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Scoliosis Research Society
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SRS: Scoliosis Research Society

Scoliosis Research Society

Dedicated to the optimal care of patients with spinal deformity

SRS Core Curriculum

The SRS curriculum is defined by 10 Knowledge Domains:

  • Knowledge Domain I: Foundation Knowledge
  • Knowledge Domain II: Early Onset Scoliosis
  • Knowledge Domain III: Adolescent Idiopathic Scoliosis
  • Knowledge Domain IV: Neuromuscular Scoliosis
  • Knowledge Domain V: Cervical Spine
  • Knowledge Domain VI: Adult Spinal Deformity
  • Knowledge Domain VII: Degenerative Spinal Deformity
  • Knowledge Domain VIII: Kyphotic Deformities
  • Knowledge Domain IX: Spondylolisthesis
  • Knowledge Domain X: Acquired Deformity

Each Knowledge Domain contains several Learning Objectives. Within each Knowledge Domain, the Learning Objectives have been organized into three categories:

  1. Learning objectives concerning development and anatomy OR etiology, classification, and natural history
  2. Learning objectives defining and identifying clinical and radiological parameters; patient health related quality of life (HRQoL) and guiding the treatment decision making process
  3. Learning objectives concerning defining, formulating and recommending treatment options, considering safety, and predicting outcomes and potential complications

Knowledge Domain I: Foundation Knowledge

Learning objectives concerning: development and anatomy

I.1.1. Learner will be able to describe the normal embryologic development and growth of the spine and neuraxis and their relation to function.

I.1.2. Learner will be able to describe changes in spine and related structures (including lung and thoracic cage) when altered by aging and/or pathology.

I.1.3. Learner will be able to identify basic anatomy, biomechanics and alignment (including 3-dimensional alignment) of the spine.

I.1.4. Learner will be able to list the major etiological factors and describe the biomechanical principles of spinal deformities.

I.1.5. Learner will be able to specify the importance of epigenetics in the development of spine pathologies. Learner will be able to describe the biology, physiology and biomechanical principles of bone growth and healing including the physes.

Learning objectives defining and identifying: clinical and radiological parameters; patient health related quality of life (HRQoL) and guiding the treatment decision making process

I.2.1. Learner will be able to perform a comprehensive history and physical examination of the patient presenting with spinal deformity.

I.2.2. Learner will be able to perform appropriate radiographic measurements to assess curve pattern, magnitude and flexibility including 3D assessment.

I.2.3. Learner will be able to describe current validated tools for HRQoL assessment including their reliability and responsiveness.

Learning objectives concerning:  Defining, formulating and recommending treatment options, considering safety, and predicting outcomes and potential complications

I.3.1. Learner will be able to describe the goals and general principles of conservative treatment modalities for spinal deformities.

I.3.2. Learner will be able to describe bone physiology and healing, how they apply to bone fusion and to discuss the advantages and disadvantages of the available bone grafting materials and substitutes.

I.3.3. Learner will be able to describe the basic biomechanics of spinal implants.

I.3.4. Learner will be able to demonstrate appropriate patient counseling and ability to obtain informed consent.

I.3.5. Learner will be able to describe the use of safety checklists (e.g., surgical site infection) and other safety measures for minimizing complications in spinal deformity surgery.

I.3.6. Learner will be able to describe principles of managing blood loss in spinal deformity surgery.

I.3.7. Learner will be able to describe the advantages and disadvantages of current modalities for neuromonitoring and response algorithms.

Knowledge Domain II: Early Onset Scoliosis

Learning objectives concerning: etiology, classification, and natural history

II.1.1 Learner will be able to define early onset scoliosis (EOS).

II.1.2 Learner will be able to describe the prevalence and etiologies of EOS.

II.1.3 Learner will be able to describe associated conditions, and evaluation of the patient presenting with EOS.

II.1.4 Learner will be able to discuss the current EOS classification systems (including congenital scoliosis).

II.1.5 Learner will be able to describe the natural history of untreated EOS and relationship of EOS to pulmonary function.

