Dear SRS Members,
Greetings from Chicago, where we are coming out of the cold winter and looking forward to a pleasant spring, which means it is time to put final touches in the planning of the 20th International Meeting on Advanced Spine Techniques (IMAST). It will be a great meeting with ICLs, debates, and panel discussions. The faculty consists of globally diverse experts. We are pleased to offer, for first time, our own CME credits. The industry will provide twenty Hands-On Workshops and more than twenty companies will exhibit their products. Vancouver, British Columbia, Canada is a great place to visit in the summer and to bring your family along for fun time. I thank Christopher Shaffrey, MD, Justin Smith, MD and the IMAST Committee, who put a lot of their time and thoughts into the program, which you will all be pleased to attend.
The preparation for the 48th Annual Meeting in Lyon, France is progressing ahead of schedule, thanks to John Dimar, MD and the Education Committee, who finalized the plans for the Pre- Meeting Course regarding global prospective in the management of spine diseases and deformity. There will be six Lunchtime Symposia of diverse topics and three Half Day Courses for Thursday afternoon covering myelomeningocele, non-operative treatment, and sagittal deformity. The Program Committee, chaired by Suken Shah, MD, received a record number of abstract submissions with more than 1,400 submissions. The committee is doing an outstanding job in peer reviewing the abstracts and will produce a distinct and scientifically valuable program. The long-awaited final results of the brace treatment study (BrAIST) will be presented by Stuart Weinstein, MD. My sincere thanks to Dr. Shah and the Program Committee.
Each of you should have received, a few weeks ago, the first official issue of the SRS Spine Deformity Journal. I trust that all of you are pleased with the quality of the articles, as well as the format and production of the journal. I encourage all of you to contribute to the success of our journal by submitting the results of your research to “Spine Deformity Journal”.
The Awards and Scholarship Committee, under the leadership of Lawrence Haber, MD, is very busy creating the principles of and accepting applications for the newly created awards. The Robert B. Winter Global Fellowship award is offered for the first time this year. It has been developed thanks to a generous gift from Dr. Winter’s associates, fellows, and friends. The award is offered to surgeons from underserved areas, and will provide training for an extended time at a spine center of the winner’s choice. The surgeon will have the opportunity to learn, and implement their experience back in his or her home place. SRS also received a gift from OrthoPediatric Company to create multiple scholarships or fellowships to grant residents, fellows, and young surgeons opportunities to attend SRS meetings and visit pediatric spine centers. I extend my sincere appreciation to the OrthoPediatric leaders.
SRS will offer its first CME Cadaver Course this October in Chicago, Illinois, USA. It will be chaired by Lawrence G. Lenke, MD and Christopher Shaffrey, MD, and is guaranteed to be an outstanding event. Please watch for the future registration announcement, as we expect slots to fill very quickly. Beyond the Cadaver Course, the CME Taskforce, led by Frank Schwab, MD, is researching additional CME educational venues to be offered. The taskforce is looking at the possibilities of web-based educational activities and CME products to be offered though our newly launched journal. The taskforce is looking for input from all members through a survey that will be sent out requesting preferences and suggestions.
An additional taskforce, which I created this year, is the Surgical Safety Taskforce, led by Kit Song, MD. The task force will present a Lunchtime Symposium at the 48th Annual Meeting in Lyon, France and are working on creating a preliminary safety check list to be used in surgery.
The Worldwide Conference Committee, under the leadership of the current Chair Ahmet Alanay, MD and the Chair-Elect Marinus de Kleuver, MD, continues its successes with the offering of six courses in 2013 at various locations around the world. Please visit our website to learn more about these courses. Attending them is not only a great educational opportunity, but also a good chance to visit other countries and make new acquaintances. The committee is currently in the process of planning 2014 courses in India, South Africa, Australia and possibly in Mexico and the Middle East.
In our continuous efforts to make SRS truly a global organization, I created a new committee, the Translation Committee, to be chaired by Munish Gupta, MD and staffed by our members, who are fluent in many different languages. We currently have partial translation in six languages. The committee will work on translating the patient education materials on the SRS website into additional languages, and periodically update the translated material.
These are but few of the endeavors of our thirty-four committees and eleven taskforces. Each of them works hard to assure the continuous progress of our society. My sincere appreciation and thanks to all chairs and members of the committees and taskforces. I would like to invite all members to participate in our society’s functions. You will soon receive a request to submit your name for 2013-2014 committee appointments. I ask that you please give it your utmost consideration.
As I have done in my previous communications, I would like to encourage all of you to donate to the SRS Research, Education, Outreach, (REO) Fund. Your gift will ensure the continuous success and strength of this great society. Our goal is to have all members participate regardless of the amount. I would like this year to fulfill the 100x100 slogan: 100% participation with donations starting at $100 per member.
In closing, I would like to thank the presidential line: President-Elect Steven Glassman, MD, Vice President, John Dormans, MD and Past-President B. Stephens Richards, III, MD for their continuous support. I also express my gratitude for our very capable staff under the leadership of the Executive Director, Tressa Goulding, CAE, CMP.
Best wishes to all,
Kamal N Ibrahim, MD, FRCS(C), MA
Jacquelin Perry, MD
May 31, 1918 – March 13, 2013
Over 400 people attended the celebration of Dr. Perry's life and 20 physical and occupational therapists, physicians, administrators, politicians and some of her patients in wheelchairs spoke. Every one of them praised her blunt honesty, pursuit of excellence, insight, courage, high standards, and, above all, her commitment to improve the life of the disabled patient. One speaker quoted John Wooden's statement that energy and talent will get you to the top, but only compassion and character will keep you there. That was certainly true for Jacqueline Perry, MD.
