March 2017

President's Message

New initiatives for a new year!
I wish to take this opportunity to wish all our readers a happy 2017. May your year be filled with success, health, and joy.

For SRS, we started the New Year with something new, something different!

For those of you who were in Time Square, New York, you might have seen a rolling advertisement for SRS being screened on one of the large overhead screens. We were given an opportunity to put up a ten-second promotional video to highlight the work of our Society. The advertisement was shown November 23, 2016 to January 31, 2017. During this time, our website traffic from New York City was doubled. As Times Square is visited by millions of people from all over the world, we are waiting to see if this will have a domino effect, raising awareness to the work of our Society globally.

Another new initiative is the Current Concepts in Spine Deformity Course. This is the first time SRS has put together a course with our Society in the lead, partnering with a regional society to deliver education around the world, using a defined curriculum, the strong SRS brand and programs that are sensitive to local and regional needs. With the help of Marinus de Kleuver, MD, PhD, from the Education Task Force, and Local Chairs, Martin Repko, MD, PhD and Alpaslan Senkoylu, MD, they have put together an outstanding program for our first course in Prague, Czech Republic. For further details about the course, please see Prof. de Kleuver’s article in this newsletter.

This Current Concepts Course, together with our curriculum development led by Laurel Blakemore, MD, will mark the beginning of a gradual transformation of our educational initiatives to a much more bottom-up approach, whereby we aim to design courses that addresses areas of need, and to develop a strong faculty base that can help us deliver the content around the world. I shall report more on our progress in my Presidential Address at the Annual Meeting & Course this year in Philadelphia, PA, USA.

In yet another new initiative, SRS had our very first webinar in December 2016. Thanks to Robert P. Huang, MD as moderator, with James “Jim” O. Sanders, MD; Charlie E. Johnston, MD; Peter F. Sturm, MD, and Jacques L. D’Astous, MD as speakers. The webinar covered all aspects of casting and was attended by 135 participants from 40 different countries. In a post webinar survey, 51 percent of the participants said that they have changed their practice as a result of their participation. The Presidential Line is so excited by this that we have set up an ad-hoc webinar committee, to identify new webinars to produce in the future. If you have ideas on what SRS should do for our next webinar, please submit a proposal via this link (https://srs.execinc.com/edibo/EducationalProposal). The casting webinar was recorded and will become available for unrestricted viewing via our website.

From the program perspective, Ronald A. Lehman, Jr., MD and Henry F. H. Halm, MD have finished preparing the program for the 24^th IMAST in Cape Town, South Africa taking place July 13-15. This will no doubt prove to be a spectacular meeting, with a comprehensive program that addresses issues beyond deformity, and an emphasis on local and regional needs. You can download the preliminary program via this link https://www.srs.org/imast2017/program. Be sure to book your housing early, July is a popular time to visit South Africa! Also be sure to look into spending a few days with your family to take in the culture, tour South Africa and go on a safari.

Our Annual Meeting & Course in Philadephia, PA, USA in September is also coming along nicely. Praveen Mumaneni, MD, chair of the Education Committee has set the theme as Multi-disciplinary Approaches to Global Spine Care. The Program Committee, chaired by Muharrem Yazici, MD, is hard at work reviewing the 1,506 abstracts that were submitted. The committee has new ideas on enhancing our Annual Meeting that will allow more presentations within the limited time period. Please reserve the dates, September 6-9, 2017 to come to Philadelphia.

All in all, this promises to be yet another exciting year for SRS. We rely on your active participation to make our Society successful. Please share your ideas and feedback on any aspect of the Society. I look forward to meeting each of you personally during one of our upcoming meetings.

Kenneth MC Cheung, MBBS(UK), MD(HK), FRCS, FHKCOS, FHKAM(Orth)
SRS President 2016-2017

Hot Topics Articles

Worldwide Courses - Current Concepts Course
Core Curriculum Task Force
Globus Medical Fellow Report

Obituary

James E. Holmblad, MD
December 11, 1921 – February 5, 2017

Dr. James Holmblad, age 95, passed away at his home in the historic Stockade District of Schenectady, New York on February 5, 2017. He was a founding member of SRS. Born in Chicago, IL he attended West Aurora High School (where he played football and ran track), Lake Forest College in Illinois, and attended medical school at the University of Pennsylvania. His post graduate training in orthopedics was at Cook County Hospital in Chicago with a brief two-year interruption to serve as a US Army flight surgeon. He subsequently trained in a year-long pediatric fellowship at Sunnyview Rehabilitation Hospital in Schenectady, New York with Dr. William Gazeley who was known for his research on spinal growth and development.

He was present at the founding meeting of SRS and focused his practice on pediatric spine deformities. He volunteered his expertise at outreach clinics in the rural towns of Saranac and Malone in upstate NY and after retiring, continued as a volunteer physician. He served as a Clinical Associate Professor at Albany Medical College and was a mentor to generations of orthopedic trainees. They learned of his gentle and caring ways in the clinic, OR, and accompanied him at outreach clinics. He was loved and appreciated by his patients and was known by his signature bowties.

He owned a local travel agency and from this interest became a world traveler often accompanied on trips with his wife of 71 years. He was an Eagle Scout and remained active in scouting for many years. In his early years, he was active in skiing and boating and in his later years, golfing and curling. He was also a bridge and cribbage player.

In addition to his wife, he is survived by his three children, five grandchildren and 10 great-grandchildren. He was very proud to be a founding member of SRS and has left his mark in helping to progress scoliosis treatment during its early years.

