SRS Newsletter
March 2011

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
President

UPDATE ON CODING FOR CORRECTION OF SPINAL DEFORMITY

By Jeffrey Neustadt, MD and R. Dale Blasier, MD
Chair and Chair-Elect of the Coding Committee

The Coding Committee has been asked to provide the membership with advice and examples to help understand the complexity of coding and reimbursement issues specific to spine and spinal deformity surgeons. Every effort has been made to be accurate and adhere to the ICD-9 coding conventions and guidelines as well as the CPT rules. However there may be unintended discrepancies or differences of opinion. With that in mind, these articles are not intended to provide legal advice to surgeons and their staffs. The information given by the committee should not be relied upon as an official interpretation of the AMA CPT® code book. The American Medical Association (AMA) is the only entity which can give an official and binding interpretation of the AMA CPT® code book, and should be contacted directly if an official comment is needed or desired. For more information contact the AMA CPT® Network at www.cptnetwork.com. It is our every intention that the articles we prepare for this year’s newsletters are helpful and useful to all members of the SRS and their staffs. - Jeffrey B. Neustadt, MD, Chair, Coding Committee

Correct procedural coding for correction of spinal deformity involves several unique issues. The common relevant issues include appropriate use of fusion levels, base codes, add-ons and modifiers. This article discusses several deformity correction scenarios and provides specific examples for their accurate coding.

Space does not allow for inclusion of all deformity correction coding issues, for example, video-assisted thorascopic surgery, vertical expandable prosthetic titanium rib, growing rods, anterior growth tethering surgery, kyphectomy, kyphoplasty, vertebroplasty and vertebral resection. These will be covered in future newsletters.

Determining Fusion Levels
In coding deformity correction, the number of segments involved in the surgery must be determined. The number of levels (2 segments = 1 level; total levels = total segments-1) determines the codes which will be used for the arthrodesis. The instrumentation code is based on the number of segments spanned. Typically these are the same but they may not be in some cases, e.g. posterior spinal fusion with instrumentation from T4 to L4. This would be coded as fusing 12 levels but instrumenting 13 segments. More on this later!

Base Codes and Add-Ons
All deformity corrections are described by one or more codes. Every surgical episode must have a base code, i.e. a code which can stand on its own. For spine, these include the codes for arthrodesis, osteotomy, hardware removal and reinsertion. Several common procedures such as instrumentation, bone grafting, insertion of cages, fixation to the pelvis and thoracoplasty are add-on codes which can never be reported by themselves. These must be reported in addition a base code.

Modifiers
Base codes are generally billed without modifiers and are expected to be reimbursed by payers at 100% of the usual rate. The preop evaluation, postop care and subsequent patient visits are presumed to be reimbursed by the base code. Add-on codes are valued based upon intraoperative work only and do not include reimbursement for preop evaluation or postop care. For this reason, they do not need multiple procedure modifiers and are not discounted by payers.

If multiple base codes are performed during the same procedure, the largest base code is generally billed first and is not discounted by the payer. Lesser base codes are billed subsequently and are appended by the 51 modifier. Because these codes are valued to include pre– and postop care which is redundant with the primary base code, the 51 modifier enables the payer to discount these codes to prevent multiple reimbursements for perioperative care. When using the osteotomy codes at multiple levels, some payers require the use of modifier 59 (distinct procedural service) to indicate additional separate levels and other payers require modifier 76 (repeat procedure by same physician).

Base Codes: Descriptions
Procedures which can be done by themselves and are valued to include pre– and postoperative work are indicated with base codes. These include arthrodesis (fusion), osteotomy and hardware removal or reinsertion:

  • Arthrodesis Codes

    Posterior:
    • 22800 Arthrodesis, posterior, for spinal deformity, with or without cast; up to 6 vertebral segments (levels)
    • 22802 Arthrodesis, same; 7 to 12 vertebral segments (levels)
    • 22804 Arthrodesis, same; 13 or more vertebral segments (levels)
    Anterior:
    • 22806 Arthrodesis, anterior, for spinal deformity, with or without cast; 2 to 3 vertebral segments (levels)
    • 22808 Arthrodesis, anterior, same; 4 to 7 vertebral segments (levels)
    • 22812 Arthrodesis, anterior, same; 8 or more vertebral segments (levels)
  • Osteotomy Codes

    • 22206 Osteotomy of spine, posterior or posterolateral approach, three columns, one vertebral segment (eg, pedicle/vertebral body subtraction); thoracic
    • 22207 Osteotomy of spine, posterior or posterolateral approach, three columns, one vertebral segment (eg, pedicle/vertebral body subtraction); lumbar
    Posterior column:
    • 22212 Osteotomy of spine, posterior or posterolateral approach, one vertebral segment; thoracic
    • 22214 Osteotomy of spine, posterior or posterolateral approach, one vertebral segment; lumbar
  • Hardware Manipulation

    • 22849 Reinsertion of spinal fixation device
    • 22250 Removal of posterior nonsegmental instrumentation (eg, Harrington rod)
    • 22852 Removal of posterior segmental instrumentation
    • 22855 Removal of anterior instrumentation

Add-on Codes: Descriptions
Add-on services (those with a ZZZ global period) contemplate services which are only intraoperative service. No pre– or postop care is included. These always must be billed in addition to a base code. Note that instrumentation can never be billed alone. It must always be performed in association with a base code which complicates coding for growing rod procedures.

  • Instrumentation Codes:

    Anterior:
    • 22845 Anterior instrumentation; 2 to 3 vertebral segments
    • 22846 Anterior instrumentation; 4 to 7 vertebral segments
    • 22847 Anterior instrumentation; 8 or more vertebral segments
    Posterior:
    • 22840 Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across one interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation)
    • 22841 Internal spinal fixation by wiring of spinous processes
    • 22842 Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments
    • 22843 same; 7 to 12 vertebral segments
    • 22844 same; 13 or more vertebral segments
  • Add-on Osteotomy:

    Three-column:
      22208 Osteotomy of spine, posterior or posterolateral approach, three columns, one vertebral segment (eg, pedicle/vertebral body subtraction); each additional vertebral segment
    Posterior column:
    • 22216 Osteotomy of spine, posterior or posterolateral approach, one vertebral segment; each additional vertebral segment
  • Bone Grafting
    Bone graft codes represent the harvest of the graft only. Reimbursement for implantation of the graft is included in the arthrodesis code. Note that 20930 and 20936 describe procedures that have been assigned a zero RVU value. 20930 Allograft, morselized, or placement of osteopromotive material, for spine surgery only. Note that this code descriptor has been modified for 2011 to include "osteopromotive material".