II.1.6 Learner will be able to describe the growth of the thoracic spine and thorax and the development of thoracic insufficiency syndrome.

Learning objectives defining and identifying: clinical and radiological parameters; patient's HRQoL, and guiding the treatment decision making process

II.2.1 Learner will be able to interpret clinical and radiological parameters in EOS.

II.2.2 Learner will be able to estimate the patient’s risk of progression based on the natural history of the deformity.

II.2.3 Learner will be able to list the indications, risks and benefits for non-operative treatment vs. surgical intervention.

II.2.4 Learner will describe the use of HRQoL data and appropriate outcome measures.

Learning objectives concerning:  defining, formulating and recommending treatment options, considering safety, and predicting outcomes and potential complications

II.3.1 Learner will be able to describe the technique of corrective cast application for EOS.

II.3.2 Learner will be able to describe the use of halo gravity traction in the treatment of EOS including complications.

II.3.3 Learner will be able to list the risk, benefits and complications of various growth friendly implant and correction strategies (e.g. distraction based, compression based, growth guided).

II.3.4 Learner will be able to describe the indications and complications of osteotomy and fusion based treatment including hemivertebrectomy in the treatment of EOS.

II.3.5 Learner will be able to describe the neuromonitoring indications and unique features of patients with EOS.

II.3.6 Learner will be able to select best treatment options considering capacity for appropriate follow-up for each patient throughout remaining growth.

II.3.7 Learner will be able to select fusion levels using clinical and radiographic parameters to optimize spinal balance and motion preservation.

II.3.8 Learner will describe use of measures to improve safety in EOS surgery and minimize perioperative complications.

II.3.9 Learner will be able to discuss complication management for the treatment options in EOS.

Knowledge Domain III: Adolescent Idiopathic Scoliosis

Learning objectives concerning: etiology, classification, and natural history

III.1.1 Learner will be able to define the prevalence for adolescent idiopathic scoliosis (AIS).

III.1.2 Learner will be able to describe theories on etiology of AIS (e.g. the multifactorial genetics of AIS, induction theories of AIS).

III.1.3 Learner will be able to define current AIS classification systems and their relevance to treatment.

III.1.4 The Learner will be able to discuss the need for early detection for AIS.

III.1.5 Learner will be able to describe the natural history of AIS and its influence on health and quality of life.

Learning objectives defining and identifying: clinical and radiological parameters; patient's HRQoL, and guiding the treatment decision making process

III.2.1 The Learner will be able to perform a complete history and physical examination.

III.2.2 The learner will be able to estimate the risks of progression in AIS using natural history and predictive models.

III.2.3 The learner will be able to list the indications for routine and advanced imaging including advantages and disadvantages of each.

III.2.4 The Learner will be able to perform appropriate radiographic measurements to assess curve pattern, magnitude and flexibility.

III.2.5 The Learner will be able to evaluate skeletal maturity using currently accepted methods.

III.2.6 Learner will describe the use of HRQoL data and appropriate outcome measures.

Learning objectives concerning:  defining, formulating and recommending treatment options, considering safety, and predicting outcomes and potential complications

III.3.1 Learner will be able to list the indications and treatment protocols for different types of orthotics including risks, benefits and psychosocial impact for each.

III.3.2 Learner will be able to list the surgical treatment options including risks, benefits and complications for each.

III.3.3 Learner will be able to select fusion levels using clinical and radiographic parameters to optimize spinal balance and motion preservation.

III.3.4 Learner will be able to describe basic and advanced correction maneuvers to correct coronal, sagittal and axial deformity.

III.3.5 Learner will describe use of measures to improve safety in AIS surgery and minimize perioperative complications.

III.3.6 Learner will be able to discuss complication management for the treatment options in AIS.

III.3.7 Learner will be able to list measures to prevent late complications in AIS.

Knowledge Domain IV: Neuromuscular Scoliosis

Learning objectives concerning: etiology, classification, and natural history

IV.1.1 Learner will be able to list the most common neuromuscular conditions and classification and their impact on curve development.

IV.1.2 Learner will be able to describe the unique differences amongst diagnosis, prevalence, and natural history of etiologies of neuromuscular scoliosis (NMS).