Obituary written by Allen L. Carl, MD

Pat on the Back

David A. Spiegel, MD

Congratulation to David A. Spiegel, MD, of the Children’s Hospital of Philadelphia, who was the recipient of the 2017 AAOS Humanitarian Award during the Your Academy 2017 event. Dr. Spiegal received this award in recognition of his dedication to improving the lives of people with orthopaedic conditions, particularly children, in underdeveloped regions. Dr. Spiegal was also awarded the Walter P. Blount Humanitarian award during the 51^st Annual Meeting & Course in Prague, Czech Republic in September 2016.

Matthew B. Dobbs, MD

During the 2017 AAOS Annual Meeting, SRS member Matthew Barrett Dobbs, MD, and Christina Gurnett, MD, PhD, received the Kappa Delta Ann Doner Vaughn Award for their paper “Advancing Personalized Medicine for Clubfoot Through Translational Research.” The Kappa Delta Research awards are bestowed for outstanding manuscripts that focus on basic and/or clinical research related to the musculoskeletal system.

Historical Committee Update

George H. Thompson, MD
SRS Historian

Since the Annual Meeting & Course in Prague, the Historical Committee has had a conference call in which members of the committee were assigned items for the timeline to provide a brief synopsis on. These items will be added to the online timeline by early summer.

Additionally, the committee is continuing their work on adding to the SRS video archives of interviews. During AAOS, Behrooz Akbarnia and I will be completing our interviews. There will be limited opportunities to record interviews at the Annual Meeting in Philadelphia this year. That being said, the committee will share a videographer with the Patient Education Committee and plans on completing 1-2 interview while in Philadelphia.

We are continuing to try and acquire the study material from the George Dommissee collection of slides on blood flow of the spinal cord for the SRS Archives. Hopefully we will also receive academic material from The Alf Nachemson estate.

As always, we are saddened by the losses of our friends and colleagues in recent months. Since my last report, we have lost Pier Giorgio Marchett, MD; Klaus Zielke, MD; and James Holmblad, MD. Dr. Holmblad was a founding member.

Chair: George H. Thompson, MD Committee: Behrooz A. Akbarnia, MD; Jason E. Lowenstein, MD; Terry D. Amaral, MD; Alejo Vernengo-Lezica, MD; Patricia N. Kostial, BSN, RN; Jay Shapiro, MD; Hani Mhaidli, MD, PhD

Worldwide Courses – Current Concepts Course

Marinus de Kleuver, MD, PhD
Education Task Force Member

Develop spine deformity treatment in your region, register your young surgeons for the first and second “SRS Current Concepts in Spine Deformity”

A Scoliosis Research Society Course.

Europe: in cooperation with EUROSPINE

March 30-April 1, 2017
Prague, Czech Republic
Advance registration is now closed but you can register on-site March 30, 2017

China: in cooperation with the Chinese SRS

October 13-15, 2017
Shenzhen, Peoples Republic of China

Latin America:

2018, dates to be announced
Brazil

Course characteristics:

Program: The course will span four half-days covering the following topics:
Foundation Knowledge, Early Onset Deformity, Adolescent Deformity, Neuromuscular Deformity, Adult Deformity, Kyphosis, and Complications.
Intimate setting with a low attendee to faculty ratio.
Network with other surgeons and learn about advances in treatment options.
Low cost.
Target audience: spinal surgeons who treat, but may not specialize in spinal deformity.

As part of the Education Task Force efforts to develop SRS educational offerings, we aim to provide didactic interactive education in a regional setting across the globe. This will be based on the 10 knowledge domains of the SRS Spine Deformity curriculum that is currently being developed (see Core Curriculum Task Force article). The first course will held be in Europe, the second course will be later in the year in China, and in 2018 the third course will be organized in Latin America.

These didactic courses are more comprehensive than current Worldwide Courses, and aim to teach all aspects of treatment of patients with spinal deformities to spinal surgeons who treat, but may not specialize in spinal deformity. The educational faculty consists of recognized regional experts, supplemented by international opinion leaders.

We ask you to encourage young surgeons in your region to register for these exiting new SRS courses.

Core Curriculum Task Force

Laurel Blakemore, MD
Core Curriculum Task Force Chair

The Core Curriculum Task Force has been charged with defining a comprehensive core curriculum for use in spinal deformity training. The curriculum should include a guideline for study as well as competency based surgical training.This will be a comprehensive curriculum of the knowledge and skill competencies for a training program that SRS would endorse. In addition, the curriculum will serve as the basis for SRS educational efforts including Worldwide Courses, to ensure consistency in post training societal education.

Committee members include Lindsay Andras, MD; Saumyajit Basu, MD; Marinus de Kleuver, MD, PhD; Praveen Mummaneni, MD; Stefan Parent, MD, PhD; Ferran Pellisé, MD, PhD, and Alpaslan Senkoylu, MD. A smaller steering committee composed of Dr. Andras, Dr. Blakemore, Prof. deKleuver, Dr. Parent and Dr. Pellisé has been overseeing the progress of an expensive Delphi survey under the guidance of consultant Willy Cats-Baril and with the enormous assistance of SRS staff liaison, Courtney Kissinger.

The panel consists of 139 expert spinal deformity surgeons from around the world, including 70 surgeons from the United States and 69 surgeons from outside the United States. A great majority of the panelists (79%) are Residency or Fellowship Directors; they have substantial spinal deformity practice (median 62% of their practice is deformity) and extensive experience (median is 23 years in practice).

To date as of February 5, 2017 the Delphi panel has completed three rounds including a two part round three with a response rate above 90% for all rounds.