    • 20931 Allograft for spine surgery only; structural
    • 20936 Autograft for spine surgery only (includes harvesting the graft); local (eg, ribs, spinous process, or laminar fragments) obtained from same incision
    • 20937 Autograft for spine surgery only (includes harvesting the graft); morselized (through separate skin or fascial incision)
    • 20938 Autograft for spine surgery only (includes harvesting the graft); structural, bicortical or tricortical (through separate skin or fascial incision)
  • Instrumentation to Pelvis

    • 22848 Pelvic fixation (attachment of caudal end of instrumentation to pelvic bony structures) other than sacrum
  • Thoracoplasty

    No code describes this procedure well. The following have been reported with success:

    • 32905 Thoracoplasty, Schede type or extrapleural (all stages)
    • 22899 Unlisted procedure, spine
  • Insertion of cages

    Note that insertion of machined allograft is specifically not listed in this code descriptor:
    • 22851 Application of intervertebral biomechanical device(s) (eg, synthetic cage[s], methylmethacrylate) to vertebral defect or interspace. Note that this code descriptor has been modified for 2011 to eliminate "threaded bone dowel[s]".

Other Adjunctive Procedures
Generally, supervision and interpretation of imaging for spine surgery—even for insertion of pedicle screws—is considered part of the procedure and should not be billed separately. Preparation and insertion of centrifuged blood products for deformity surgery is not reimbursable.

Examples of Surgical Coding

Scenario 1: Posterior Spinal Fusion for Kyphosis
This scenario describes a patient with kyphosis with an apex at T9. Instrumentation and fusion are performed from T2 to L2 (13 vertebrae, 12 segments or levels). Ponte or Smith-Petersen osteotomies are performed at T8–9, T9–10 and T10–11. Fragments excised at osteotomy are added to the fusion mass as bone graft. Additional graft is taken through a separate incision from the iliac crest.

For this procedure, the base code is: 22802 Arthrodesis, posterior, for spinal deformity, with or without cast; 7 to 12 vertebral segments. The osteotomies could also be base codes because they are 90-day global codes, but the arthrodesis code has a higher RVU value.

The first osteotomy should be billed as: 22212 Osteotomy of spine, posterior or posterolateral approach, one vertebral segment; thoracic and should be appended with a 51 modifier because it is a 90-day global code.

The second and third osteotomies should be billed as: 22216 Osteotomy of spine, posterior or posterolateral approach, one vertebral segment; each additional vertebral segment. This is an add-on code and does not require a modifier.

The instrumentation should be billed as: 22844 Posterior segmental instrumentation; 13 or more vertebral segments. This is an add-on code and does not require a modifier.

The iliac bone graft should be billed as: 20937 Autograft for spine surgery only (includes harvesting the graft); morselized (through separate skin or fascial incision). This is an add-on code which does not require a modifier. Note that bone graft codes assign value to the harvest and not the implantation.

The bone graft taken as fragments from the osteotomy should be billed as: 20936 Autograft for spine surgery only (includes harvesting the graft); local (eg, ribs, spinous process, or laminar fragments) obtained from same incision. While this is billable, no work value is assigned to this code.

Scenario 2: Anterior Spinal Fusion for Scoliosis:
This scenario describes a patient with scoliosis with an apex at L1. The spine is approached by a right thoracolumbotomy. Instrumentation and fusion are performed from T11 to L3 (five vertebrae, four segments or levels). Fragments of the eleventh rib excised at thoracotomy are placed in the intervertebral spaces as bone graft. Cages are placed at the two lowest intervertebral spaces to maintain lumbar lordosis. During closure, a chest tube is placed.

The base code is:
22808 Arthrodesis, anterior, for spinal deformity, with or without cast; four to seven vertebral segments. The surgical approach is not separately billable. If another surgeon makes the approach for the spine surgeon, then spine and approach surgeon become co-surgeons for the base code which is appended by modifier 62. The base code includes preparing the disc spaces and insertion of bone graft.

The instrumentation code is:
22846 Anterior instrumentation; 4 to 7 vertebral segments) and includes any rod rotation, compression or distraction used to correct the deformity. No modifier is needed as this is an add-on code.

The bone graft is billed as:
20936 Autograft for spine surgery only (includes harvesting the graft); local (eg, ribs, spinous process, or laminar fragments) obtained from same incision No modifier is needed as this is an add-on code. Note that the code has zero value.

The insertion of cages is billed as two episodes of:
22851 Application of intervertebral biomechanical device(s) (eg, synthetic cage(s), methylmethacrylate) to vertebral defect or interspace. No modifier is needed as this is an add-on code. The insertion, maintenance, and removal of the chest tube are included in the approach and are not separately billable.

Scenario 3: Posterior Spinal Fusion for Neuromuscular Scoliosis
This scenario describes a patient with a collapsing scoliosis of the whole spine. Instrumentation and fusion are performed from T2 to the sacrum (17 vertebrae, 16 segments or levels). Multiple pedicle screws, hooks and sublaminar wires are placed to secure the rods. Instrumentation stops at the sacrum and does not extend to the iliac wings. The iliac wings are small, osteoporotic and not considered a good source of graft, so allograft and a centrifuged blood product are placed to encourage fusion after the facet joints are excised.

The base code is: 22804 Arthrodesis, posterior, for spinal deformity, with or without cast; 13 or more vertebral segments.

The instrumentation code is:
22844 Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 13 or more vertebral segments).

If the instrumentation had extended to the ilia, it would have been appropriate to add: 22848 Pelvic fixation (attachment of caudal end of instrumentation to pelvic bony structures) other than sacrum.

Placement of allograft is described by:
20930 Allograft, morselized, or placement of osteopromotive material, for spine surgery only

Placement of a centrifuged blood product is not covered by any code.

Ethics Committee Report

By J. Abbott Byrd III, MD
Ethics Committee Chair

"Hey doc, I'm Joe Spinerep with the Acme Spine Company. We are a new, small, private company but have some of the best spine widgets around. I have been trying to meet with you for a long time as you are one of the best and busiest spine surgeons in town. We have a great program for doctors like you and I wanted to make sure that you got in on the ground floor. Acme Spine is able to offer a stock option program to a small group of busy surgeons and while the company is privately held now, the plan is to go public when sales increase at which time those options will be quite valuable." ETHICAL???

"Well doc, if you are not interested in stock options, we have another program that might be attractive. Acme Spine is also putting together a small group of consulting surgeons to evaluate our full line of widgets. The program really won't take much of your time as all you need to do is fill out a product evaluation form after you do a case. We can only pay market rates for the evaluations but a busy surgeon such as yourself will have the opportunity to do multiple evaluations on our many products." ETHICAL???

"Well doc, if you are not interested in a consulting arrangement, we have another program that could help your practice. Acme Spine has a marketing package to promote you and our fine line of spinal widgets. We have tried it in other markets and it has worked great. Basically, we run newspaper and radio ads promoting our widgets and at the end mention that you are one of the few doctors to bring this great technology to the area. I am sure that this will increase your surgical volume." ETHICAL???