IV.1.3 Learner will be able to discuss the impact of medical comorbidities associated with the most common etiologies of NMS.

Learning objectives defining and identifying: clinical and radiological parameters; patient's HRQoL, and guiding the treatment decision making process

IV.2.1 Learner will be able to perform a complete history and physical examination of the patient with NMS including sitting balance and pelvic obliquity.

IV.2.2 Learner will be able to describe the role of preoperative optimization including interdisciplinary care teams.

IV.2.3 Learner will describe the use of HRQoL data and appropriate outcome measures.

Learning objectives concerning:  defining, formulating and recommending) treatment options, considering safety, and predicting outcomes and potential complications

IV.3.1 Learner will be able to describe ethical issues involved in treatment decisions for NMS patients.

IV.3.2 Learner will be able to describe non-operative treatment options.

IV.3.3 Learner will be able to describe the goals and strategies to optimize timely operative management of NMS.

IV.3.4 Learner will be able to select fusion levels using clinical and radiographic parameters to optimize spinal balance and motion preservation.

IV.3.5 Learner will be able to identify indications and contraindications for fusion to the pelvis.

IV.3.6 Learner will be able to identify indications for growth friendly techniques and goals of treatment.

IV.3.7 Learner will describe use of measures to improve safety in NMS surgery and minimize perioperative complications.

Knowledge Domain V: Cervical Spine

Learning objectives concerning: etiology, classification, and natural history

V.1.1 Learner will be able to describe types of primary cervical deformity and their etiology, pathology and natural history.

V.1.2 Learner will be able to describe risk factors for developing secondary cervical deformity (e.g., trauma, iatrogenic).

V.1.3 Learner will be able to list conditions associated with development of cervical instability (e.g. Down syndrome, skeletal dysplasias).

Learning objectives defining and identifying: clinical and radiological parameters; patient's HRQoL, and guiding the treatment decision making process

V.2.1 Learner will be able to perform a complete history and physical exam of the cervical deformity patient.

V.2.2 Learner will be able to describe normal and pathologic craniovertebral and cervicothoracic junction anatomy and alignment.

V.2.3 Learner will describe the use of HRQoL data and appropriate outcome measures

Learning objectives:  defining, formulating and recommending treatment options, considering safety, and predicting outcomes and potential complications

V.3.1 Learner will be able to describe indications and modalities for conservative treatment of cervical deformity.

V.3.2 Learner will be able to describe indications, risks and benefits of surgical treatment options.

V.3.3 Learner will be able to describe age-based correction strategies including approaches, fixation and bone grafting options.

V.3.4 Learner will describe use of measures to improve safety in cervical deformty surgery and minimize perioperative complications.

V.3.5 Learner will be able to discuss complication management for the treatment options in cervical deformity.

V.3.6 Learner will be able to list measures to prevent late complications in cervical deformity.

Knowledge Domain VI: Adult Spinal Deformity (ASD)

Learning objectives concerning: etiology, classification, and natural history

VI.1.1 Learner will be able to describe the etiologies and characteristics of adult spinal deformity (ASD) (e.g. untreated pediatric, degenerative, osteoporosis, neuromuscular, iatrogenic post-surgical).

VI.1.2 Learner will be able to discuss current classification systems, taking into account treatment implications and prognosis.

VI.1.3 Learner will be able to describe the natural history of ASD taking into account etiology and patient comorbidities.

Learning objectives defining and identifying: clinical and radiological parameters; patient's HRQoL, and guiding the treatment decision making process

VI.2.1 Learner will be able to perform a complete history and physical examination with a focus on potential compensatory mechanisms.

VI.2.2. Learner will be able to identify medical comorbidities influencing prognosis.

VI.2.3 The learner will be able to describe the normal and pathological standing coronal, axial and sagittal alignment parameters and extraspinal compensatory mechanisms.

VI.2.4 The learner will be able to define the indications and interpretation of advanced imaging and radiographs (e.g DEXA, CT, MRI).