So far, the group has agreed to the overall structure of the curriculum, using the following ten broad Knowledge Domains:

1) Foundation Knowledge

2) Early Onset Scoliosis

3) Adolescent Idiopathic Scoliosis

4) Neuromuscular Deformity

5) Adult Spinal Deformity

6) Degenerative Spinal Deformity

7) Kyphosis

8) Spondylolisthesis

9) Cervical Deformity

10) Acquired Deformity

In round three, we addressed the Learning Objectives. These are intended to be a brief, clear statement of what the learner will be able to perform at the conclusion of the learning experience. Learning objectives define the expected goal of a curriculum, course, lesson or activity in terms of demonstrable skills or knowledge that will be acquired by a student as a result of instruction. We refined these into three groups of learner objectives applicable, across all of the domains:

Defines Etiology, Classification and Natural History.
Identifies clinical and radiological parameters modifying patient’s HRQOL and guiding treatment decision making process.
Formulates and recommends treatment options, considering best evidence, safety, predicted outcomes and potential complications (risk / benefit).

The Delphi process has provided a tremendous amount of data in round three which requires a labor intensive analysis to move to the final stages. The Core Curriculum Task Force met, along with Willy Cats-Baril and Courtney Kissinger, in Chicago on February 20^th to analyze the data obtained during round three and direct the final rounds of the survey. In the final Delphi rounds we will define the following objectives for each knowledge domain:

Cognitive Skills: core skills used by the learner to think, read, learn, remember, reason, and pay attention.

Psychomotor Skills: physical skills such as movement, coordination, manipulation, dexterity, grace, strength, speed; actions which demonstrate the fine motor skills such as use of precision instruments or tools.

Assessment Tools: refers to the wide variety of methods or tools that educators use to evaluate, measure, and document the academic readiness, learning progress, skill acquisition, or educational needs of students.

A report of the February meeting will be delivered at the SRS Board of Directors Meeting on March 13, 2017.

Chair: Laurel Blakemore, MD Committee: Lindsay Andras, MD; Saumyajit Basu, MD; Marinus de Kleuver, MD, PhD; Praveen Mummaneni, MD; Stefan Parent, MD, PhD; Ferran Pellisé, MD, PhD, and Alpaslan Senkoylu, MD

Long Range Planning Committee Update

David W. Polly, Jr., MD
Long Range Planning Committee Chair

The Long Range Planning Committee is charged with identifying sites for future Annual Meetings & Course and the IMAST meeting. Committee members include: John P. Dormans, MD; Ferran Pellisé, MD, PhD; Benny T. Dahl, MD, PhD; Kenneth MC Cheung, MD; Henry F. H. Halm, MD, and Ronald A. Lehman, Jr., MD.

Currently, we are looking at potential sites for 2020.Thank you to many members and groups of members for providing wonderful suggestions about possible venues.

Site selection is based upon a series of criteria. These criteria are viewed in a matrix format. These criteria include:

1) Does the site have the physical capacity to handle the meeting? This requirement includes meeting space, sleeping space, breakout room space. Given the increasing size of the Society and our meetings, our choices are becoming more constrained, especially given our relatively narrow time windows for both meetings.

2) Ease of travel. Given our increasingly international nature, airport capacity is becoming a more important factor.

3) For IMAST there are constraints about ability of our industry partners to get their equipment in and out of the location and/or country.

4) Safety. There are significant challenges throughout the world about the safety of foreigners traveling in various locations.

5) AdvaMed/EucaMed and ACCME rules about meeting venues. Destination resorts (i.e. location at a beach) is not acceptable to some of these governing bodies. Various constraints exist as to what can and cannot be supported. This also appears to be a moving target as the rules are changing and evolving.

6) Membership density at or near the proposed location. This is a consideration but it is weighed in with all of the other criteria.

7) Cost. As a society we try to be good stewards of our limited resources. A variety of contract factors play in to this such as paying or not paying for meeting space (such as hotel space or convention center meeting space), hotel costs, travel costs, and meeting support costs.

8) Ease of making the details of the meeting work. Some locations have been easy and reliable, others have been profoundly challenging.

Currently for 2020, we are looking at North American venues for the Annual Meeting, to include Phoenix, AZ; Seattle, WA; Denver, CO; and Austin, TX. For IMAST, outside North America in 2020, we are looking at Australia, New Zealand and possibly Chile. These choices have been proposed by members and/or staff and discussed among the Long Range Planning Committee. There have been several great submissions/proposals by members. In some cases dates were not available. In others there were not adequate physical facilities. Site visits are done by myself and Tressa Goulding. Our recommendations are then made to the Board of Directors, along with projected costs. All of these factors are considered and a final decision is made by the Board and contracts initiated and then signed.

Chair: David W. Polly, Jr., MD Committee: John P. Dormans, MD; Ferran Pellisé, MD, PhD; Benny T. Dahl, MD, PhD; Kenneth MC Cheung, MD; Henry F. H. Halm, MD, and Ronald A. Lehman, Jr., MD.

Awards & Scholarships Committee Update

Jeffrey S. Kanel, MD
Awards and Scholarships Committee Chair

The Awards and Scholarships Committee is pleased to announce the winners of the 2017 SRS Traveling Fellowship. This year, three North American SRS members will join Richard E. McCarthy, MD, the Senior Traveling Fellow, on a tour across Europe, visiting fellow SRS member institutions.

Please join us in congratulating the Fellows and wishing them well during their travels in May.