"Well doc, we don't seem to be making much headway but I would sure like to discuss this more with you over dinner. Why don't you let me take you and your wife out to that fancy steak restaurant in town. It is supposed to be one of the best around and has the best wine list in the state." ETHICAL???

"Well gee doc, I just don't know what else I can do to earn your business. It is a shame that we can't work together because I thought you and Acme Spine had a great future together."

The Ethics Committee is preparing a comprehensive document to offer ethical guidance for these and other questions with which the SRS, as an organization, and its members, as individual surgeons, are often faced. The document will begin with the SRS Conceptual Mission Statement which will broadly outline standards for ethical and professional practice and academic activity. The Standards of Professionalism (SOPs) section will focus on issues of importance to the individual surgeon such as advertising, conflicts of interest with industry, as well as expert opinion and testimony. Ethical issues of interest to the SRS will be addressed by the section on Professional Medical Associations (PMAs). This section will address the ethical relationship of the SRS with industry. Other subjects that will be addressed include society meetings, research support and the issue of conflict of interest for the SRS leadership. The document will conclude with the SRS Ethical Discipline Management Process which will clearly outline the reporting mechanism, evaluation and adjudication process for alleged ethical breeches.

It is the goal of the Ethics Committee to present the completed document to the Presidential Line for comment by late May and then to the Board of Directors for approval at the July meeting. After approval, the document will be presented to the membership at the Annual Meeting in Louisville.

Despite the many problems that surround our chosen profession, we must remember that it is the ethical practice of medicine that best serves our patients and sets our profession apart from many others.

FOSA Review

By Allen Carl, MD
FOSA President 2010-2011

The Federation of Spine Associations (FOSA) met at the AAOS Annual Meeting on Saturday, February 19, 2011. FOSA is a specialty day meeting of the major orthopedic spine societies including SRS, NASS, CSRS, and ASIA. Each brings a unique component to make this conference a fulfilling educational experience.

This year marked the 24th time FOSA has met at the Academy. It was the vision of forward-thinkers who helped to showcase spine issues to the members of AAOS. The original officers at the first meeting were Dr. David Bradford, President; Dr. John Kostuik, Vice President; and Dr. David Selby, Secretary/Treasurer. Each of the 4 societies now select 2 members to be on the Executive committee and as Program chair. The President rotates every year between societies and has the responsibility of selecting the program topic.

This year, the meeting’s topic was "Complications," selected based on audience feedback from the prior year’s course evaluation. Dr. Joseph Perra put together an excellent two-hour program from the SRS that included a review of peri-operative complications including the topics of neurologic injury, blood loss, vision loss, as well as a review of 16 reports mined and collated from the SRS M&M database. A final topic of risk assessment and avoidance rounded out the presentations. Illustrative cases were presented at the lunch time program. SRS faculty included Drs. Perra, Dekutoski, Blakemore, Stevens, Transfeldt, and Berven.

The other three societies followed with two-hour presentations also focusing on complications.

For those of you attending the AAOS Annual Meeting in future years, consider FOSA for the Saturday Specialty Day meetings. This will not only support the SRS, but you will hear interesting presentations from the other three societies which make up FOSA on topics that are germane and topical to your spinal practices.

Drs. Munish Gupta and Timothy Kuklo have served as the SRS representatives and officers to FOSA this past year.

Bylaws Committee Report

By James Roach, MD
Bylaws Committee Chair

The members of the Bylaws Committee (James Roach, MD; Robert Huler, MD; Patrick Cahill, MD; Mike Albert, MD; Jose Herrera-Soto, MD and Jeffrey Coe, MD) have begun reviewing and reorganizing the SRS Policy and Procedure Manual that has not been updated in several years.

We started the review with the Governance Council and will work our way through the committees that fall under this council. Each Governance Council committee has been assigned to a member of the Bylaws Committee. The Committee member will first review the annual charges and the current Policy and Procedures relative to the committee under review. The Bylaws Committee member will then contact the chair of the committee under review and will seek answers to the following questions:

  • What are the tasks of the committee?
  • How does the committee accomplish these tasks?
  • Who is responsible for completion of the tasks?
  • What is the timeline for accomplishing the tasks?

Answers to these questions will be used to develop the policies for each committee. Evaluation of the other Councils and their committees will proceed in a similar fashion. The final document will have hyperlinks to allow members to easily move to the committee or issue of interest. At this point, the Bylaws Committee is focused solely on the Policy and Procedure review as there are no pending issues regarding the SRS Bylaws.

Fellowship Committee Report

By Serena Hu, MD
Fellowship Committee Chair

The 2010-2011 Fellowship Committee consists of Serena S. Hu, MD (Chair); Carlos Tello, MD; Laurel Blakemore, MD; Hilalli Nordeen, MD; and Mark Weidenbaum, MD (Past Chair).

For the 2010 fall and spring membership application review cycle we have accepted 31 Active fellows advancing from Candidate fellowship, 8 Active fellows accepted through the fast track program, 35 Candidate fellows, 15 Emeritus fellows, and 1 Associate fellow.

We are pleased to announce our new 2011 Fellows:

Active Fellows
Afshin Aminian, MD
Philip S. Anson, MD
Nitin Bhatia, MD
Michael D. Daubs, MD
Joseph P. Davey, MD
Vedat Deviren, MD
Daryl C. Dykes, MD
Michael Flippin, MD
Peter G. Gabos, MD
Matthew F. Halsey, MD
Darrell Hanson, MD
Kazuhiro Hasegawa, MD, PhD
Brian P. Hasley, MD
Lloyd A. Hey, MD, MS
Robert Po-Chen Huang, MD
Leonel Hunt, MD
Masatoshi Inoue, MD
J. Patrick Johnson, MD
Ajeya P. Joshi, MD
Khaled Kebaish, MD
Joseph G. Khoury, MD
Scott J. Luhmann, MD
Ruben A. Maenza, MD
Amir A. Mehbod, MD
Hani Mhaidli, MD
Pier Paolo Mura, MD
William Ray Puffinbarger, MD
Fernando Emilio Silva, MD
Hiroshi Taneichi, MD
J. Channing Tassone, MD
Koki Uno, MD, PhD
 
Fast Track to Active
Darrel S. Brodke, MD
Cody Bunger, MD, DMSc
Rene Castelein, MD, PhD
Ziya L. Gokaslan, MD
Lotfi Miladi, MD
Luiz H. Pimenta, MD, PhD
Jean-Marc Vital, MD
Hai Yong, MD
 