VI.2.5 Learner will be able to describe the use of HRQoL data and appropriate outcome measures

Learning objectives concerning:  defining, formulating and recommending treatment options, considering safety, and predicting outcomes and potential complications

VI.3.1 Learner will be able to list the conservative treatment options for ASD including risks, benefits and complications for each.

VI.3.2 Learner will be able to list the surgical treatment options for ASD including risks, benefits and complications for each.

VI.3.3 Learner will be able to describe the concept of risk assessment, define and apply strategies to minimize the rate of complications, including but not limited to preoperative optimization.

VI.3.4 Learner will describe use of measures to improve safety in ASD surgery and minimize perioperative complications.

VI.3.5 Learner will be able to identify late complications and discuss their management.

Knowledge Domain VII: Degenerative Spinal Deformity

Learning objectives concerning: etiology, classification, and natural history

VII.1.1 Learner will be able to describe the pathogenesis of degenerative deformities.

VII.1.2 Learner will be able to describe the natural history of degenerative spinal deformities and how this influences treatment decisions.

Learning objectives defining and identifying: clinical and radiological parameters; patient's HRQoL, and guiding the treatment decision making process

VII.2.1 Learner will be able to perform a complete history and physical examination focused on disease-specific findings (e.g back vs. leg, neurogenic vs. vascular).

VII.2.2 Learner will be able to describe radiographic findings including spino-pelvic parameters, sagittal alignment and assessment of bone quality.

VII.2.3 Learner will be able to define co-morbidities to allow for risk stratification of patients.

VII.2.4 Learner will describe the use of HRQoL data and appropriate outcome measures.

Learning objectives concerning:  defining, formulating and recommending) treatment options, considering safety, and predicting outcomes and potential complications

VII.3.1 Learner will be able to list indications, risks and benefits of conservative and surgical treatment options.

VII.3.2 Learner will be able to describe indications, risks and benefits for standard diagnostic injections and use for surgical decision making.

VII.3.3 Learner will be able to select fusion levels using clinical and radiographic parameters to optimize spinal balance and motion preservation.

VII.3.4 Learner will be able to describe the advantages and disadvantages of staging major surgeries in adult spinal deformity.

VII.3.5 Learner will be able to discuss anterior and posterior treatment options including   different types of osteotomies.

VII.3.6 Learner will describe use of measures to improve safety in degenerative deformity surgery and minimize perioperative complications.

VII.3.7 Learner will be able to identify complications and discuss their management.

VII.3.8 Learner will be able to discuss the possible risk factors and strategies for prevention of junctional pathology.

Knowledge Domain VIII: Kyphotic Deformities

Learning objectives concerning: etiology, classification, and natural history

VIII.1.1. Learner will be able to define age specific normal and pathologic sagittal alignment.

VIII.1.2. Learner will be able to describe the etiology, prevalence and natural history of sagittal plane deformity / kyphotic deformities.

Learning objectives defining and identifying: clinical and radiological parameters; patient's HRQoL, and guiding the treatment decision making process

VIII.2.1 Learner will be able to perform a complete history and physical examination of the kyphotic patient with a focus on potential compensatory mechanisms.

VIII.2.2 Learner will be able to define the clinical symptoms in sagittal spinal deformities.

VIII.2.3 Learner will be able to describe the normal and pathological standing sagittal parameters and extraspinal compensatory mechanisms.

VIII.2.4 Learner will be able to define the indications and interpretation of advanced imaging and special radiographs (e.g flexion-extension, fulcrum, CT, MRI).

VIII.2.5 Learner will describe the use of HRQoL data and appropriate outcome measures.

Learning objectives concerning:  defining, formulating and recommending treatment options, considering safety, and predicting outcomes and potential complications

VIII.3.1 The learner will be able to list the conservative treatment options including risks, benefits and complications for each.

VIII.3.2 Learner will be able to list the surgical treatment options including risks, benefits and complications for each.

VIII.3.3 Learner will be able to select fusion levels using clinical and radiographic parameters to optimize spinal balance and motion preservation.

VIII.3.4 Learner will be able to describe basic (e.g cantilever) and advanced correction maneuvers to correct sagittal plane deformity.