After recruiting her to Rancho in the 1950's, Vernon Nickel promoted her internationally which allowed her time to treat patients, both surgically and non-operatively. Together, they travelled to Houston and on their return developed the cranial halo to stabilize the spine, and implanted the Harrington rod to allow polio patients to sit and pursue their rehab program while their spines fused. She devised tendon transfers to increase the usefulness of various joints for all sorts of neurological disorders.
By the time I arrived at Rancho in 1969, she was no longer operating but was spending her entire time teaching anatomy and developing what became the most sophisticated pathokinesiology laboratory in the world. Chuck Bonnett, I and our residents and fellows continued to benefit greatly from her insight into the treatment of neurologically created spinal deformity.
She was a true visionary and a warrior for ways to help the disabled. She was relentless in her inquisitiveness and search for the truth. To communicate her ideas, she wrote more than 400 peer reviewed articles and 40 book chapters.
She was a very fine orthopedist, physical therapist and a delight to work with. Time spent with her was always a learning experience and a privilege. Undoubtedly, she was the finest female orthopedic surgeon of her generation and one of the most inspirational physicians of all time. It was my great opportunity and deep pleasure to be regarded as her associate in the treatment of the difficult orthopedic problems. I liked her very much and will miss the enthusiastic twinkle in her eye and the incisive discussions we enjoyed.
John Carlisle Brown, MD
Jacquelin Perry, MD
By Valerie J. Nelson, LA Times
The country was in the grip of a polio epidemic in the1950s when orthopedic surgeon Dr. Jacquelin Perry began performing spinal surgeries in Downey that helped paralyzed survivors of the disease regain mobility. When some of the same patients returned to her 40 years later seeking help for pain and muscle weakness wrought by the aftereffects of polio, Perry remained true to form. She blazed a trail, transforming herself into the leading authority on post-polio syndrome. She was also known for her pioneering analysis of the human gait, publishing a definitive textbook on the subject in her 70s.
Perry, who had Parkinson’s disease but was still practicing as of last week, died Monday at her home in Downey. She was 94. Her death was announced by Rancho Los Amigos National Rehabilitation Center, with which she had been affiliated since1955.
“She was a giant, a revered figure in her field,” said Greg Waskul, executive director of the center’s foundation. “Dr. Perry was so creative and innovative. Most of the great doctors have one specialty, but she came up with many new theories and exercises to keep people moving.”
During World War II, Perry had served as a physical therapist in the Army, treating polio patients in Hot Springs, Ark. But she yearned to “make my own decisions,” she later said, and decided to study medicine at UC San Francisco. After joining Rancho Los Amigos, Perry collaborated with Dr. Vernon Nickel on polio cases. For spinal surgery patients, the pair developed the halo, a metal ring still in use today that is screwed into the skull, immobilizing the spine and neck. When The Times honored her as the 1959 Woman of the Year in science, Perry pointed out that “most doctors go into medicine to save lives. I’m more interested in getting handicapped persons functioning again.”
After a brain artery blockage forced Perry to stop operating, she founded Rancho’s Pathokinesiology Laboratory in 1968 to analyze the biomechanics of walking. She served as chief of the department until 1996 and continued to consult in semi-retirement. “Dr. Perry was a visionary pioneer in the field of rehabilitation sciences and gait analysis,” said Judith M. Burnfield of the Institute for Rehabilitation Science and Engineering at Madonna Rehabilitation Hospital in Lincoln, Neb.
With physical therapist colleagues at Rancho, Perry established an observational system used by clinicians around the world to determine why patients are having trouble walking and how to manage the problem. Her research on patients with severe deficits arising from neurologic and orthopedic injuries continues to guide present-day therapeutic approaches, said Burnfield, who helped Perry update her textbook, “Gait Analysis,” first published in1992. The first cases of post-polio syndrome were not seen until 1980, according to Perry, and they surprised doctors. The condition stems from further weakening of overworked nerves and muscles damaged years before by polio’s initial infection.
The same drive that had helped polio patients overcome the disability as children got in the way in adulthood, according to Perry, who instructed patients to downshift physically to protect themselves.
“As far as I’m concerned, I’ve never worked,” Perry told The Times in 1999. “I do what I like to do.” The only child of a clothing shop clerk and a traveling salesman, Perry was born May 31, 1918, in Denver and moved to California the year she turned 6. She never married and had no immediate survivors. At UCLA, she earned a bachelor’s degree in physical education in 1940. She taught swimming for one day before quitting to attend physical therapy school at Walter Reed Hospital in Washington, D.C.
After earning her medical degree in 1950, Perry was recruited to help launch Rancho’s rehabilitation program after completing her residency at UC San Francisco. From 1972 to the late 1990s, she was a professor of surgery at USC’s medical school, where she established a scholarship for study of the human gait. The no-nonsense Perry was seen as both an intimidating and inspiring teacher. Those who survived presenting a case before her were often given an unofficial award. They called it “the red badge of courage.”
A celebration of Perry’s life will begin at noon March 22 in the Support Services Annex Building at Rancho Los Amigos National Rehabilitation Center, 7601 E. Imperial Highway, Downey. email@example.com
Joseph Riina, MD
Joseph Riina, MD passed away October 14, 2012. He was born July 20, 1967 in Brooklyn, New York. Following his Fellowship in Spinal Surgery at OrthoIndy, he began his career at Orthopaedics Indianapolis in 2000. At the time of his passing he was serving as the President of the Orthopaedic Research Foundation and Co-Director of the OrthoIndy Spine fellowship and OrthoSpine Medical Director St. Vincent Hospital Indianapolis. He was an active member in multiple national and international spine societies and a respected educator and researcher, with numerous publications and presentations. He worked out on a regular basis with his son, Joseph; coached his son, Nicholas' lacrosse team; and enjoyed time spent with his daughter, Lauren. He was the devoted husband of Kari Riina, beloved father of Joseph, Nicholas, and Lauren, cherished son of Joseph and Gloria Riina, and fond brother of Dr. Louis Riina and Dr. Howard Riina and their families.