Candidate Fellows
Tsutomu Akazawa, MD, PhD
Raed M. Ali, MD
Abdul Rakib Saleh Al-Mirah, MD
Abdulmonem Mohammed Alsiddiky, MD SSCO
Mirza Biscevic, MD, PhD
Shane Burch, MD, FRCS(C)
Jesus Burgos Flores, MD, PhD
Samuel K.W. Cho, MD
Paul D. Choi, MD
Benny Dahl, MD,PhD, DMSci
Antony JF Field, FRACS, MB ChB
Martin Gehrchen, MD, PhD
Ahmad Rami Hamed, MD, FRCS, MSc(orth)
Maged Ramsis Hanna, MD, MRCS
Carol C. Hasler, MD
Ilkka J. Helenius, MD, PhD
Shuriz Hishmeh, MD
Judson W. Karlen, MD
Ketan S. Khurjekar, MS, DNB, MCh
Toshiaki Kotani, MD, PhD
Robert K. Lark, MD, MS
Sergio A. Mendoza-Lattes, MD
Robert A. Morgan, MD
Joshua M. Pahys, MD
Afshin Eli Razi, MD
Martin Repko, MD, PhD
Wudbhav N. Sankar, MD
Hassan A. Serhan, PhD
Ahmed M. Shawky, MD
Wade M. Shrader, MD
Khalid M. Swailem, MD
Shunji Tsutsui, MD, PhD
Gregory R. White, MD
Mitsuru Yagi, MD, PhD
Lukas P. Zebala, MD
 
Associate Fellows:
Angela M. Strader, RN  
 
Emeritus Fellows:
William P. Bunnell, MD
J. Martin Carlson
Robert J. Caudle, MD
Daniel Chopin, MD
John M. Flynn, MD (San Juan, PR)
John M. Gray, MD
Dieter Grob, MD
Richard Gross, MD
Dale V. Hoekstra, MD
Daniel L. Morrison, DO
Stephen L. Ondra, MD
Peter Pizzutillo, MD
Benoit P. Poitras, MD
Ian A. F. Stokes, PhD
Paul M. Tsou, MD
 

News:
The SRS will present a membership information session at the 2011 IMAST and Annual Meeting & Course. This meeting is designed to clarify questions about the process of becoming an SRS Candidate member and the process to advance from Candidate to Active membership. The Fast Track program, which will only be open until June of 2014, will be reviewed as well as other topics. Please encourage your potentially interested colleagues to attend.

Candidate Fellows:
As a society committed to improving the care and treatment of spine deformity patients, it is important that all members and our society, continually evaluate, learn and improve in our care of these patients. This requires a critical self-review of one’s cases on regular basis. Towards this, all Candidate members seeking to advance to Active status are required to submit an 11-month case list of all patients treated, which includes data on non-operative cases. As of September 2009 Active applicants must include non-operative patients/cases in their case list and failure to do so will prevent a Candidate Fellow from becoming an Active Fellow. Please note that the annual online M&M report is different and separate from the 11 month case list. The case list includes reporting of complications and outcomes.

Morbidity and Mortality Reminder:
2010 online M&M reports are due on April 1, 2011. The site is also open for entering 2011 reports. This is an annual requirement for both Candidate and Active fellows (surgeons). Active fellows (surgeons) who do not complete M&M reports will be expected to contribute $300 to the Research Fund for continued M&M related research. The SRS considers the M&M reporting a valuable part of our membership and encourages submissions all members.

Dues:
As of September 2008, you will not be allowed to register for SRS meetings if your dues are not paid. Dues are scheduled on a calendar year and should be paid before December 31 of each year. You can now pay your dues online or print an invoice online under the Member’s Only section of the SRS website. If dues are not paid by the Annual Meeting, a 20% late fee will be charged.

Tribute to a Pioneer and Leader in Orthopaedic Surgery: Professor Arthur Yau

Department of Orthopaedics and Traumatology,
University of Hong Kong
and SRS Global Affairs Advisory Board

Professor Arthur Charles Yau Meng-Choy (1929 - 2011), MBBS, FRCSEd, FACS, FAMS, FHKCOS, FHKAM

Professor Arthur Yau, a member of the Scoliosis Research Society, passed away on the 13th of January 2011.

Arthur Charles Yau Meng-Choy, MBBS, FRCSEd, FACS, FAMS, FHKCOS, FHKAM

Professor Yau was born in Kuala Lumpur, Malaysia in 1929. He studied engineering for a year before taking up medicine at the University of Hong Kong, graduating in 1956. Soon thereafter, the late Professor AR Hodgson saw Professor Yau as a young talent and recruited him in 1962 as a part-time lecturer into the Department of Orthopaedic Surgery at the University of Hong Kong. He progressed through the ranks of senior lecturer and reader to take up a personal Chair in 1972. He became the Head of the Department of Orthopaedic Surgery in 1975 and continued to serve in this capacity until 1980. He was a founding member of the Western Pacific Orthopaedic Association (1962), President of the Hong Kong Orthopaedic Association (1975), Medical Director of the Duchess of Kent Children’s Hospital (1975-1976), organizing chairman of the first Scoliosis Research Society meeting in Hong Kong (1977), and was Pro-Vice-Chancellor of the University of Hong Kong (1977-1978). After he entered private practice at the Canossa Hospital in 1980, he continued to maintain a close relationship with the orthopaedic fraternity in general and the University Department in particular. He was a founding fellow of the Hong Kong College of Orthopaedic Surgeons and served as a council member from 1987 to 1993. He remained in the Court of Examiners of the college and played an active role in its development.

Professor Yau’s contributions to orthopedics were immeasurable and cemented him as a true pioneer in the field. In the 1960s, together with the late Professor Hodgson, they established the anterior approach for treatment of TB spine. In 1966, he was one of the three surgeons named to participate in the prospective multicenter clinical trial on the treatment of tuberculosis of the spine initiated by the Medical Research Council of London. This study demonstrated that anterior debridement and spinal fusion provided the best results, and the technique was later dubbed the “Hong Kong Operation.” This put The Duchess of Kent Children’s Hospital and the University of Hong Kong on the world map, and ushered in the beginning of what became an unwavering stream of spine surgeons to visit Hong Kong to learn this technique. Around that same period and along with Dr. John O’Brien and Professor Hodgson, Professor Yau was instrumental in developing the halo-pelvic traction apparatus. This enabled gradual correction of severe and rigid spinal deformities while minimizing neurovascular complications. In the late 1970s, he developed for anterior spinal fusion a titanium mesh implant, which is a forerunner of the present day anterior cage used for spinal fusion.

Although Professor Yau was a very active orthopedic surgeon, he always found time for sports, family, and friends. It was typical for Professor Yau to indulge in Malaysian cuisine and, of course, golfing – his second passion after orthopedics.

Professor Yau was a scholar, an educator, an innovator, a master surgeon, and a beloved friend. He was not only a pioneer and leader in his craft but also a man who lived his life to the fullest. Professor Yau is and will remain a role model in the hearts of many worldwide.

He is survived by his wife, Catherine, six children and six grandchildren, and an entire community of orthopaedic colleagues and appreciative patients.

M&M Data Due April 1st

The Morbidity and Mortality Committee has been working hard to improve the quality and usefulness of the M&M data. The anticipated effect has been an improved participation rate from the membership in M&M data collection.