VIII.3.5 Learner will be able to describe age-based correction strategies including approaches, fixation and bone grafting options.

VIII.3.6 Learner will describe use of measures to improve safety in kyphosis surgery and minimize perioperative complications.

VIII.3.7 Learner will be able to identify complications and discuss their management.

Knowledge Domain IX: Spondylolisthesis

Learning objectives concerning: etiology, classification, and natural history

IX.1.1 Learner will be able to define and describe the etiology of spondylolysis and spondylolisthesis.

IX.1.2 Learner will be able to define the natural history of spondylolysis and spondylolisthesis including neurologic complications.

IX.1.3 Learner will be able to classify spondylolysis and spondylolisthesis according to current classification systems.

Learning objectives defining and identifying: clinical and radiological parameters; patient's HRQoL, and guiding the treatment decision making process

IX.2.1 Learner will be able to list a differential diagnosis.

IX.2.2 Learner will be able to perform appropriate history and physical examination to correctly diagnose spondylolysis and spondylolisthesis.

IX.2.3 Learner will be able to utilize radiographic and advanced imaging methods to evaluate spondylolisthesis including sagittal parameters.

IX.2.4 Learner will describe the use of HRQoL data and appropriate outcome measures.

Learning objectives:  defining, formulating and recommending) treatment options, considering safety, and predicting outcomes and potential complications

IX.3.1 Learner will be able to define conservative treatment indications, risks and benefits methods and outcomes.

IX.3.2 Learner will be able to describe functional outcome of operative and non-operative treatment.

IX.3.3 Learner will be able to define the surgical treatment indications, risks and benefits for spondylolysis and spondylolisthesis including instrumented and non-instrumented techniques.

IX.3.4 Learner will describe the indications for neuromonitoring in surgery for high grade spondylolisthesis.

IX.3.5 Learner will be able to define indications for reduction and risks/benefits of reduction methods.

IX.3.6 Learner will be able to describe pars repair methods (repair vs. fusion) including indications, risks and benefits and surgical outcomes.

 IX.3.7 Learner will describe use of measures to improve safety in spondylolisthesis and minimize perioperative complications.

IX.3.8 Learner will be able to identify complications and discuss their management.

Knowledge Domain X: Acquired Deformity

Learning objectives concerning: etiology, classification, and natural history

X.1.1 Learner will be able to identify and classify non-developmental acquired pathology, (infection, iatrogenic, post-traumatic, osteoporosis, neoplastic) and evaluate causative pathology.

X.1.2 Learner will be able to list the risk factors for development and progression of each type of acquired spinal deformity (e.g. age, geographic location).

X.1.3 Learner will be able to describe spinal deformity following spinal cord injury (long term outcome in children and adults).

Learning objectives defining and identifying: clinical and radiological parameters; patient's HRQoL, and guiding the treatment decision making process

X.2.1Learner will be able to perform a complete history and physical examination with a focus on etiologic factors and potential compensatory mechanisms.

X.2.2 Learner will be able to identify medical comorbidities influencing prognosis.

X.2.3 Learner will be able to describe the normal and pathological standing coronal, axial and sagittal alignment parameters and extraspinal compensatory mechanisms.

X.2.4 Learner will be able to define the indications and interpretation of advanced imaging and radiographs (e.g DEXA, CT, MRI).

X.2.5 Learner will describe the use of HRQoL data and appropriate outcome measures.

Learning objectives concerning:  defining, formulating and recommending treatment options, considering safety, and predicting outcomes and potential complications

X.3.1 Learner will be able to describe indications and modalities for conservative treatment of acquired deformity including specific pharmacotherapy for osteomyelitis, osteoporosis and neoplastic processes.

X.3.2 Learner will be able to describe indications, risks and benefits of surgical treatment options.

X.3.3 Learner will be able to describe age-based correction strategies including approaches, fixation and bone grafting options.

X.3.4 Learner will describe use of measures to improve safety in acquired deformity surgery and minimize perioperative complications.

X.3.5 Learner will be able to discuss complication management for the treatment options in acquired deformity.