The 2017 SRS Traveling Fellows are:

Samuel K. Cho, MD (USA) – Icahn School of Medicine at Mount Sinai, New York
Han Jo Kim, MD (USA) – Hospital for Special Surgery, New York
Joshua A. Pahys, MD (USA) – Shriners Hospital for Children, Philadelphia

The Fellows will be visiting:

Barcelona, Spain (May 6-10) – Ferran Pellisé, MD, PhD with Francisco Javier S. Perez-Grueso, MD
Karlsbad, Germany (May 10-13) – Michael Ruf, MD
Moscow, Russia (May 13-17) – Sergey Kolesov, MD, PhD
Neustadt, Germany (May 17-20) – Henry F.H. Halm, MD
Lyon, France (May 20-23) – Pierre Roussouly, MD with Daniel Henri Chopin, MD
Istanbul, Turkey (May 23-27) – Azmi Hamzaoglu, MD and Ahmet Alanay, MD

Follow their travels using the hashtag #SRSTravelingFellows

The Awards Committee continues to solicit applications for the SRS-Medtronic Research Fellowship and Asia-Pacific Fellowship until April 15. The next SRS Traveling Fellowship application cycle opens August 1, 2017 and closes October 1, 2017. This year, SRS members outside of North America are encouraged to apply for the SRS Traveling Fellowship.

Chair: Jeffrey S. Kanel, MD Committee: Ian J. Harding, BA, FRCS (Orth); Kan Min, MD; Ram Mudiyam, MD, MBA; Russ P. Nockels, MD; Ferran Pellisé, MD, PhD; Patrick J. Cahill, MD; Muharrem Yazici, MD; Abdul Rakib Al-Mirah, MD; Dong-Gune Chang, MD, PhD; Hamid Hassanzadeh, MD; Ajay R. Kothari, MD; Ahmed Salem Mohamed, MD; Bangping Qian, MD; Reuben CC Soh, MBBS, MMedOrth, FRCS; Michael T. Hresko, MD; Frank La Marca, MD; Surya Prakash Rao Voleti, MS, DNB; Stefan Parent, MD, PhD; Matthew E. Cunningham, MD, PhD; Hak-Sun Kim, MD; Cristina Sacramento Dominguez, MD, PhD; Burt Yaszay, MD

Globus Medical Fellowship Reports

Nelson Astur, MD
Santa Casa de São Paulo, São Paulo, Brazil
2016 Globual Medical Fellowship Award Recipient
The Hong Kong Spine Experience: A Brazilian Spine Surgeon in Hong Kong
October – November, 2016

In June this year, I was awarded a SRS Globus Medical Fellowship. I was able to spend three weeks at a spinal deformity center staffed by active SRS members. Among numerous available fellowship centers in the world, I ended up choosing the farthest place from my hometown of São Paulo, Brazil. Taking into consideration the leading role of Asia in spinal deformity surgery and innumerous high impact publications coming from this part of the world, I elected The University of Hong Kong (UHK), Hong Kong as my host center. Furthermore, the historic and current reputation of the spine team in Hong Kong was the final element to define my choice.

As scary as it could be applying for a fellowship in a country where the main language is Chinese, Hong Kong is an extremely international town and fortunately, the official language at Queen Mary Hospital and other medical facilities there is English. And although food could be a barrier, besides Western meals that are available everywhere, it was part of the whole cultural experience to try Asian routine meals, which had become really enjoyable during my stay. Thus, with all problems solved, I started my fellowship in Shenzhen, Mainland China, where I could experience the power of China in building gigantic facilities, such as the UHK Shenzhen Hospital. I had two days with Prof. Kenneth Cheung following surgery of severe spine deformities undergoing major correction, such as a lumbar kyphosis in an achondroplasic patient and severe scoliosis in an ostegenesis imperfecta patient.

With such a nice start, the following three weeks were all in Hong Kong, half of it at Queen Mary Hospital, and the other half at Duchess of Kent Children’s Hospital. My reception was very pleasant with a very competent, passionate, and extremely hard working staff directed by Dr. YW Wong and Prof. Keith Luk. Whenever I had a question, all efforts were done to answer it. Feeling like a member of the group, I was exposed to ward visits, clinics, inpatient care, staff meetings, preoperative meetings, and surgeries, surgeries, surgeries. Cases presented and operated in such a short-period fellowship were very rich and interesting. Pediatric and adult deformity, oncology spine, revision surgery, cervical spine, infection, and degenerative cases were all taken care of; feeling like there was no space for simple disc herniations. It was a very good opportunity to improve skills in decision-making and operative techniques, such as osteotomies, vertebral resection, laminoplasties, pelvic fixation and so on.

As it could not get any better, lucky me, the 7^th SRS Spine Deformity Solutions: A Hands-On Course took place in Hong Kong during my time there, and as a fellow, I was invited to attend as a participant and also help in monitoring. An amazing opportunity to learn with SRS’s leaders such as Dr. Lawrence Lenke, Dr. Munish Gupta, Dr. Christopher Ames, Dr. Ahmet Alanay, Dr. Kuniyoshi Abumi, and many others.

Other than busy three hard working weeks, Hong Kong turned out to be a very pleasant city, with a busy and vibrant downtown, balanced by nice neighborhoods and beaches surrounded by rich nature and fresh sea breeze. Tourism is always an option too there, which made my weekends fully enjoyable. Finally, thank you to SRS and HKU, especially Prof. Ken Cheung, for providing a great experience in spine care, which I will certainly apply in my routine practice in São Paulo, Brazil.

Rajat Mahajan, MD
Indian Spinal Injuries Centre, New Delhi, India
2016 Globus Medical Fellowship Award Recipient

I was happy and thrilled when I got the news about my fellowship from the SRS office. I was happy that I would be able to work with the likes of Prof. Kenneth Cheung, Dr. Wong, and Prof. Keith Luk and learn from them. Moreover the Queen Mary Hospital has been a legacy to one of the best and finest spine surgeons of the world.

I arrived in Hong Kong on January 8, 2017. My fellowship duration was for three weeks. I took one day to rest and was on to my work the next day. My work involved observing spine surgeries in two hospitals, Queen Mary hospital and Duchess of Kent Children’s hospital. I stayed in a hotel, which was not far away from the hospital. All my travel, accommodations, and meal expenses were covered through the fellowship.