One of the Committee's charges is to assess the value of the M&M data to the membership. The Committee values your opinion and asks that you participate in an online survey that will be e-mailed to you in early April. Results will be available in the September SRS Newsletter.

Deadline: The M&M submission site for 2010 data will close on April 1, 2011 at 11:59 PM CDT.

Active Fellows (surgeons) are required to submit annual online reports. If you choose not to submit, a $300 contribution to the M&M research collection fund will be assessed on your annual membership dues invoice. The assessment will begin in 2011 for non-submission of 2010 reports.

All Candidate Fellows (surgeons) are required to submit online annual reports. Non-compliance with this requirement may hinder your chance to apply for Active Fellowship. Candidate Fellows do not have the option to opt out by paying the assessment.

If you have questions please contact Nilda Toro at ntoro@srs.org

Research Grant Committee Report

By Dilip K. Sengupta, MD
Reseach Grant Committee Chair

Research and Education is the principle lifeline of our society.

The Research Grant Committee received a record number of grant applications in the fall cycle (October 1, 2010). Thirty-nine grant applications were received from ten countries, which included 15 Small Exploratory, eight New Investigator, nine Standard Investigator and seven Evidence Based Medicine grants applications. Most grant applications proposed high quality research.

We expanded the committee by the addition of four new members, raising the total number to 19 members. The committee appreciates the help from Courtney Kissinger, SRS staff liaison, for her untiring work to complete the arduous review process smoothly and on time. The committee reviewed all the applications in detail, and after two days of extensive discussion over conference calls we selected six research grants for funding (one Standard Investigator, two New Investigator, three Small Exploratory). In total, $179,987.00 of research funds were released in this grant cycle.

The successful recipients of the research grant in the current cycle are:

  • Rachel Wevrick, PhD
    Etiology of Scoliosis in a Mouse Model of Prader-Willi Syndrome
    $100,000-2 Years
  • Diana Glaser, PhD
    Real-Time Analysis of the Biomechanics and the Effectiveness of Fusionless Spinal Growth Modulation Devices
    $25,000-2 Years
  • Ahmad Nassr, PhD
    Vertebral Fracture Prediction Finite Element Model of the Human Osteoporotic Spine Using Novel Computational and Experimental Validation Approaches
    $25,000-2 Years
  • Frank Acosta, MD
    Improving Bone Formation in Osteoporosis through Mechanical Signaling Pathways
    $10,000-1 Year
  • Shunmoogum Patten, PhD
    Genetic determinants of vestibular dysfunction in AIS
    $10,000-1 Year
  • Peter Newton, MD
    Three Dimensional Visualization of Vertebral Growth Cartilage and Disc; the Effects of Growth Modulation
    $9,987-1 year

The committee also had their first face-to-face meeting during the 2011 AAOS Annual Meeting in San Diego, and made important decisions formulating policy guiding the grant review process without bias. A subcommittee of four members was formed to generate a white paper highlighting the clinical and academic impact of the research completed by SRS research grantees in the past.

The "Outcomes" page on the "Research" section of the SRS website has been reorganized and updated to include grants from 2004-2008.

The Research Grant Committee proudly announces the electronic grant application submission and review site, beginning this spring grant cycle, April 1, 2011. We welcome you all to submit research grant applications online, and wish you good luck!

Global Outreach Committee Report

By Theodore Wagner, MD
Global Outreach Committee Chair

The Global Outreach Program (GOP) was established nearly ten years ago with a goal to establish international exchange and teaching of spine surgery. The goal included establishing sites where members of the SRS might join in this effort. The challenge has included the creation of a webpage, identifying the primary surgeon associated with the site, identifying a person on the ground, and establishing the availability of housing and possible financial support.

Great effort has been made by the previous chairs of this committee along with many different members. This year, I have identified eleven sites which in the past were registered by SRS members. However, only seven sites were regularly attended. The SRS has only recognized Bulgaria as an "SRS site" with a financial commitment of $500,000 over five years through a grant from Osteotech. Other sites in Columbia, Ecuador, Ghana, Vietnam, Costa Rica, and Indonesia have been active on an annual or biannual basis and certainly qualify as official sites.

A priority item for this year is to update the website with information about each of the sites. This would include the scheduled time of the visits to the site, the availability of housing, a description of the operating theater and the name of the local surgeon and/or administrator.

The challenge to collect good data on the patients treated in the many sites has not yet been universally successful. The SRS has chosen to support the FOCOS database created by Dr. Boachie. Hopefully, each of the sites will adopt the system and enter data that can be used to create clinical outcome reports.

This year the GOP will make a visit to Aleppo, Syria in March to determine if this would be an appropriate site to be recognized by the SRS. The trip will be attended by Dr. Kamal Ibrahim, Dr. Peter Sturm, and myself.

As the chair of the Global Outreach Committee, I have been invited to join the Awards and Scholarship Committee to help with the decision to grant overseas physicians scholarships to attend the SRS meetings and to participate in a mini-fellowships in the United States. We feel the applicant must have practiced spine surgery for two years, be recommended by an SRS member, and in general, originate from a underserved area.

The GOP chair has also been invited to be part of the Worldwide Conference Committee. The potential site visit to Syria has been arranged in coordination with the WWC leadership.

The availability of instrumentation (implants and tools) remains a complicated challenge as we work with the many manufacturers. It is clear that if our goal is to train the local surgeons to care for their patients with spine injuries and deformity, a less expensive but dependable system must be developed. The Global Outreach Committee will need to continue to discuss this issue as a challenge for the future.

IMAST Preliminary Program Online Now

The preliminary program for the 18th International Meeting on Advanced Spine Techniques (IMAST) is now available on the SRS website. Take this opportunity to preview the outstanding Instructional Course Lecture program planned by IMAST Chair Todd J. Albert, MD and the IMAST Committee. Information on podium and e-poster presentations is forthcoming in April.

Registration and housing are also open and may be completed on the SRS website. Don’t forget to purchase your tickets now for the Course Reception on Friday, July 15 at the Copenhagen Opera House. Only a limited number of tickets are available at just $25 each for registered delegates and registered guests only.

Worldwide Conference Update: SpineWeek

By Marinus de Kleuver MD, PhD
SpineWeek Chair
and Ahmet Alanay, MD
Worldwide Conference Committee Chair

SpineWeek is a joint meeting of many spine societies, organized once every four years, with a very high profile and attendance. In May 2012, SpineWeek will be held for the third time, and the participating societies will be the Spine Society of Europe, ISSLS, European-CSRS, SILACO, Brasilian Spine Society, NASS and our SRS.

SpineWeek will take place May 28 - June 1, 2012 in Amsterdam, the Netherlands. The SRS will organize a one day course with invited lectures, debates and case discussions on Wednesday, May 30th. Based on the very successful half day meeting in Geneva, we hope to attract 300-500 attendees. The historic city of Amsterdam can be reached easily by airplane, train and car. The Amsterdam RAI congress center is very well connected by public transport and it is located alongside the main ring road ten minutes from the airport.

