American Medical Society for Sports Medicine Sports Ultrasound Curriculum for Sports Medicine Fellowships.

ABSTRACT: Sports ultrasound is commonly used by sports medicine physicians to enhance diagnostic and procedural accuracy. This expert consensus statement serves as an update to the 2015 American Medical Society for Sports Medicine recommended sports ultrasound curriculum for sports medicine fellowships. Although written in the context of the American sports medicine fellowship training model, we present a stepwise progression in both diagnostic and interventional sports ultrasound that may be applicable to the broader sports medicine community. The curriculum is divided into 12 units with each unit including didactic instructional sessions, practical hands-on instruction, independent scanning practice sessions, and mentored clinical experience. To assist with prioritization of learning, we have organized relevant pathology and procedures as essential, desirable, and optional. The expanded content can serve as an outline for continuing education postfellowship or for any physician to further advance their sports ultrasound knowledge and skill. We also provide updated scanning protocols, sample milestones, and a sample objective structured clinical examination (OSCE) to aid fellowships with implementation of the curriculum and ongoing assessment of fellow progress.

Minimally invasive resection of intradural-extramedullary spinal neoplasms.

OBJECTIVE: Spinal intradural-extramedullary neoplasms are uncommon lesions that usually cause pain or neurological deficit secondary to neural compression. Traditional treatment of these tumors includes open laminectomy with intradural resection. We describe an alternative minimally invasive surgical technique in a consecutive series of patients undergoing treatment for symptomatic lesions. METHODS: Six patients (four men, two women) presented with symptoms including pain (five out of six) and/or neurological deficit (two out of six) with radiographic evidence of intradural pathology. All patients underwent surgical resection using a minimally invasive, unilateral approach. Pain relief was analyzed using the visual analog scale and magnetic resonance imaging to evaluate the extent of resection. Traditional laminectomy for tumor resection disrupts the muscular, ligamentous, and bony structures of the spine, which may contribute to pain and instability. Minimally invasive resection of intradural tumors offers the option of reducing approach morbidity when resecting these lesions. Using a tubular retractor system (X-Tube, Medtronic Sofamor-Danek, Memphis, TN) and microscopic surgical techniques, we were able to resect different intradural lesions successfully. RESULTS: All patients underwent successful, complete resection of their intradural-extramedullary tumors. The average patient age was 47 years (range, 41-60 yr) with one cervical, one thoracic, and four lumbar lesions. The mean operative time was 247 minutes (range, 180-320 min), the estimated blood loss was 56 mLs (range, 40-75 mLs), and the hospital stay was 57 hours (range, 48-80 h). Histologically, five tumors were determined to be schwannomas and one was identified as a myxopapillary ependymoma. There were no complications associated with this surgical technique. Postoperative magnetic resonance imaging demonstrated complete resection in all cases. CONCLUSION: Intradural-extramedullary neoplasms can be safely and effectively treated with minimally invasive techniques. Potential reduction in blood loss, hospitalization and disruption to local tissues suggest that, in the hands of an experienced surgeon, this technique may present an alternative to traditional open tumor resection.