He was our first spinal fellow, who became a valued colleague and a close friend. To me he was “Joey.” It was a joy to help him learn. He was a priceless resource to bounce ideas and eccentricities off, and a friend with a crazy sense of humor. He will be missed greatly by us all.
Terry R. Trammell, MD
Isador H. Lieberman, MD, MBA, FRCSC was given the Golden Apple Award from Health Volunteers Overseas. Dr. Lieberman has done work with the Uganda Spine Surgery Mission.
Benjamin A. Alman, MD was recently named Chairman of the Department of Orthopaedic Surgery at Duke University School of Medicine.
R. Dale Blasier, MD
Coding Committee Chair
Many surgeons are performing procedures on the growing spine for Early Onset Scoliosis across the country, which includes VEPTR and growing rod procedures. These procedures, although mature and well-established, do not have their own CPT descriptors. As a result, surgeons have had to choose from existing codes which do not well-describe what is actually done during these procedures.
Because there are no codes which specifically describe these procedures, there are several problems: 1) There are not any standardized description or vignette which applies to these procedures 2) There is not a way to track the number of these procedures done across the country because there is no way to separate growing procedures from standard procedures as they use the same codes 3) It is not possible to track billing and reimbursement for procedures performed on children with early onset scoliosis.
As a result of these problems, the Scoliosis Research Society Coding Committee was tasked with determining whether new codes should be developed which specifically address non-fusion procedures performed on the growing spine. The goals for establishing new codes would be enabling tracking of these procedures, ensuring reimbursement and minimizing denials and to establish correct coding which accurately describes each procedure.
The issue was discussed by the Board of Directors during the 47th Annual Meeting in Chicago, Illinois, USA. It was determined that it would be appropriate to survey the SRS membership to determine satisfaction with the existing codes, determine which CPT codes are being used and assess the level of interest for the development of new codes.
The survey was created and circulated by email to North American members of the SRS in November of 2012. The survey asked if the member performed VEPTR or growing rod procedures and whether they used CPT codes to describe them. Members were asked if they felt they were fairly reimbursed for the procedures. The survey also sought to determine if the member felt there was a need to develop new codes to describe these procedures. Each member was also asked to describe which CPT codes would be used to describe procedures performed during the course of treatment including: 1) insertion, 2) revision, 3) lengthening and 4) removal. The questions were asked for both growing rod and VEPTR procedures.
There was a low rate of response to the survey. Forty three of 61 respondents (71%) used CPT codes to report VEPTR or growing rod procedures. Forty of 59 respondents (68%) favored changing the coding structure for these procedures.
Responses regarding VEPTR procedures:
Thirty two of 63 respondents (51%) performed VEPTR procedures. Only 26% (11 of 42) felt they were fairly reimbursed for their work.
The majority of respondents reported VEPTR insertion procedures using codes for insertion of segmental instrumentation. A smattering of respondents reported insertion of non-segmental instrumentation, unlisted procedures, or did not know what to use. For revision or reinsertion, the majority reported the use of 22849 (reinsertion of hardware) and 22850 (Removal of posterior non-segmental instrumentation). A smattering used an unlisted code or were not sure. For lengthening, almost all used the reinsertion code – 22849. For removal, most reported 22850 (removal of posterior non-segmental instrumentation) or 22852 (removal of posterior segmental instrumentation)
Responses regarding growing rod procedures:
Thirty six of 51 respondents (71%) performed VEPTR procedures. Only 40% (15 of 38) felt they were fairly reimbursed for their work.
The majority of respondents reported growing rod insertion procedures using codes for insertion of segmental instrumentation. A smattering of respondents reported insertion of non-segmental instrumentation, unlisted procedures, or did not know what to use. For revision or reinsertion, the majority reported the use of 22849 (reinsertion of hardware) sometimes with 22850 (removal of posterior non-segmental instrumentation). A smattering used an unlisted code or were not sure. For lengthening, almost all used the reinsertion code, 22849. For removal, most reported 22850 (removal of posterior non-segmental instrumentation) or 22852 (removal of posterior segmental instrumentation).
Problems with utilization of existing codes.
Correct Coding: There are several problems with using existing spinal instrumentation codes: 1) Spinal codes are being used in VEPTR cases in which the hardware does not make contact with the spine. 2) Hardware insertion codes are “add-on” codes and cannot be used in isolation without a “base” code such as arthrodesis. 3) The reinsertion code is being reported, even when no hardware is removed or inserted. 4) There is no agreement among users as to which codes to use. In short, the use of existing codes violates principles of correct coding.
Surgeon satisfaction: Sixty-eight percent of respondents favored changing the coding structure for these procedures. With regard to VEPTR procedures, only 26% of respondents felt they were fairly reimbursed for their work. With regard to growing rod procedures only 40% of respondents felt they were fairly reimbursed for their work.
The Development of new codes
It appears appropriate to proceed with developing a set of codes to describe growing rod and VEPTR procedures for the following reasons:
The current plan is to proceed with the development of relevant new codes for these procedures with the assent of the SRS Board of Directors. Member comments for or against this proposal can be sent to Katy Kujala-Korpela, (firstname.lastname@example.org).
Committee Chair: R. Dale Blaiser, MD Committee Members: Jeffrey B. Neustadt, MD; Neel Anand, MD; Christopher J. DeWald, MD; Michael P. Chapman, MD; Mathew D. Hepler, MD; Nigel J. Price, MD.
