SRS Newsletter
March 2011
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President's Message

SRS president

I hope this newsletter finds you off to a great start for 2011. The first two months of this new year have been very busy and productive for our society. Since our last correspondence in December, we recently completed our winter Board of Directors meeting as well as a full day retreat on the topic of “Globalization,” both held in San Diego at the AAOS Annual Meeting. We have agreed to collaborate with the AOSpine organization to perform a clinical research trial on adult spinal deformity. We also prepared and sent out a RFP to several publishers for starting our own journal of spinal deformity, and have worked collaboratively with many other surgical societies on the topic of maintaining coverage for adult and pediatric deformity procedures in this very challenging health care reimbursement environment. Finally, the full version of our E-Textbook on Spinal Deformity is available on our website and is a landmark achievement for our society. I will elaborate below on all of these important topics.

Our winter BOD meeting includeed discussion of several strategic issues of importance to our society leadership of which you should all be aware. First, a financial strategic discussion examined the best options for investing a cash surplus that we have obtained following an exceedingly successful 2010 budget year. We are entertaining several options to maximize interest while minimizing risk to these proceeds. Also, Steve Mardjetko (chair) and the rest of the Endowment Task Force continue to develop a plan for starting our own SRS endowment/foundation which we hope to have in place by the next Annual Meeting in September of this year, with specific levels of contribution producing certain society-based awards/recognition. Also at the meeting, our 2012 Worldwide conference sites were chosen and include India, Ukraine, Bosnia Herzegovina, China (at the COA-Chinese Orthopaedic Association meeting) and SpineWeek in Amsterdam. The WWC continues to gradually elevate the international reach of our educational efforts under the leadership of Ahmet Alanay from Turkey.

The next strategic discussion revolved around the role of Clinical Practice Guidelines (CPG) and Appropriate Use Criteria (AUC) for a society such as ours. Kristy Weber, MD, Chair of the Quality Initiative of the AAOS, joined us, as well as James Sanders, MD, who has been very active in guideline development at the AAOS, and David Polly, MD, our former secretary who has tremendous knowledge in this arena. AAOS is changing its major focus for the near future to AUC, which depends not only on the available literature, but also to a significant extent on expert opinion to develop criteria and indications for various surgical procedures. We have put Dr. Sanders in charge of a task force to examine the best manner for the SRS to proceed in various guideline or AUC development for certain spinal deformity diagnoses and treatments. We look forward to the task force's recommendations on this very timely topic. Although seemingly "US-centric" currently, we feel the development of SRS position statements/guidelines will certainly be applicable to all spinal deformity surgeons worldwide. Along with that topic is the development of a registry of spinal surgery patients. We have been collaborating with the North American Spine Society (NASS) and others on this concept for the past nine months. There seems to be momentum in the healthcare environment to harness the power of multisociety collaboration on a spinal patient registry that includes both operative and nonoperative enrollment, but the feasibility, costs and participation in such a venture are yet to be fully determined. We will keep the membership abreast of the ongoing deliberations on this topic as we determine whether the SRS should participate in this process as it unfolds. Personally, I would like to thank all of our board members and guests for a truly interactive and productive meeting.

The following day in San Diego, the Presidential Line convened an all day retreat on the topic of "Globalization," in order to ascertain where on the pendulum of organizational structure our society falls from a purely North American to a fully global organization. We were thrilled that 39 members from 21 countries (many of whom came from as far as New Zealand, China, South Africa, etc. specifically for this retreat) actively participated in this open dialogue hosted by Cate Bower, a communications specialist very familiar with our society. We reviewed where on this pendulum we felt the SRS is currently, then examined in detail six aspects of our society to delve deeper into where these various facets of our society should be in two, five, and 10 years. These six categories included Education, Membership, Governance, Leadership, Finances and Research and all were led by past, current or future presidents of the SRS, along with a spectrum of BOD members, non-North American members and several younger members of the SRS. It was a very productive meeting, and the consensus was that the SRS is slowly becoming a global organization. The vast majority of the attendees felt confident we were on the pathway toward the realization of our mission statement, which is to improve the care of all patients (worldwide) with spinal deformity. The first part of the plan includes having the four councils and their respective chairs (and chairs-elect) team up with a PL member to propose concrete strategies and tasks to the BOD at the July IMAST meeting. After which, we will incorporate the consensus points of these six topics into our current strategic plan, where appropriate, so that future society leaders can follow the vision that has been set forth from this effort. The entire PL and I, would again like to thank all of the members who not only took the time to attend this retreat, but also were fully engaged in this topic allowing for a most successful and productive day.