On my first day, I met Dr. Paul who is a young dynamic spine surgeon. I found Dr. Paul to be a very well informed, amicable, and an unpretentious person. I learned a lot from him especially examining scoliosis patients, distal radius and ulna classification to assess maturity, ITB pump, and other fine tricks of clinical examination. I had an opportunity to work with Prof. Keith Luk, Dr. Wong and Prof. Cheung. I had an opportunity to observe transarticular C1C2 fixation with Prof. Keith Luk, which was new for me. I had an opportunity to attend grand rounds and was impressed with the academic discussion that followed on rounds. I was also mesmerized with the emphasis on the research in the hospital. I had an opportunity to work in the Outpatient Department with Dr. Wong. He is a great teacher and a fine human being. He taught me the conservative aspects of spine surgery and strengthened my belief that not all spine ailments require surgery. I also had an opportunity to observe one AIS correction with him in the OR.

Prof. Cheung, being the chief of the department of spine and orthopaedics, still took time to greet me and introduce me to the other members of the department. I had never thought that in my young age as a spine surgeon, I would be working with the SRS President. It was a dream come true for me when he asked me to join him in a Shilla deformity corrective procedure for early onset scoliosis. On the weekend, I went to see the tourist spots in the city and enjoyed the flavors of Hong Kong. I took my flight back home on January 27. It was a very memorable trip in my career. I would like to thank Scoliosis Research Society for giving me this opportunity to be one of the proud fellowship winners.

Ethics Corner

B. Stevens Richards, III, MD
Ethics Committee Member

The committee publishes in each issue of the newsletter a case of possible ethical or professionalism dilemma and invites members to send their comments. Please send your comments to info@srs.org. The committee will collect all responses, summarize and publish them in the subsequent newsletter.

Here is a rare scenario, fortunately.

Dr. Smith works in an academic environment and had a 16 year old female patient with spinal deformity needing surgical correction. He met with the family preoperatively explaining the surgery, including the potential complications. The operative consent signed by the parent listed him as the primary surgeon along with “associates, technical assistants, and other health care providers”. The family met Dr. Smith’s trainee assistant the day before surgery.

During the operation, the intraoperative neuromonitoring tracings went flat when the trainee inadvertently violated the spinal canal with a pedicle-finding trocar. All of the appropriate resuscitative measures were undertaken and, although the waves began returning after 45 minutes, Dr. Smith elected to forego the final instrumentation until a later setting. The incision was closed, and the patient was transferred to the recovery room where she was spontaneously moving her lower extremities. A future surgical procedure will be needed.

Postoperatively, Dr. Smith meets with the family explaining the problem that occurred, and then goes on to tell them that the trainee was responsible for the mistake despite Dr. Smith’s instructions to be careful, and that he (Dr. Smith) saved the day...

Questions for SRS members:

What is the appropriate manner in which Dr. Smith should have discussed this issue with the family?
The operative consent stated that others would assist in the surgery. The family was aware of that. Does that make it reasonable for the trainee to be blamed for the complication?
Along the same line, does allowing the trainee to perform some of the procedure in Dr. Smith’s name (as listed on the operative consent) make Dr. Smith the responsible individual if something goes wrong?

Please send in comments, which will be archived and published in this “Ethics corner” June 2017 issue

Early responses:

1. This is excellent. Ultimately, the attending surgeon is responsible for a trainee's actions. I don't know if it's different now and/or the same everywhere, but in Ohio, a patient traditionally could not take legal action against a resident without naming the supervising attending physician as a defendant as well. Two points:

A. As mentioned, the attending surgeon determines an appropriate level of responsibility for a trainee. If the trainee is largely responsible for a mistake, it still falls on the surgeon to realize this was either very bad luck, insufficient guidance, or inappropriate delegation of responsibility. No matter which, the attending surgeon ultimately is responsible for the mistake having occurred. The buck stops with the attending surgeon.

B. In this scenario, making yourself look better at the expense of a trainee will likely irreparably affect the care the trainee can provide the family on behalf of the attending surgeon. This is unprofessional behavior. When discussing complications, the tone should be as neutral and non-inflammatory as possible. It should focus on dealing with the complication, not assigning blame.

2. A common scenario of who is responsible for each action. While I typically use “we”, when questioned by patient or family as to actual occurrence, we must be honest. However, the scenario presented should lead to our thoughtfulness of how we discuss and present to our patient’s information. Being the “hero”, does not help. Also, being present in the room and scrubbed, can be highlighted.

Chair: Kamal N. Ibrahim Committee: John P. Lubicky, Hilali Noordeen, Brent D. Adams (C), Jason Bernard (C), Ryan D. Muchow (C), Timothy S. Oswald, James M. Eule, Timothy A. Garvey, H. Robert Tuten, B. Stephens Richards III, Jochen P. Son-Hing, MD, FRCSC

Coding Corner: The Utility of RVU Calculators

John Asghar, MD
Coding Committee Member

For some time, relative value units (RVUs) have been the key way to measure medical practice productivity. RVUs are a marker created by the Centers for Medicare and Medicaid Services to measure the productivity of physicians.

An RVU is tabulated for CPT codes by calculating things like the time it takes for an office visit or procedure and the technical skill and training needed to perform a service. Geographical differences are also taken into account.

The Work RVU (wRVU) is a component of the total RVU and is a specific and systematic measure of physician productivity. wRVUs certainly are not perfect, but are commonly used to create compensation packages for physicians and negotiating managed care contracts.

Given the complexities of coding for spinal deformity surgery, the wRVU can be a nebulous set of numbers that are magically assimilated by a practice manager and difficult to obtain on your own. However, the American Association for Physician Coders (AAPC) has developed a wRVU calculator that allows you to input your CPT codes and generate an approximate wRVUs for your surgical cases. Though it is an excellent tool for helping to understand your wRVU productivity, certain caveats do exist. It does not take into account wRVU changes attributed to modifiers, nor does it account for geographical as well as other variations.