Laurel C. Blakemore, MD
Fellowship Committee Chair
Dear SRS Member,
As you know, despite a multitude of bone graft options, there remains a lack of clear guidance in the literature regarding the best, safest and most cost effective bone grafting technique for degenerative lumbar fusions. We would like to survey SRS members on their current use of bone grafts and bone graft substitutes to guide future research in this area. Please take few minutes to complete this short survey by using a web link below.
We appreciate your time.
Chair: Laurel C. Blakemore, MD Committee Members: Carlos A. Tello, MD; Hilali H. Noordeen, MD; Douglas C. Burton, MD; Munish C. Gupta, MD.
Alistair G Thompson, FRCS
SRS Historical Committee Member
The Historical Committee welcomes all members to submit articles of historical significance related to scoliosis or spinal deformity for consideration to be featured in the Historian’s Corner. If you are interested in submitting an article please contact the Historical Committee’s staff liaison, Katy Kujala-Korpela at email@example.com.
Sir Charles Bell 1774 – 1842 best known for the description of the lower motor neurone paralysis of the facial nerve which bears his name; made major contributions to our understanding of the anatomy and physiology of the nervous system. He also developed a special interest in spinal conditions including deformity and paralysis.
In 1804 he left his native Edinburgh for London and established a reputation as a teacher of anatomy and surgery, eventually purchasing the anatomy school of William Hunter (brother of John Hunter.) The site of the school is marked today by a plaque in Great Windmill Street, Soho, London, England. Charles Bell acquired a huge collection of anatomical and pathological specimens which were sold to the Royal College of Surgeons of Edinburgh in 1825. A superb artist, he illustrated many of his clinical observations in drawings and paintings.
The Bell Collection contains a large number of articulated scoliotic spines which were probably prepared by a process of boiling and may be unique. Examination of theses spines by C.T. scanning has revealed typical findings of the changes in scoliotic spines in the concave pedicles so relevant to current surgical treatments of these deformities. Bell may have treated some scoliotic spines by tenotomy. Visitors to Edinburgh today may visit the RCSEd Museum and view his exhibits.
Bell is jointly recognised with François Magendie of France as the first to describe the dorsal roots of the spinal cord as sensory and the ventral roots as motor. Bell postulated a ‘sixth muscle sense’ and believed that disturbance of this may lead to spinal deformity – an extremely far sighted concept. He published a New Anatomy of the Brain and Nervous System in 1811 and his contributions to science were recognised when he became a fellow of the Royal Society. He was the first Professor of Surgery at the London Middlesex Hospital and was knighted in 1831. He returned to Edinburgh as Regius Professor of Surgery in 1836 – a pioneering clinical surgeon indeed!
Committee Chair: Behrooz A. Akbarnia, MD Committee Members: Nathan H. Lebwohl, MD, Past Chair; Vishal Sarwahi, MD; Azmi Hamzaoglu, MD; Reinhard D. Zeller, MD; Lawrence I. Karlin, MD; Alistair G. Thompson, FRCS; Jason Lowenstein, MD.
Suken A. Shah, MD
Program Committee Chair
The abstract submission process closed on February 1 via the website and I am pleased to report that over 1,400 abstracts were submitted for the Annual Meeting and IMAST. The abstracts have all been scored in a blinded fashion by our dedicated reviewers and aggregate scores will now be tabulated by Scholar One.
The Program Committee will meet in Chicago, Illinois, USA at the American Academy of Orthopaedic Surgeons Annual Meeting (AAOS) to formulate the preliminary program and start the process of author notification. We hope to notify all authors in April about the status of their abstract submissions.
We do plan to keep the changes in place from last year; feedback was enthusiastically positive. 1.) Membership will be involved in the voting for the Hibbs Clinical and Basic Science Awards at the time of their podium presentations via a Smartphone application or paper ballot. The podium presentations of the finalists for the Hibbs Awards will be grouped at the Annual Meeting in a plenary session to allow the audience to view them in one session and to vote immediately following. 2.) A concurrent session will be held on Friday morning to allow more podium presentations to be given at the Annual Meeting. The number and quality of abstracts submitted to the Annual Meeting has continued to increase. The concurrent session will allow 15 to 20 additional abstracts to be presented. 3.) Lastly, due to the success of the case presentation sessions the last two years, they will be repeated this year in a forum on an interesting topic moderated by the experts. Although any category of interesting case is allowed, we will place an emphasis on those presentations focusing on the topics of surgical complications and neurologic deficits.
Chair: Suken Shah, MD Committee Members: Daniel J. Sucato, MD, MS; Daniel W. Green, MD; Timothy S. Oswald, MD; Jahingir K. Asghar, MD; Frank J. Schwab, MD; Stanley S. Lee, MD; John G. Thometz, MD; James O. Sanders, MD; Theodore J. Choma, MD; Ronald A. Lehman Jr., MD.
Many thanks to our abstract reviewers for their time and dedication devoted to the quality of the program:
47 Choma, Theodore
Knapp, D. Raymond
Charles E. Johnston, II, MD
Research Grant Committee Chair
The Research Grant Committee received 21 grant applications for the Fall 2012 funding cycle. For the first time, there were six highly-technical grants involving genetics and molecular biology, of such sophistication that the committee, with the help of Carol Wise PhD, utilized non-member expert reviewers of national and international acclaim to assist in evaluating these grants. Two of these proposals (*) were eventually funded, as well as three others:
D. Sengupta: Dynamic stabilization system to prevent proximal junctional kyphosis -$10 thousand
V. Balasubramanian: True pathoanatomy of the rib hump in AIS and its influence on surgical intervention - $22 thousand
K. Kamiya: Cartilage dependent Ras-MAPK signaling and induction of scoliosis (continuation) - $25 thousand
R. Gray: Druk mutant zebrafish model for scoliosis* - $25 thousand
J. Gorski: SKI-1 somitogenesis regulation of scoliosis* -$25 thousand
Total funds awarded for this cycle were somewhat limited at $107 thousand. However, the amounts available for the 2013 spring and fall cycles are expected to be at least $150K each, and so the Research Grant Committee is anticipating more activity than last year as the availability of these funds becomes known.
