact with the workplace duration of sickness absence unable to assess Ref Guide to Assessing Psychosocial Yellow Flags in Acute Low Back Pain Risk Factors for Long Term Disability and Work Loss Accident Compensation Commission New Zealand January 1997 Kendall N A S Burton A K Main C J amp Watson P J 2009 Tackling Musculoskeletal Problems A guide for clinic and workplace identifying obstacles using the psychosocial flags framework www tsoshop co
37. t anatomically restored or became apparently insufficient after surgery hardware removal metal removal because of a complication hardware re implantation re implantation after metal removal or implant failure abscess drainage abscess drainage because of postoperative infection further decompression expanded enlarged decompression because initial decompression was insufficient other not documented specify Details of re intervention unknown or unwillingness to record them Hospital stay uneventful no special events other than during a routine hospitalisation ICU gt 2 days extended stay intensive care unit stay longer than 2 days extended stay longer than normal with regard to the respective intervention and because of complications page 35 Spine Tango User s Manual Part Dictionary of Terms Surgery 2011 and Follow up Status of complications status of complications at the time of discharge resolved Complications are completely or almost completely resolved No more obvious restrictions from complications improved Complications have improved but are still obvious and may still restrict patient function or well being persisting Complications remain with same severity as when they occurred Therapeutic goals upon discharge achievement of the therapeutic goals that were set preoperatively and recorded in the sur
38. t i non opioid M 24 5 adjuvant pain persisting or increasing 1 non opioid adjuvant Level 1 Step 1 MILD PAIN Paracetamol NSAIDS and adjuvants if needed adjuvants include if nerve pain tricyclic antidepressants anti convulsants steroids Level 2 Step 2 MILD TO MODERATE PAIN Mild acting opioids Step 1 Non opoids and adjuvants if needed mild acting opioids codeine dihydrocodeine dextropropoxyphene Level 3 Step 3 MODERATE TO SEVERE PAIN Stronger opioids Step 1 non opioids and adjuvants if needed Stronger opioids Morphine dimorphine fentanyl hydromorphine Overall outcome examiner Reflects the general impression of the outcome from the physician s perspective Rehabilitation none no organized and structured postop treatment home based individually practiced exercises at home as initially shown by a therapist in hospital outpatient inpatient structured and monitored rehabilitation program page 38 Spine Tango User s Manual Part Dictionary of Terms Surgery 2011 and Follow up Decision no further follow up further follow up Patient discharged from care and supervision by treatment center Appointment made for further followup at treating center revision foreseen Surgical revision decided at the time of followup visit examination other primary intervention Additi
39. t smoking at all page 20 Spine Tango User s Manual Part Dictionary of Terms Surgery 2011 and Follow up Flags Presence of flags for T LBP patients and managing modrrabie risk factors musculoskeletal disorders Classification Assessment for the treatment of acute LBP patients considering psychosocial risk factors The psychosocial flags system can e g help occupational health practitioners create suitable rehabilitation plans for employees none red Medical Biomedical factors Serious pathology diagnosis Co morbidity i e co existence of other diseases Failure of treatment yellow Psychosocial or behavioral factors Beliefs about pain amp injury e g that there is a major underlying illness disease that avoidance of activity will help recovery that there is a need for passive physical treatments rather than active self management Psychological distress e g depression anger bereavement frustration Unhelpful coping strategies e g fear of pain and aggravation catastrophising illness behaviour overreaction to medical problems Perceived inconsistencies and ambiguities in information about the injury and its implications Failure to answer patients and families worries about the nature of the injury and its implications orange Abnormal psychological processes Distinguishing normal from abnormal psychological processes repre
40. tem for assessing a patient before surgery Unknown Only if not indicated by the anaesthesiologist page 24 Spine Tango User s Manual Part Dictionary of Terms Surgery 2011 and Follow up ASA 1 no disturbance ASAI Healthy individual with no systemic disease undergoing elective surgery Patient not at extremes of age Note age is often ignored as affecting operative risk however in practice patients at extreme of age are often thought to represent increased risk Examples Fit patient with inguinal hernia Fibroid uterus in otherwise healthy woman ASA 2 mild moderate ASA Il Individual with one system well controlled disease Disease does not affect daily activities Other anesthetic risk factors including mild obesity alcoholism and smoking can be incorporated at this level Examples Non limiting or only slightly limiting organic heart disease Mild diabetes essential hypertension or anemia ASA 3 severe ASA Ill Individual with multiple system disease or well controlled major system disease Disease status limits daily activity However there is no immediate danger of death from any individual disease Examples Severely limiting organic heart disease Severe diabetes with vascular complications Moderate to severe degrees of pulmonary insufficiency Angina pectoris or healed myocardial infarction page 25 Spine Tango Us
41. uding the pars region 5 Pathologic Spondylolisthesis Bone disease Paget s Metastatic disease or Osteopetrosis 6 latrogenic Spondylolisthesis induced as a result of previous lumbar spine surgery via LAIF or Laminectomy Type of spondylolisthesis Reference Wiltse LL Rothman LG 1989 Spondylolisthesis classification diagnosis and natural history Seminars in Spine Surgery 1 2 78 94 congenital dysplastic Type II isthmic Congenital abnormalities of the upper sacrum or the arch of L5 permit the olisthesis to occur The lesion is in the pars interarticularis Three subtypes can be recognized A Lytic failure B Elongated but intact pars C Acute fracture Type degenerative Long standing intersegmental instability see comment main pathology Type IV traumatic Fracture in other areas of the bony hook than the pars Type V pathological Localized or generalized bone disease Type VI postsurgical Due to iatrogenic instability if in adjacent segment tick pathology gt Type of degeneration gt adjacent segment and tick other This type of spondylolisthesis is not defined in this section To define a degenerative spondylolisthesis tick main pathology degenerative disease and specify as degenerative spondylolisthesis page 13 Spine Tango User s Manual Part Dictionary of Terms
42. uk flags London TSO Surgery Surgery Date Format Day Month Year DD MM YY YY Surgical procedure Therapeutic goals What the surgery should achieve from the surgeon s perspective axial pain relief Aim of back neck pain relief after surgery peripheral pain relief Aim of leg arm pain relief after surgery functional improvement Aim of functional improvement compared to preoperative status e g longer walking capacity mobility achieved by the intervention improvement of working ability home and job Improvement of capacity of sports practice motor improvement Aim of motoric neurological improvement compared to the preoperative status e g muscular function of the legs arms sensory improvement bladder sex function improvement Aim of sensory neurological improvement compared to the preoperative status e g recovery of sensibility Aim of improvement of the bladder and sexual function compared to the preoperative status spinal stabilization Aim of stabilization of the spine page 22 Spine Tango User s Manual Part Dictionary of Terms Surgery 2011 and Follow up stop deformity progression Aim of avoiding progression of the spinal deformity prophylactic decompression Aim of prophylactic preventive decompression for avoiding development of neurocompression cosmetic improvement Improvement of the physic
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