American Association for Professional Coders: https://www.aapc.com/practice-management/rvu-calculator.aspx

Chair: Mathew D. Hepler, MD Committee: Shay Bess, MD; Jahangir K. Asghar, MD; Judson W. Karlen; MD; Barton L. Sachs, MD, MBA, CPE; Michael S. Chang, MD; Walaa Elassuity, MD; R. Dale Blasier, MD; Richard J. Haynes, MD

Research Grants

Patrick T. Cahill, MD
Research Grants Committee Chair

The Research Grants Committee continues the activities of reviewing grant applications and awarding grants. The committee also continues to strengthen its monitoring of past grant awards to ensure that the Society maximizes its return on investments in research grants.

During the fall grant application cycle, the committee reviewed 18 grants. Committee members were divided into five groups, the groupings based on the members’ self-ranked expertise in specific areas of knowledge. We expanded the usage of outside experts to assist in the review process. Four non-member scientists with expertise in genetics, biomechanical engineering, and animal level research augmented the review process. A leader was assigned to each group. Each group evaluated 7-8 grants that loosely coincided with the group’s expertise. Each member assigned a ranking from 1-5, and the grant applications rankings were assigned an average score. All grant application scores from all five teams were posted to all members. A conference call of the group leaders was carried out to decide the final ranking.

Four grants were awarded totaling $150,000. The awarded grants were:

Title of Project	Pr. Inv/Co Inv.	Type of Grant	Amt. Approved
Alveolar Recovery After Posterior Spinal Fusion	Brian Varisco	SI	$50,000.00
Functional role of gene variants in adolescent idiopathic scoliosis	Florina Moldovan	Globus - SRS SI	$50,000.00
The Spinal Balance Score: A novel linear and unidimensional patient-reported outcome measure for adult spinal deformity	Dominique Rothenfluh	Zimmer Biomet - SRS SI	$25,000.00
Identification of genes causing idiopathic-type scoliosis in the medaka model	Kristen Gorman	NI	$25,000.00

The committee wishes to acknowledge Zimmer Biomet, Inc. and Globus Spine, Inc. for their generous donations to make these exciting projects a reality.

Chair-elect Leah Carreon MD, MSc, administered the outcomes subcommittee. This group reviews reports on previously awarded grants to ensure that the work is being performed. They make annual determinations on the quality and completeness of each grant awarded prior to the SRS dispersing additional funds. The committee has reviewed 18 reports during the recent months.

The committee has selected five previous grant awardees to present their work in a more in-depth format during the Research Grants Lunchtime Symposium during the Annual Meeting & Course in Philadelphia in September.

Chair: Patrick T. Cahill, MD Committee: Michael Rosner, MD; Siavash S. Haghighi, DVM, PhD; James S. Harrop, MD; Seyed Mir Mostafa Sadat, MD; Maxwell Boakye, MD, MPH, MBA, FACS; Jason PY Cheung, MBBS (HK); Calvin C. Kuo, MD; Charles Gerald T Ledonio, MD; Joshua Murphy, MD; Chris J. Neal, MD; Saba Pasha, MD; Themistocles S. Protopsaltis, MD; Huiren Tao, MD, PhD; Feng Zhu, MD; David F. Antezana, MD; Leah Y. Carreon, MD, MSc; Morio Matsumoto, MD; Vikas V. Patel, MD; Ivan Cheng, MD; Marcel F. Dvorak, MD, FRCSC; Frank LaMarca, MD; Luis E. Munhoz da Rocha, MD; Virginie Lafage, PhD; Jwalant S. Mehta, FRCS(Orth); Robert A. Morgan, MD; Jianxiong Shen, MD

E-Text Committee Update

Amer F. Samdani, MD
E-Text Committee Chair

The E-Text Committee is continuing to review, revise, and update the existing E-Text chapters on the website. Currently, 14 chapters are undergoing revision in an effort to keep the information fresh and up to date. Two new chapters are being added: “Risk Stratification for Adult Deformity” and “Genetic Prognostic Testing in Adolescent Idiopathic Scoliosis.”

The E-Text and Website Committees are together undertaking the task of improving the appearance and functionality of the E-Text for mobile devices. In addition, we feel that the E-Text is a valuable resource and have offered this resource to several other societies, who may add a link to the E-Text from their websites.

Our current staff liaison is Kathy Blanke, and I would encourage anyone who has any suggestions for improving the E-Text experience to mention them to me or Kathy. Thank you!

Chair: Amer F. Samdani, MD Committee: Past Chair John C. France, MD; Sanjeev Suratwala, MD; Chee Kidd Chiu, MBBS; Arvindera Ghag, Andrea Piazzolla, MD; Carlos Eduardo Barsotti, MD; Mohammed M. Mossaad, MD; Teresa Bas, MD

Global Outreach: Outreach is Calling, No Need for Stalling

Ferran Pellisé, MD, PhD
Global Outreach Committee Chair

The Global Outreach Committee has worked hard to accomplish the committee charges and develop its main priorities: outlining a GOP Road-Map, creating a new online GOP database and draft a GOP paper describing one year of activity at SRS GOP sites.

Our website has been recently updated and new educational material is available. The FOCOS Hospital halo-gravity traction (HGT) system video is now accessible online. The video is an excellent opportunity to learn how to build HGT-walker and wheelchair frames.

The new, simple, practical, M&M compatible, online GOP database is being piloted and will be accessible in the next few weeks. This “basic” database will replace trip reports and become the prospective registry of SRS GOP activity. The web form is accessible to any SRS member to use but entry is required of all GOP sites. Raw data reports can be requested from the SRS office.