In early January, the BOD voted unanimously to enter into a research collaboration with the AOSpine organization, arguably the largest group of spinal surgeons worldwide. They have a history of productive clinical research trials, and wanted to expand into the arena of spinal deformity research. At the same time, following a very productive research retreat at the 2010 AAOS meeting organized by our then-president Richard McCarthy, MD, our society felt we should strongly consider society-wide clinical research topics when appropriate. Following several conference calls with the leadership of both organizations, we agreed on a proposal to investigate a promising neuroprotective agent, Riluzole. This was vetted by a combined task force from both organizations, which included Kenneth Cheung, MD and Christopher Shaffrey, MD who are involved with both organizations, Leah Carreon, MD, a senior research clinician from the Leatherman Spine Institute in Louisville and an active SRS member, Peter Langer, the head of Research at AOInternational, and myself. We decided on a two-tiered approach, beginning with a multicenter prospective cohort analysis of "high risk" adult spinal deformity surgery to ascertain an accurate neurologic complication rate in these patients, followed by a prospective randomized clinical trial of the Riluzole drug to determine if it does, in fact, improve the neurologic outcomes of these surgeries. Be on the look out for an invitation to participate in this landmark collaborative research study, as all SRS members will have the opportunity to fill out a survey to aid in the selection of approximately 15 sites from around the globe. Work on this exciting project will begin by the end of this calender year. We are also pleased to announce that the Norton Healthcare System from Louisville has graciously provided the SRS with a grant to cover the financial contribution from our society to run this initial pilot study, and would like to thank Steven Glassman, MD, our Education Council Chair for spearheading this most generous grant from his institution. The leadership of both organizations are excited about this historic partnership and we look forward to a successful collaboration in the spirit of multicenter international clinical research.

Next, as mentioned in the last newsletter, a task force has been working on the potential for our society to start its own journal of spinal deformity and further progress has been made. Working with an experienced and well-respected consultant, Morna Conway, a RFP has been sent to publishers to gauge their interest in partnering with our society on this endeavor. We are pleased to say that several very well-known publishers have expressed a sincere interest in making a formal proposal, and we expect to be able to choose between three or four of these publishers. Our task force was able to meet with several of these companies and their representatives at the AAOS meeting and we feel confident that we are on the correct path. The plan is to review the formal proposals and invite two or three "finalists" to a meeting where our task force can receive additional information to be able to choose who we feel would be the best fit for our society, and then present this to the BOD at the July IMAST meeting. If we proceed down this pathway, a key component to the success of our own journal will undoubtedly be a highly-motivated and experienced society member to become the inaugural Editor-in-Chief. Please see the announcement in this regard later in the newsletter. Please let any of the task force members (George Thompson, MD; Richard McCarthy, MD; Randall Betz, MD; Vicki Kalen, MD; Tressa Goulding or myself) know of your or any other member’s interest in filling this most important position as we continue to move forward on this important historic educational and research priority for our society.

Next, I would like to inform the membership of an important advocacy effort occurring a bit behind the scenes in which the SRS is fully participating. In response to a memorandum of non-coverage reimbursement for various lumbar fusion patients and procedures from the North Carolina Blue Cross/Blue Shield company, a multisociety coalition spearheaded by the AANS/CNS Joint Section of Spine and Peripheral Nerves was convened to respond to this important state-wide initiative with potentially national and even international ramifications. Basically, BC/BS has developed rather strict coverage indications that are not in our patients’ best interests according to the multiple societies involved in the issue including AANS, CNS, AAOS, NASS, POSNA and the SRS among others. A formal response letter was drafted and sent to BC/BS regarding the rather restrictive indications, and a meeting was arranged amongst the various society stakeholders to allow for deliberation. I am pleased to report that our efforts were completely successful in reversing the non-coverage issues and I would personally like to thank Richard McCarthy, MD our Past President, as well as James Roach, MD, an SRS member and current POSNA President, for their efforts on our behalf including participation in the formal meeting with the insurance company’s representatives. Our collective societal coalition’s “voice” was heard loud and clear regarding these issues, and we are poised to react in this collaborative fashion to additional non-coverage issues, which will undoubtedly arise in the coming months/years ahead.

Lastly, we are very pleased to report that the electronic text on Spinal Deformity is now available on the Members-Only section of our website. I personally want to thank James Ogilvie, MD, Chair of the E-Text Committee and Editor-in-Chief of the entire project, as well as the many SRS members who served as section editors and chapter authors. This is a sentinel work and we are extremely proud of the results. It will certainly go a long way in solidifying our society’s role as the premier educational resource on spinal deformity topics around the globe. This is also an important membership perk as access to non-members currently exists on a fee-for-service basis. We will monitor this paid access closely to judge the overall impact that this type of financial arrangement has for the SRS in regards to non-members interested in utilizing this e-text material. In the coming months, additional videos will be added to the chapters and Praveen Mummaneni, MD, Chair-Elect of the committee, will be spearheading that effort. Please let him know if you are able to provide any video content that would be of value to this effort.

So that summarizes the very busy winter months our society has had in early 2011. As always, the rest of the PL and I greatly appreciate the efforts expended by so many of our dedicated SRS members and staff. You will have received an email notification requesting applications for committee appointments and I strongly encourage all of you to consider volunteering on at least one of our active committees. The strength of the SRS rests solely on the shoulders of its members. It is through committee involvement that the seeds of continued societal growth, as well as growth and knowledge of its members reside. Thank you again for the privilege to be your president and please get involved wherever you can to help us continue down our path of improving care for all spinal deformity patients worldwide!

Lawrence G. Lenke, MD