The Research Outcomes subcommittee, a newly formed subcommittee charged with quality control and review of funded grants, evaluated and/or accepted ten interim or final reports funded from previous years. For the one-hour Research Grants Lunchtime Symposium at the 2013 Annual Meeting, five additional projects from 2010-11 have been requested to present preliminary findings to the membership. Based on our experience with the symposium at the 2012 Annual Meeting in Chicago, Illinois, USA (“Breaking news”), this should produce a lively Question and Answer session for these five investigators. All members are invited to attend this lunchtime symposium at the 48th Annual Meeting in Lyon, France.
Chairman, Research Grant Committee
Chair: Charles E. Johnston, II, MD Committee Members: John M. Flynn, MD; Kirkham B. Wood, MD; Lori Dolan, PhD; Jonathan H. Phillips, MD; Samuel K. Cho, MD; Michael P. Kelly, MD; Virginie C. Lafage, PhD; Annalise N. Larson, MD; Jwalant S. Mehta, FRCS(ortho); Michelle C. Marks, PT, MA; Jonathan E. Fuller, MD; Andrew G. King, MD; Joseph H. Perra, MD; Brian D. Snyder, MD, PhD; Carol A. Wise, PhD; Khaled Kebaish, MD; Baron S. Lonner, MD; Michael Rosner, MD.
James W. Roach, MD
Ethics Committee Chair
“What are the ethical considerations for informed consent in a teaching hospital; is it ethical for house staff to obtain consents?”
As we indicated in the December 2012 Ethics Committee article, orthopaedic surgeons make ethical decisions every day, often without a great deal of deliberation. The vast majority are consistent with good patient care and occur because of common sense and appropriate judgment. Nevertheless not all decisions in medicine are straight forward and some present physicians with complex issues, having potential ethical implications. In our first article we presented a group of moral principles to be considered when assessing an issue with ethical elements. In this letter we present another hypothetical case to further illustrate ethical decision making.
As a junior resident finishes a pre-operative history and physical, the nurse asks if the informed consent was completed and says that Dr. X expects the house staff to obtain it. The resident has just left a service where the attendings always obtained their own consents. The resident wonders which way is better.
While all four moral principles, non-maleficence, justice, respect for autonomy and beneficence are applicable, informed consent is mostly about autonomy. The principle of respect for autonomy necessitates that the physician respect the patient as an individual, who, when given adequate information, should be able provide autonomous choices regarding treatment. The important parts of an informed consent process include disclosure, understanding, and voluntary authorization. The activity should be a process, not just the formality of obtaining a signature on a form. Disclosure is achieved during a conversation between the surgeon and the patient which includes a description of the anticipated benefits as well as the possible risks involved in the procedure. The Professional Practice Standard of informed consent requires disclosing facts considered necessary for a reasonable person to be able to accept or refuse a physician’s recommendation. In the instance of non-emergency surgery, it is important that the conversation does not seemed rushed and the patient is given sufficient time for questions to be asked and answered. The surgeon should ask enough questions to assess the patient’s level of understanding. The patient is then given time to evaluate the information and to decide whether or not to proceed. The entire process is predicated on the patient being sufficiently mentally competent to make rational decisions. There are time constraints about how close to the actual surgery the informed consent document must be completed. In many states an informed consent is valid if it has been signed within a few weeks of the intended surgery.
Returning to our question, “What are the ethical considerations for informed consent in a teaching hospital; is it ethical for house staff to obtain consents?” the Ethics Committee would say it is, assuming the resident-in-question has sufficient knowledge to provide the proper disclosure and is reviewing with the patient what the attending has documented in the record. Obtaining an informed consent is an important teaching experience for the resident and if resident-informed consents are done properly, all three informed consent elements can be accomplished and perhaps the process can even be enhanced.
In a typical office practice patients are evaluated and elective surgery scheduled days or weeks in the future. This is a perfect situation to create an enhanced informed consent process. The initial conversation between the patient and surgeon at the time of the surgical recommendation should include a thorough description of the anticipated benefits and the common procedure risks. The surgeon or resident should summarize this conversation in the office progress note, including which benefits and risks were mentioned. When the patient comes to the hospital for the procedure the house staff reiterates the risks and benefits and obtains the signed consent. The attending surgeon is then able to examine the patient, answer any further questions and review the consent document prior to surgery. This process enhances understanding as it provides the patient, over an extended period of time, three individual discussions of potential risks and benefits.
In this analysis, the use of house staff in obtaining consents does not produce any ethical concerns and actually could help patient understanding of the proposed procedure. A final caveat regarding house staff completion of the informed consent document is the risk that the planned procedure might not be accurately recorded on the document. This can be especially problematic if the patient is an adult and the consent error is not discovered until after the patient has been anesthetized. Nevertheless this problem is easily avoided if the surgeon examines the patient and the chart preoperatively, with careful attention given to the consent form and as happens in many hospitals, the nursing staff reconciles the permit with the posted case before the patient is anesthetized.