Amsterdam is often referred to as one of the most colorful cities and one of the most important cultural centers in Europe. Its charming canal belt, historic monuments and prestigious museums are world-renowned. Amsterdam boasts hundreds of specialty shops, restaurants, cozy bars etc. and features a large number of open-air markets. It is a dazzling and unique city. Particularly in the spring, you will be impressed by the colorful canvas of hyacinths, crocuses, daffodils and our national treasure: the tulips. No other city mixes cosmopolitan style and relaxed atmosphere quite like Amsterdam, where our hospitable nature attracts an excitingly diverse population. When exploring the city, do it the Dutch way: by bike!

With excitement and pride the Worldwide Conference Committee invites you to attend the SRS course at SpineWeek. It promises to be of high scientific quality, with a world-class line-up of speakers and a generous spectrum of other spine and social activities.

Regional Update: 5th Annual Meeting of the German Spine Society Report

By Michael Ruf, MD
Global Affairs Advisory Board Member

The 5th Annual Meeting of the German Spine Society was held in Bremen December 16 -18, 2010. The German Spine Society was founded in 2006 as a union of the former German Society for Spine Surgery and the Society for Spinal Research. Since the unification, the number of members has rapidly grown. With more than 700 members presently, the German Spine Society is now the biggest spine society in Europe.

The meeting was inaugurated by PD Dr. Wolfgang Börm, Flensburg, Germany. The focal topics were experience, experiments, innovations, and evidence. Sixty-four oral presentations, 188 posters, and 14 special posters were presented during the three-day meeting. Seven invited lectures enhanced the main topics. A large number of additional workshops were offered. The Georg-Schmorl-Award was presented to Claudia Eder, Vienna, for her work titled “Bone debris collected during surgical decompression: A suitable autograft for spinal fusion?”

More than 1,300 participants, mostly from Germany, Austria and Switzerland, enjoyed the open discussions and the exchange of experiences with colleagues.

The 6th Annual Meeting will take place in Hamburg, December 8 - 10, 2011.

Regional Update: An update from Egypt, a SRS member's perspective

Mohammed Mosaad, MD
Global Affairs Advisory Board Member

In Egypt, medical services are divided into four types of hospitals: governmental, university, insurance type of hospitals, and private hospitals. In government hospitals, services are completely free and all cases can be treated including spinal cases, mostly trauma cases, tumors and some deformity cases, especially AIS. In the university hospitals, such as Cairo University, Ein Shames, Alexandria, Zagazig, Assuit, and Tanta University, all cases of spinal problems are treated. For instance, trauma cases, complicated deformity (including anterior and posterior surgeries), a large numbers of AIS, degenerative deformities, as well as other types of pediatric problems. The arrangement here is based on the number of surgeons and number of beds in the hospital. All instruments and implants are bought by the administrations of the universities. On the other hand, the insurance type of hospitals also treat all types of spinal problems, especially trauma and AIS in pediatric insurance hospitals, but in these hospitals, the patients must pay a portion of the cost according to their contract with the hospital. Furthermore, in private hospitals, all types of surgeries are done in which the patients are required to pay for everything including the bed, treatment, services, and implants, and so expensive implants are used. In conclusion, the development of spine surgery around the world has influenced spine surgery service in Egypt. Very complicated spine surgeries can be done in Egyptian hospitals and many patients can benefit from what Egyptian surgeons have learned from meetings like SRS, NASS and ISSLS.

Academic meetings are regularly held in Egypt and these are two recent examples:

The 6th International Association for the Study & Application of the Methods of Ilizarov (ASAMI) Conference was held on June 16-19, 2010 at the Mena House Oberoi Hotel in Cairo, Egypt. It was also the eve of the 90th anniversary of method creator, Russian academician, G.A. Ilizarov and 60th anniversary of the method. These great events will be celebrated in 2011. The conference was well attended with over 1,000 delegates from 47 different countries participating in over 68 sessions. There were more than 230 lectures with 41 guest speakers from around the world. The scientific program consisted of numerous papers on the Ilizarov method including limb reconstruction, as well as a symposium about the recent advances in the biology of bone reconstruction. Two lectures highlighted external fixation as a method to correct spinal deformity, one from Ilizarov Institute and the other from Texas by John Birch. It is great that many Egyptian orthopedists and other surgeons from around the world study the method of Russian orthopaedic surgeon Ilizarov and came together to share and learn the latest techniques.

The Egyptian Orthopaedic Association (EOA) 62nd Annual International Congress was held December 6-9, 2010 at the Grand Hyatt Cairo, Egypt. The congress was well attended with more than 2,500 Egyptian and Arab surgeons with guest speakers from different countries that presented over 55 lectures on different topics inf orthopaedic surgery. There were about 78 sessions, nine symposia, and more than 100 work shops held beside the scientific sessions with more than 120 technical companies represented. Three sessions highlighted spinal problems in trauma and AIS, and two lectures discussed degenerative spinal problems and tumor care. Through their meetings, the EOA continues to provide great opportunities to experience the finest in orthopedic education, research and technology.

Invitation for Applications: Editor, SRS JOURNAL

The Scoliosis Research Society (SRS) announces the search for the Editor of its new journal, Spinal Deformity, Official Journal of the Scoliosis Research Society. The SRS has created a Search Committee to invite and review applications, which will be due by April 30, 2011. An appointment will be made by July 31, 2011, and the successful candidate will embark on developing content for the new journal, in collaboration with the Society and the Publisher (still to be selected) during the 3rd Quarter of 2011. The journal will launch with its first issue at the SRS Annual Meeting, September 2012.

Mission Statement
Spinal Deformity is a peer-reviewed clinical and research journal focused on issues related to spinal deformity, and provides a forum for clinical researchers, basic scientists, clinicians, and others to publish original research and explore controversies. A major source of content will be the presentations at SRS’ two meetings, the Annual Meeting and IMAST.

Spinal Deformity welcomes and encourages submissions from all disciplines including orthopedics, neurosurgery, orthotics, rehabilitation, and research into the mechanisms, genetics, and epidemiology of spinal disorders.

About Spinal Deformity
Spinal Deformity will debut at SRS 2012 (September 2012) with the inaugural issue, which will contain largely solicited reviews and some papers presented at IMAST 2012. It will publish six times in 2013, with a page budget of 80 printed pages/issue (approximately 10 – 11 articles per issue). Over the next few years, it will grow to a monthly publication of around 840 pages annually, depending on manuscript flow and the quality of the submissions. It is envisioned as international from the outset, and will be a major publishing outlet for contributors to the Annual and IMAST meetings. It will encourage online publication of surgical techniques videos and other functionalities of a 21st Century journal. It will have both a print and online version.