The GOP Road Map was revealed in the September 2016 Newsletter where we discussed three site categories based on infrastructure, surgical activity and reporting. Educational SRS endorsement shall be increased for sites continuously accomplishing reporting duties. We are pleased to announce the Awards & Scholarships Committee has voted to enact a positive bias for GOP-associated applicants when applying to award opportunities linked to Global Outreach sites.

The Global Outreach Lunchtime Symposium at the Annual Meeting & Course in Philadelphia, PA, USA, will be entitled “SRS GOP Mission Trips: How to be Effective and Safe at a Reduced Cost.” During this lunch symposium you will hear from members of the GOP Committee and representatives from GOP Endorsed Sites about tips and tools that help achieve sustainable outreach efforts. We invite you to join us for this sure-to-be interesting and enlightening hour.

We actively seek participation of all SRS members in our outreach program. Please take a look at our interactive world map that includes all our sites. We encourage you to participate in outreach activities as well as interact and network with site leaders at IMAST and the Annual Meeting. Those who seek GOP recognition for new sites may contact latonio@srs.org to be put on to the GOP Committee Meeting agenda in Philadelphia.

The GOP Committee wants to publicly thank SRS staff liaison, Lily Atonio for the superb job done all over the year providing advice, input and contributing to the development of the above mentioned committee projects.

Chair: Ferran Pellisé, MD, PhD Committee: Raphael D. Adobor, MD, PhD; Carlos A. Abreu de Aguiar, MD; Dheera Ananthakrishnan, MD, MSE; Saumyajit Basu, MD; Christopher J. Bergin, MD; Donald J. Blaskiewicz, MD; Benny T. Dahl, MD, PhD, DMSci; Phyllis d’Ambra, RN, MPA; Antonio Hurtado, MD; Seung-Jae Hyun, MD, PhD; Brice Ilharreborde, MD, PhD; Andrew G. King, MB, ChB, FRACS, FACS; Timothy P. McHenry, MD; Hani H. Mhaidli, MD, PhD; Kan Min, MD; Gregory M. Mundis, Jr., MD; Edward K. Nomoto, MD; Elias C. Papadopoulos, MD; Shoji Seki, MD, PhD; Edward P. Southern, MD; Vidyadhara Srinivasa, MS, DNB, FNB (Spine); Akin Ugras, MD; J. Michael Wattenbarger, MD; Bettye A. Wright, PA, RN

Growing Spine Committee Update

Scott J. Luhmann, MD
Growing Spine Committee Chair

The Growing Spine Committee continues to be very active. The inaugural educational webinar for SRS was on December 12 on “Casting for Early-Onset Scoliosis – Why, When and How”. Chaired by Robert P. Huang, MD (Past Chair) and James O. Sanders, MD (Chair Elect), they led a star-studded panel of spine casting experts which included Dr. Sanders, Charles E. Johnston, MD; Jacques D’Astous, MD, and Peter F. Sturm, MD. With a significant amount of help from the SRS administrative staff, it was a resounding success with over 130 internet attendees from around the globe. Kudos to all those who contributed! The webinar was extremely well-received by the attendees and validated this as an effective educational tool for SRS. The Growing Spine Committee is now developing additional topics for future webinars.

The Growing Spine Committee continues to work on enhancing the SRS website content and expanding the E-Text section of the growing spine (under the direction of Amer Samdani, MD, Chair of the E-Text Committee).

Since FDA approval of the MAGEC device for Early-Onset Scoliosis (EOS), spine surgeons have embraced this novel device which enables non-surgical, painless distraction of the growing spine construct without anesthesia. Unfortunately, EOS surgeons have struggled on the appropriate coding and billing for this ground-breaking device. To this end Jeffrey Cassidy, MD, is developing a survey to be distributed to the SRS members who use the MAGEC device about their coding and billing practices.

Lastly, under the direction of Christina Hardesty, MD and Dr. Huang, a white paper on “Updated Techniques and Result for Early-Onset Scoliosis” is in process. The latest information from leading experts on growing rods, VEPTR, Shilla, vertebral stapling and tether will be assembled. Submission to Spine Deformity - The Official Journal of the Scoliosis Research Society, is planned for later this spring.

Chair: Scott J. Luhmann, MD Committee: Robert P. Huang, MD; Francisco Sanchez Perez-Grueso, MD; John G. Thometz, MD; Wael Alkasem, MD; Jeffrey A. Cassidy, MD; Mazda Farshad, MD, MPH; Hyoungmin Kim, MD, PhD; Moyo C. Kruyt, MD, PhD; Hideki Murakami, MD, PhD; Rolf B. Riise, MD; Denis Sakai, MD; Shoji Seki, MD, PhD; Shiau-Tzu Tzeng, MD; Nigel J. Price, MD; Amer F. Samdani, MD; James O. Sanders, MD; Andre Luis F. Andujar, MD; Teresa Bas, MD, PhD; Jeff B. Pawelek; Peter F. Sturm, MD; Ron El-Hawary, MD; Colin Nnadi, FRCS (Orth); Eric D. Shirley, MD

Website Committee Update

Todd Milbrandt, MD
Website Committee Chair

The Website Committee is excited for the work ahead in 2017. Under the previous leadership of Ron El-Hawary, MD, we have inherited a fantastic new website. While the continual improvement of this site is the core of our charges we have many other initiatives as well.