Chair: James W. Roach, MD Committee Members: J. Abbott Byrd Jr., MD; M. Wade Shrader, MD; Michael J. Bolesta, MD; Richard E. McCarthy, MD; Brian G. Smith, MD.
James O. Sanders, MD
Evidence-Based Medicine Committee Chair
The Evidence-Based Medicine (EBM) Committee is a new committee working to develop expertise in the society to perform systematic reviews and assist the Scoliosis Research Society (SRS) in developing evidence-based materials such as practice guidelines, Appropriate Use Criteria (AUC) and also to help define research priorities by identifying important gaps in our knowledge.
Systematic reviews differ from typical reviews, in that all of the articles are graded based on the strength of their evidence, and the best available evidence is used to direct the conclusions. Articles with higher levels of evidence are less likely than lower level studies to have significant confounding factors and biases. Where possible, the data from these better articles is pulled out (abstracted) to actually put numbers to the conclusions.
Our maiden project is child and adolescent spondylolysis. We have identified over 1000 articles dealing with the issue but have whittled that to a much more manageable number by eliminating review articles and case reports. We are in the process of pulling the data from these to identify what we actually know from our literature about the topic in terms of the etiology, diagnosis, prognosis, and treatment. We find we have to even deal with such basics as “what is a spondylolysis?”
Our goal is to have the systematic review completed this year. Once we identify areas of significant knowledge deficiency, these will be sent back to leadership for their consideration in future directed research. We should be able to tackle another topic this next year and continue to develop this new expertise in our members.
Chair: James O. Sanders, MD Committee Members: David W. Polly Jr., MD; Shay Bess, MD; Jacob M. Buchowski, MD, MS; Charles H. Crawford III, MD; Justin S. Smith, MD, PhD; Michael G. Vitale, MD, MPH; Douglas C. Burton, MD; Serena S. Hu, MD.
Anthony S. Rinella, MD
Website Committee Chair
Chair: Anthony S. Rinella, MD Committee Members: Michael S. Roh, MD; Ross R. Moquin, MD; D. Raymond Knapp, MD; John R. Dimar, MD; Lori A. Karol, MD; Adrian C. Gardner, MD; Andre Luis F. Andujar, MD; Vishal Sarwahi, MD; Rajiv K. Sethi, MD; Ahmad Nassr, MD; Behrooz A. Akbarnia, MD; Munish C. Gupta, MD; Mark D. Rahm, MD; Frank J. Schwab, MD; Michael Flippin, MD; Stefan Parent, MD; Ron El-Hawary, MD; Todd Milbrandt, MD.
Ahmet Alanay, MD
Worldwide Conference Committee Chair
Dear Members of the Society,
The Worldwide Conference Committee finished its 2012 schedule with two courses held in Tel-Aviv, Israel and Ho Chi Min City, Vietnam. Both meetings had a great interest from the local and regional spine surgeons. I would like to thank Mark Weidenbaum, MD and Yizhar Floman, MD (co-chairs of the Israel course) and Charles Johnston, MD and Vo Van Thanh, MD, PhD (co-chairs for the Vietnam course) for the great job they have produced in both sites. Thanks also to the faculty of both courses.
Click image to enlarge
Coming to 2013, it seems that this year's program will also be very busy with six meetings all around the world. Here is a short summary of 2013 meetings;
The first course of the year will be at Cappadocia, Turkey in mid-April. This will be a one-day program including lectures and workshops just before the bi- annual international spine meeting organized by the Turkish Spine Society (TSS). I should also emphasize the meeting place as being one of the most interesting parts of Turkey as a region of exceptional natural wonders, in particular characterized by fairy chimneys and a unique historical and cultural heritage.
The second course will also be in mid-April, at Florianopolis, Brazil and this will again be a one-day course just before the Brazilian Spine Society (BSS) Annual Meeting. Florianopolis is the capital city and second largest city of Santa Catarina state in the Southern region of Brazil. It is composed of one main island and is known to be one of the most exciting sites of Brazil with fishing boats, lacemakers, colorful folklore, excellent cuisine and colonial architecture.
The third course is in Kharkiv City, Ukraine at the end of May. This will be a day and a half course and will be followed by a meeting of the International Society for Minimally Invasive Spine Surgery (ISMISS). Kharkiv is a major cultural, scientific, educational, transport and industrial centre of Ukraine and its second largest city.
The fourth course of the year will take place in Valencia, Spain at the end of May, in conjunction with the traditional SILACO meeting which is held every three years outside South America. The heritage of ancient monuments, views and cultural attractions makes Valencia one of the country's most popular tourist destinations.
Next course will be in Sarajevo, Bosnia-Herzigovina and will be the first SRS-Balkan meeting gathering spine surgeons from all around the Balkan countries. Sarajevo is the capital city and is historically famous for its traditional cultural and religious diversity, with adherents of Islam, Ort hodoxy, Catholicism and Judaism coexisting there for centuries. The meeting will be a two full days stand alone meeting including lectures, roundtables case discussions and workshops.
The final course of the year will be at Beijing, China in November. This one-day SRS course in China will be held every two years in conjunction with the Chinese Orthopaedic Association (COA) and Chinese Spine Society (CSS). Beijing is the second largest Chinese city by urban population after Shanghai and is the nation's political, cultural, and educational center.
You can find detailed information about all our courses, including programs and the faculty, on the SRS web site: http://www.srs.org/meetings/worldwide_conferences.htm
We are more than happy with the interest from everywhere in the world to organize WWC courses. We have already determined four sites for 2014 courses and are taking applications for 2015 courses. Our committee is working hard to disseminate the knowledge of spinal deformity all around the world and we are hoping to develop new projects and improve our global educational activities for our society’s mission to foster optimal care for spinal deformity patients globally.