Applications
Applicants should provide a statement of why they are interested in this position, along with three letters of recommendation from knowledgeable colleagues, and current CV, including evidence of fulfillment of the following criteria:

  1. Academic and Publishing Record
    Evidence of strong academic achievement and robust list of publications in relevant fields.
  2. Editorial Experience
    Experience as an Editor, Associate Editor or Editorial Board Member (or similar) of an indexed journal in a related field.
  3. Content and Format Development
    Perspective on developing the journal’s content, through the editorial structure and process, outreach to authors, strategic development of the journal, and deployment of web-based features available through the publisher’s platform.

Submit your application materials by May 27, 2010 to: tgoulding@srs.org

Historian’s Corner

Dr. Russell Hibbs
Department of Orthopaedic Surgery -
Columbia University Medical Center

By Nathan Lebwohl, MD
SRS Historian

Most SRS members think of Dr. Kenton Leatherman when they think of Louisville, Kentucky, the host city for the upcoming 2011 Annual Meeting. Dr. Leatherman was a founding member of the SRS and led this society as President in 1975. He was an important contributor to modern surgical techniques, especially through his work on anterior spinal surgery and vertebral resection for severe rigid deformity. But few of us realize that another famous orthopaedist, whose name is known to anyone who has ever attended an SRS meeting, was a product of the outstanding medical center in Louisville.

Dr. Russell Hibbs graduated from medical school at the University of Louisville in 1890. Originally from Kentucky, he moved to New York in 1893 and began his orthopaedic training at the New York Orthopaedic Dispensary and Hospital in 1884. In 1890, following a bitter disagreement with his superior, the Board of Trustees appointed Hibbs to replace him as Surgeon in Chief, at the age of 29. Much of the clinical work that occupied Hibbs’ time involved the treatment of musculoskeletal tuberculosis. The mainstay of treatment was to immobilize the infected joints. Theorizing that a bony fusion would provide better immobilization than the braces and casts commonly used at that time to immobilize the spine for treatment of Pott’s disease, Hibbs performed his first spinal fusion on January 9, 1911. Though probably not the first surgeon to fuse the spine (Fred Albee claimed to have done his first spinal fusion in 1909, also to treat tuberculosis) Hibbs recognized that the operation could be used to treat spinal deformity due to causes other than tuberculosis, and titled his initial 1911 report “An operation for progressive spinal deformities.” In 1914, Hibbs performed his first operation for paralytic scoliosis. Albee included a case of spinal fusion for paralytic scoliosis in his 1915 textbook “Bone graft surgery,” so the question of who was first remains unanswered. The assumption many surgeons have, that Hibbs was first, is reinforced by the eponymous award for excellence in research given annually by the SRS. How did the awards for best clinical and basic science papers at the Annual Meeting come to be known as the Hibbs Award?

If you visit the SRS website, you can learn more about Russell Hibbs in the excellent biography posted on the Hibbs Society page. But a search of the online SRS Archive provides the answer to our question. In 1977, Hugo Keim, who practiced at the New York Orthopaedic Hospital, approached SRS President Kirklin Ashley with an offer to fund an award for the best research paper presented at the Annual Meeting. Keim had received a one million dollar gift from the family of a grateful patient which he used to endow a spinal research foundation, and he offered to use the proceeds of that fund, in part, to provide this award. The SRS Board of Directors thought that it would be better if the $5,000 offered annually would be used as "seed money" for a research project, rather than an award for a completed project. They also proposed that the award be named in honor of Russell Hibbs. "This would bring credit to your hospital from whence your many contributions have stemmed," wrote Ashley to Keim. “In addition it would recognize Dr. Hibbs, whose courage and skill revolutionized the treatment of scoliosis and other spinal deformities.” In 1980, the first grant was given to Kazuhiko Satomi and Jens Axelgaard to study the effects of selective cord transections on spinal evoked potentials, and a paper on that topic was presented the following year. In 1981, at the recommendation of Rae Jacobs, a decision was made to revert to Dr. Keim’s original proposal, awarding the best paper presented, rather than providing a grant for proposed research. Two awards of $2,500 were made annually, one for best clinical paper, and one for best basic science paper. Ensor Transfeldt and Ed Simmons received the first award for best basic science research paper, and John Herring received the award for best clinical paper. Keim continued supporting the awards through 1983. When his support ended, the Board decided to continue the Hibbs Awards, but reduced the amount awarded to $1,000. Today, there is no longer a financial prize given with the award, but I was unable to find documentation in the archive regarding when this change occurred.

Do you have a question about the history of the SRS? The archives are available online to all members. We are continually adding to the materials, and welcome contributions of historic documents, photographs and artifacts. To view the archives, just click on the link on the member’s only page of the SRS website, and enjoy your walk down memory lane.

SRS Launches E-Textbook

The Scoliosis Research Society is proud to announce the official launch of the SRS E-Textbook! The e-textbook will not only add high quality, in-depth spine deformity information to the SRS website but it will be available to surgeons, medical professionals and residents around the world. Thanks to the efforts of over 50 authors, the textbook features chapters in spinal deformity foundation knowledge, sagittal, coronal and translational deformity, non-operative treatments, surgical approaches and intra-operative techniques. Access for SRS members is free and non-members can purchase subscriptions of variable length and access levels, ranging from 24 hours of read-only access up to 12 months with full access.

To access the e-textbook please go to http://etext.srs.org/.

Website Committee Report

By John Sarwark, MD and Michael Roh, MD
Website Committee Co-Chairs

SRS Announces New Facebook Page. SRS is joining the social media world; Patient Education Committee member Ahmad Nassr, MD has created an SRS Facebook page. Please sign up and be a fan of the SRS page!

The appearance of the SRS website is currently undergoing significant renovation with improved access to the wealth of information on the site and increased user-friendliness with graphics and multimedia for patients and families who are directed to the site.

The website itself has been reviewed and updated. Numerous subsections of the website have been revised. Several members of the Website Committee were especially helpful. Michael Flippin, MD and Adrian Gardner, FRCS reviewed the Physicians and Healthcare Professionals section; Mark Lee, MD reviewed the Meetings and Research sections; Michael Roh, MD and Matthew Geck, MD initiated and reviewed the Wikipedia page; Anthony Rinella, MD reviewed and redesigned the Global Outreach section, which will go live shortly.

At the request of the SRS Presidential Line, a survey initiative was started to obtain feedback from trusted patients and families. To this end, a printed questionnaire and a Survey Monkey Link were prepared to record impressions of both the SRS website, as well as other scoliosis-related websites.

Communication with Paul Sponseller, MD was initiated regarding a video that will highlight the benefits and success stories of non-operative treatment of spinal deformity. Kristin Venuti is a nurse practitioner at Johns Hopkins who works in pediatric orthopedics, and she is coordinating this effort. Her first patient interview was scheduled for January 24, 2011.