Because the website is central to many other SRS committees, we have set up a structure so that there are liaisons to ensure good communication. Our core business is not content formation but content communication via the website and other venues. To that end, we have laid out our tasks for the year and who will be leading them. We have attempted to assign a member and a candidate member to each task. They are:

Website Data (Google Analytics)- Ron El-Hawary (M) Denis Sakai, and Calglar Yilgor
1. Investigate and report on the new website design.
2. Explore a manuscript comparing old and new.
3. Improve the ranking of the website.
Website Update/Maintenance- Kathy Blanke, Ahmad Nassr (M), and Josh Pahys (C)
1. The website will be edited and the information kept contemporary.
Social Media Task Force- Lloyd Hey (M) Denis Sakai (C)
1. This group will be creating content for Twitter and Facebook.
2. We would also like to propose a Lunchtime Symposium for Annual Meeting 2018.
3. “Leveraging Social Media to Improve your Practice”.
E-Text- Sumeet Garg (M) Josh Pahys (C)
1. This group has been working closely with the E-Text committee to improve the look and feel of the E-Text.
2. We will then use Google Analytics for E-text vs ibook.
Patient Education- Kevin Neal (M) Kirk Owens (C)
1. Working with the education committee, we are working on the previous efforts to have SRS members videotape answers to FAQ that we have on the website.
2. This will continue in 2017 annual meeting in Philadelphia.
SRS Surgical Video Theater- Todd Milbrandt (M) Harold Von Bosse (M) Edmund Choi (C)
1. This group is exploring how to display the videos on the website.
2. Examples from other societies (POSNA), and vumedi will be investigated.
Webinars-Task to be addressed by separate task force outside of website committee.

Chair: Todd Milbrandt, MD Committee: Ron El-Hawary, MD; Michael S. Roh, MD; Anthony A. Scaduto, MD; Edmund Choi, MD; Haruki Funao, MD; Sumeet Garg, MD; Toshiaki Kotani, MD, PhD; Roger K. Owens, II, MD; Joshua Pahys, MD; Gabriel Piza Vallespir, MD, PhD; Caglar Yilgor, MD; Kevin M. Neal, MD; Praveen V. Mummaneni, MD; Timothy R. Kuklo, MD, JD; Ahmad Nassr, MD; David H. Clements, III, MD; Amer Samdani, MD; George H. Thompson, MD; Peter D. Angevine, MD, MPH; Lloyd A. Hey, MD; Robert P. Huang, MD; Harold J.P. Van Bosse, MD

Safety & Values Committee Update

Rajiv Sethi, MD
Safety and Value Committee Chair

The Safety and Value Committee has had a productive year thus far. The Committee was involved with the planning and execution of the Pre-Meeting Course in Prague focused on the topic of risk stratification. This course tied together international, pediatric, and adult themes in the field of risk stratification and was well received.

There will also be a section of an issue of the Journal of Spine Deformity devoted to this topic in the near future. Dr. Sethi and Dr. Lonstein will be contacting experts in specific topic areas in the arena of risk stratification.

This committee is also working closely with the chairs of the Spine Safety Summit which held its annual meeting in New York City on February 10, 2017. Prior to the meeting there was a mixing of study groups on February 9 on the topics of infection prevention, dashboards and risk severity scores, where pediatric and adult study group members worked together to enhance forward progress. This meeting also allowed cross pollination between multiple SRS committees and members on the subject of safety in spine surgery.

Members of this committee are involved with important international efforts in enhancing spine safety. Recently, the Association of Spine Surgeons of India asked for Safety and Risk Stratification to be main the theme of the SRS Worldwide Course there in January 2017. This was an extremely well attended meeting with 300 surgeons. The meeting agenda was arrived upon after performing a needs assessment of local needs and the meeting was tailored to the local surgeons.

Finally, several members of this committee are involved with efforts to work with other societies including AAOS, POSNA and AANS and prepare educational publications that enhance safety and performance improvement.

Chair: Rajiv Sethi, MD Committee: Suken A. Shah, MD; John R. Dimar, II, MD; Mark A. Erickson, MD; Terry D. Amaral, MD; Nicholas D. Fletcher, MD; G. Ying Li, MD; Kris Radcliff, MD; Khoi D. Than, MD; Michael G. Vitale, MD, MPH; David S. Marks, FRCS; Matthew F. Halsey, MD; XueSong Zhang, MD

Communications Committee Update

John P. Lubicky, MD
Communications Committee Chair

Past issues of the SRS Newsletter are archived on the website for members to access as they wish. The newsletter’s purpose is to disseminate information about SRS activities and to present opportunities for involvement in order to increase engagement in society activities through the committee and council reports.

The newsletter also makes announcements concerning upcoming meetings as well as a Pat-on-the-Back and Obituary sections when indicated. The newsletter has reached out to SRS global partners for news of their events as well, though the response has been poor. The committee liaison, however, will continue this effort.

Committees or councils can, however, submit reports anytime if important or pressing issues arise. The newsletter has also initiated designated “Hot Topics” to draw the readers’ attention to particularly interesting or crucial reports in each issue. Because ethical issues in medicine and more specifically in spine surgery have become hot button issues, the newsletter is including an Ethics Committee section, Ethics Corner, in each issue that is designed to encourage audience response to ethical questions. The newsletter is also highlighting upcoming courses and meetings that would be of interest to members.

The committee was asked to identify and/or develop articles or items for designated SRS pages in each issue Spine Deformity - The Official Journal of the Scoliosis Research Society. Initial communications with the editor, John Lonstein, MD, indicated that such articles should be of research or educational nature. This will be pursued by the committee chair by soliciting short articles on topical subjects.

Chair: John P. Lubicky Committee: William F. Lavelle, MD; Vikas V. Varma, MD; Nelson R. Carvalho, MD; Abdul Malik Mohd Hussein, MBBS, FRCS; Justin S. Smith, MD, PhD; Vidyadhara Srinivasa, MS, DNB, FNB (Spine); Paul Celestre, MD