With my warm regards,
Ahmet Alanay, MD
Chair: Ahmet Alanay, MD Committee Members: Kamal N. Ibrahim, MD, FRCS(C), MA; Munish C. Gupta, MD; Youssry MK El-Hawary, MD; Scott D. Hodges, DO; John R. Dimar, II, MD; Ravi S. Bains, MD; Walaa Elassuity, MD; Sergio A. Mendoza-Lattes, MD; Ahmed M. Shawky, MD; David H. Clements, III, MD; Marinus De Kleuver, MD, PhD; Mark Weidenbaum, MD; Hani Mhaidli, MD; Stephen J. Lewis, MD, MSc, FRCSC; Kenneth J. Paonessa, MD.
José A. Herrera-Soto, MD
Bylaws and Policies Committee Chair
The Bylaws and Policies Committee’s primary goal is to ensure compliance with bylaws and written policies. We do this by responding to questions that arise regarding the bylaws. In addition, we are currently updating the Policy & Procedure Manual with the approval of the Board of Directors (BOD), communicating changes to the Scoliosis Research Society office and staff liaison. The Committee completed updating the Policy & Procedure Manual by soliciting edits from committee chairs. Thank you to Michael Albert, MD and James Roach, MD who lead the charge in achieving this goal. As the manual is an evolving document, we will require from the committee chairs to evaluate and update their respective policies on a bi-annual basis and make recommendations for changes. We will focus this year in updating the governance council and research council committees. The finance and education councils will need updates during 2014.
We are currently recommending amendments to the policies and procedures for the Research Grant Committee, under the leadership of Charles Johnston, MD, to make people receiving grants accountable for their studies. Any disciplinary action regarding malutilization of funds would need approval from the Board on a case by case basis. These disciplinary actions can include: withholding of the remaining awarded funds, request of return of funds used improperly, ineligibility for future research grant awards, and/or inegibility to present papers or posters at IMAST or SRS for an indefinite period of time. Any questions regarding this Committee, please do not hesitate to contact Courtney Kissinger, Staff Liaison, or José Herrera-Soto, MD Chair.
Chair: Jose Herrera-Soto, MD Committee Members: Michael C. Albert, MD; M. Wade Shrader, MD; Jeffrey D. Coe, MD; Karl E. Rathjen, MD; Dilip K. Sengupta, MD.
Youssry M.K. El-Hawary, MD
Global Outreach Committee Chair
The 2012-2013 Global Outreach Committee is quite popular this year! This is due to the eagerness of members to help underserved area. I would like to welcome the following new committee members: Donald P.K. Chan, MD; Michael H. Jofe, MD; Bettye A. Wright, PA, RN; Andre Luis Fernandes Andújar, MD; Michael S. Chang, MD; Mohammad El-Sharkawi, MD; Patrick C. Hsieh, MD, MSc; Darren R. Lebl, MD; Gregory M. Mundis, MD; Elias C. Papadopoulos, MD; Ferran Pellise, MD, PhD; Alpaslan Senkoylu, MD; Alejo Vernengo-Lezica, MD.
The Global Outreach Committee will be hosting a Lunchtime Symposium for the 48th Annual Meeting in Lyon, France, chaired by Ken Paonessa, MD. Currently the speakers planned for this symposium are Oheneba Boachie-Adjei, MD, Elias Papadopoulos, MD, Ferran Pellisé Urquiza, MD, PhD and Hazem B. El Sebaie, MD, FRCS. Also at the Annual Meeting, the committee will have an informational table. Staff is currently sending follow-up letters to those who visited the table last year and expressed interest. The Global Outreach Committee has also submitted an abstract based on the data from the survey done last year. Information is currently being gathered regarding where the various Global Outreach sites receive their instrumentation donations and financial support.
The Global Outreach Committee’s next meeting will be at the American Academy of Orthopaedic Surgeons Annual Meeting in Chicago, Illinois, USA.
Chair: Youssry El-Hawary, MD Committee Members: Kenneth J. Paonessa, MD; Michael J. Mendelow, MD; Mohammed M. Mossaad, MD; Anthony P. Schnuerer, PA; Andre Luis Fernandes Andújar, MD; Michael S. Chang, MD; Mohammad El-Sharkawi, MD; Patrick C. Hsieh, MD, MSc; Darren R. Lebl, MD; Gregory M. Mundis, MD; Elias C. Papadopoulos, MD; Ferran Pellise, MD, PhD; Alpaslan Senkoylu, MD; Alejo Vernengo-Lezica, MD; Ahmet Alanay, MD; Kyu-Jung Cho, MD; Matthew J. Geck, MD; Hossein Mehdian, MD, FRCS(Ed); Donald P.K. Chan, MD; Michael H. Jofe, MD; Anthony S. Rinella, MD; Bettye A. Wright, PA, RN.
Lawrence G. Lenke, MD
Globalization Committee Chair
This new committee is charged with providing awareness to the leadership of the Scoliosis Research Society (SRS) regarding issues, challenges and opportunities of SRS members from Non-North American countries. We have begun with three regional sections: Europe, co-chaired by David Marks, FRCS and Francisco Perez- Grueso, MD; Latin America, co-chaired by Carlos Tello, MD and Osmar Avanzi, MD; and Asia-Pacific, co-chaired by Noriaki Kawakami, MD and Hee-Kit Wong, MD.
The committee is also involved in site selection for our non-North American International Meeting on Advanced Spine Techniques (IMAST) and Annual Meeting selections. The past several months, the Long Range Planning Committee has vetted three potential 2015 IMAST venues including Seoul, Korea, Singapore and Kuala Lumpur and the A-P region has assisted in that selection which should be finalized at the upcoming Board of Directors (BOD) meeting in mid-March at the American Academy of Orthopaedics Surgeons (AAOS) annual meeting.