A subcommittee has been formed to spearhead the renovation of the Patients and Family section of the website, comprised of Anthony Rinella, MD (Co-Chair), Michael Roh, MD (Co-Chair), Jay Shapiro, MD and Kit Song, MD. This section is a priority for our target audience—patients and families. The renovation will include a reorganization of the existing information, as well as construction of animated material which will direct site visitors to this user-friendly section of the site.

Approval was given to contract for services with Patrick Carrico, a web designer with extensive experience in the construction of medical and spine-related websites. We anticipate that we will continue to move seamlessly in bringing the website homepage improvements on-line, as well as continue with the Patients and Family renovation.

Sections that have been reformatted and updated

  • Advocacy and Public Policy
  • Educational materials
  • Contact us
  • Global Outreach
  • Membership
  • News
  • Spine meetings
  • Merchandise
  • Research
  • Worldwide Conferences

Governance Council Update

Hubert Labelle, MD
Governance Council Chair and Secretary

The Governance Council consists of (in alphabetical order) the Advocacy and Public Policy, Bylaws and Policies, Coding, Ethics, Fellowship, Global Affairs Advisory Board, Historical, Industry Relations, Newsletter, and Public Relations Committees. All of the committees have active charges and are engaged in activities in support of the SRS.

The Advocacy & Public Policy Committee, chaired by John Lubicky, MD, has been quite active and is working to involve all committee members and more SRS members in trying to get a declaration designating June as Scoliosis Awareness Month in their states. Please refer to Dr Lubicky’s recent article in the December 2010 Newsletter on how to attempt to obtain a Proclamation by your State’s Governor. The Committee is also working with the Non-Operative Committee to develop or update information on alternative treatments and have submitted nominations for two AAOS committees member positions. Our President, Lawrence Lenke MD, and John Lubicky MD, will both represent SRS at Research Capitol Hill Days on March 16-17.

The Bylaws Committee, chaired by James Roach, MD, is in the process of reviewing and reorganizing our Policy and Procedures Manual, as requested by the Presidential Line and the Board of Directors. They have started this task by reviewing the Governance Council and all committees that fall under this council, and will work their way through all four Councils over the coming year. Their effort will ensure that this document is up to date and adequately covers the day-to-day details of our organization.

The Coding Committee, chaired by Jeffrey Neustadt, MD, is actively pursuing its goal of helping members understand the correct coding by preparing coding case examples and articles for publication in each newsletter. Upcoming subjects are coding for osteotomies and articles on the Relative Value Upgrade Committee (RUC) of the AMA and the Common Procedural Terminology (CPT) who defines the language of coding.

The Ethics Committee, chaired by Abbott Byrd, MD, is completing a comprehensive SRS Ethics Document. The goal is to have it approved at the July Board meeting and presented to members at the 2011 Annual Meeting in September. This document consists of four sections: 1- ANSRS Conceptual Mission Statement, 2- A Professional Medical Association ethical section, which addresses the various ethical issues for the SRS as a society, 3- A Standards of Professionalism document adapted for SRS members, and 4- A SRS Ethical Discipline Management Process document.

The Fellowship Committee is chaired by Serena Hu, MD, and reviews applications twice a year. It is interesting to note that out of 25 Candidate applicants this year, 16 are from outside of the United States, suggesting a trend towards more globalization of our society.

The Historical Committee, led by Nathan Lebwohl, MD, is preparing a PowerPoint presentation /e-poster on the history of spine surgery in Louisville for the upcoming Annual Meeting. He will also schedule additional video interviews during the meeting of members who have made significant contributions to the field of spinal deformity. The existing videos are available to members on the website.

The Industry Relations Committee, led by Richard McCarthy, MD, has reviewed and approved the 2011 Corporate Partner’s Program Brochure, and is actively meeting with our industry partners to insure that appropriate processes are followed and that value is delivered to both parties in the preparation of our meetings.

The Public Relations Committee, chaired by Michael La Grone, MD, has finalized a brochure on "What you should know about the SRS," which contains basic information for patients regarding our society and its mission, as well on information about patient advocacy organizations. This document will be made available on the website and 20 to 30 copies will be sent shortly to all members for distribution in their offices.

The Newsletter Committee is chaired and edited by Vicki Kalen MD, and always welcomes ideas for articles in the Newsletter or new features on an ongoing basis. Feel free to contact her at: vickikalen@comcast.net.

The Global Affairs Advisory Board is chaired by Kenneth Cheung, MD and continues to act as a resource on matters related to our international representation among active members of the SRS.

Future Meetings & Courses

Future Meetings & Courses

18th IMAST
July 13-16, 2011
Copenhagen, Denmark

46th Annual Meeting & Course
September 14-17, 2011
Louisville, Kentucky, USA

Worldwide Conferences

September 6-9, 2011
Prague. Czech Republic
In conjunction with SICOT

October 12, 2011
Buenos Aires, Argentina
In conjunction with SILACO

December 1-4, 2011
Beijing, China
In conjunction with the Chinese Orthopaedic Association

December 8-10, 2011
Kuala Lumpur, Malaysia
In conjunction with the Malaysian Orthopaedic Society


2011 Corporate Partners

Double Diamond Level Support

Depuy Spine K2M Medtronic

Diamond Level Support

Stryker

Platinum Level Support

Synthes Spine

Gold Level Support

Osteotech

Globus Medical

Trans1

Silver Level Support

Nuvasive Zimmer Spine  

Bronze Level Support

Ackermann Medical GmbH & Co. KG
Alphatec Spine, Inc.
Apatech
Biomet Spine
Biospace Med
BrainLAB
Ellipse Technologies, Inc.
Elsevier Canada
Exactech, Iinc.
FzioMed, Inc.
LANX
Lippencott Williams& Wilkins
NuTech Medical
Orthofix, Inc.
Orthovita
Paradigm Spine
Showa Ika
Spineguard, Inc.
Spine View
Vexim SAS
X-Spine

Sponsors In-Kind

DePuy Spine SpineCraft  

Strategic Plan

GOAL 1. Funding: The Scoliosis Research Society will have a funding base large and diversified enough to ensure financial independence in funding research and sound fiscal operating policies.

GOAL 2. Research: The Scoliosis Research Society will be the global source of research on spinal deformities

GOAL 3. Education: The Scoliosis Research Society will be the global source of education on spinal deformities

GOAL 4. Globalism: Through its members and programs, the Scoliosis Research Society will improve spinal deformity care globally

GOAL 5. Advocacy: The Scoliosis Research Society will be recognized as the leading resource for information and public policy on spinal deformities.

GOAL 6. Society Leadership: The Scoliosis Research Society will operate in a manner consistent with its stature as the pre-eminent spinal deformity society.

Vision Statement

The SRS will increase its recognition domestically and internationally as the leading source of information and knowledge on spinal disorders affecting all patients, regardless of age.