The committee is also in the process of sending out member-wide surveys to gauge the current membership in these regions for issues of relevance of SRS to their practice, research and education as well as opportunities for increased involvement at the committee and leadership levels. A separate survey sent out to appropriate non-members in the region with the potential for membership will also provide valuable insight into this group of deformity surgeons as well. The goal of the committee is to improve the communication and experience of our global SRS members while also providing information to the leadership on the vast membership that exists outside the confines of North America to ensure a steady forward globalization of the society and its mission.
Chair: Lawrence G. Lenke, MD Committee Members: Noriaki Kawakami, MD; Hee-Kit Wong, MD; David S. Marks, FRCS; Francisco Sanchez-Perez-Grueso, MD; Carlos A. Tello, MD; Osmar Avanzi, MD; Oheneba Boachie-Adjei, MD; Kenneth M.C. Cheung, MD.
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, Globalization, Historical, Industry Relations, Newsletter, and Public Relations committees. The main responsibility of the Council is to act as liaison between committees within the council and the board of directors. I am happy to report the all of the committees have active charges for 2013 and are engaged in activities in support of the SRS.
The Advocacy & Public Policy Committee, chaired by Brian Smith, MD, is continuing its effort to promote Scoliosis Awareness Month, which is June 2013, in collaboration with the National Scoliosis Foundation. In 2012, proclamations recognizing Scoliosis Awareness Month were obtained in 39 states, and it is hoped that more states will sponsor this resolution in 2013.
The Coding Committee, chaired by R. Dale Blasier, MD the Ethics Committee, chaired by James Roach, MD, the Fellowship Committee, chaired by Laurel Blakemore, MD and the Historical Committee chaired by Behrooz Akbarnia, MD have all reported on their recent activities in the December newsletter.
The Corporate Supporters Committee, formerly known as the Industry Relations Committee, is led by our Past President B. Stephens Richards, III, MD. The Committee is currently reviewing for approval and distribution the 2013 Corporate Partner’s Program Brochure.
The Newsletter Committee is now chaired and edited by John Lubicky, MD, FAAOS, FAAP. The Committee is busy producing quarterly newsletter and always welcomes ideas for articles in the newsletter or new features on an ongoing basis. Feel free to contact John at: firstname.lastname@example.org .
The Public Relations Committee, chaired by Lori Karol, MD, continues to review educational and promotional videos before they are released to national media and to work in liaison with the Website Committee and the 50th Anniversary Task force in a Public Relations initiative that will show the great improvements in scoliosis care over the past 50 years.
As for the Bylaws and Policies, and the Globalization committees, their annual reports are included in this newsletter.
The next meeting of the Governance Council will occur at the 20th International Meeting on Advanced Spine Techniques (IMAST) meeting in Vancouver, British Columbia, Canada this July.
Chair: Hubert Labelle, MD Council Members: Brian G. Smith, MD; Jose Herrera-Soto, MD; R. Dale Blasier, MD; James W. Roach, MD; Laurel C. Blakemore, MD; Lawrence G. Lenke, MD; Behrooz A. Akbarnia, MD; B. Stephens Richards, III, MD; John P. Lubicky, MD, FAAOS, FAAP; Lori A. Karol, MD.
Douglas C. Burton, MD
Morbidity and Mortality Committee Chair
The Morbidity and Mortality (M&M) Committee has been active over the last year with the institution of the new “infection” module into the data collection website. Much work has been done on this module by past committees and 2012 was the first year that this information is collected. We now have four modules: death, visual acuity loss, neurologic deficit, and acute infection. As a reminder, the deadline for 2012 online M&M reporting is April 1, 2013.
Last year the Board of Directors agreed to fund data extraction from the M&M database for individual research. The process and guidelines for submitting a Request for Proposal (RFP) is located on the Members-Only section of the SRS website under Morbidity and Mortality (“Research for Proposal for M&M Data Research”). In an effort not to duplicate projects we have provided a list of current research. There is also a bibliography of published papers using the M&M database, which demonstrates the usefulness and value of our M&M collection process as well as to serve as a guide to future researchers as they consider studies using the M&M database.
In his report to the membership at the 47th Annual Meeting in Chicago, Illinois, USA, Paul A. Broadstone, MD, Past Chair, gave an excellent update of the 2011 database results. In 2011, our compliance with submission as a society has increased to 90% (85% in 2010 and 80% in 2009). There were 45,412 entries and the complication rates were 0.88% for all complications combined. Thank you again for all who participate in the collection process.
Chair: Douglas C. Burton, MD Committee Members: Paul A. Broadstone, MD; Yongjung J. Kim, MD; Gregory V. Hahn, MD; Annalise N. Larson, MD; William F. Lavelle, MD; Darren R. Lebl, MD; Kamran Majid, MD; Alejo Vernengo-Lezica, MD; Robert F. Heary, MD; Howard M. Place, MD; Jonathan E. Fuller, MD; Karl E. Rathjen, MD; Praveen V. Mummaneni, MD; Joseph M. Verska, MD.
Double Diamond Level Support
Platinum Level Support
Silver Level Support
Bronze Level Support
Ackerman Medical GmbH
Apatech Ltd, a Baxter Co.
Lippincott, Williams, Wilkins
Osseon Therapeutics, Inc.
Providence Medical Technology
Salient Surgical Technologies
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.
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.
You have received this message because you have had previous contact with the Scoliosis Research Society. If you do not wish to be included in our mailing list, please forward this message to email@example.com. © 2012 Scoliosis Research Society. No part of this publication may be reproduced without the prior written permission of the SRS.