President's Message

Todd J. Albert, MD
SRS President 2017-2018

The start of 2018 has been a busy time for the SRS, ending a strong 2017 with educational, research, and advocacy activities. We had an excellent course chair training that was held in New York at Hospital for Special Surgery in December led by our educational consultant, Joe Green, as well as past president and Education Task Force chair, Ken Cheung. There was tremendous involvement from both international and regional representatives who are course chairs for the upcoming year. Ken will highlight this in his column.

I would like to make the entire membership aware of an important initiative that the SRS is supporting along with many of our industry partners. The Adult Symptomatic Lumbar Scoliosis II is an extension of the National Institute of Health (NIH) funded study led by Keith Bridwell and others to compare operative to non-operative treatment for adult symptomatic lumbar scoliosis. This important study is continuing to gain follow up in the longer term from originally enrolled patients. The SRS has taken this on in conjunction with the ISSG, who will be acting as the contract research organization (CRO), and important industry supporters to continue the study to gain insight and results appropriate for our patients to gain answers in this important and increasingly prevalent disease state.

We want to especially acknowledge our industry core supporters, Globus Medical, K2M, Medtronic, NuVasive, and Zimmer Biomet who have generously stepped up to help continue to fund this study. It will be the highest level randomized prospective study with excellent data collection to be able to perform cost utility and cost effectiveness analysis and to be able to answer questions for our membership, our patients and the payers as to the efficacy of intervention for adult symptomatic lumbar scoliosis. We appreciate the help of our partners and our members who have spent many hours working on the study and will continue to work hard in this partnership to gain the answers we need.

Abstract submissions have closed, and many of our members were busy at work completing their submissions. We had an impressive year, with 1,617 submissions for IMAST and the Annual Meeting. Our program committees for Annual Meeting and IMAST have just gotten together on March 6 to go through the grading and to start to create an excellent program for both IMAST in Los Angeles, CA, USA and our Annual Meeting in Bologna, Italy.

The IMAST meeting in Los Angeles is expected to be superb, celebrating its 25^th Anniversary with significant special programming highlighting this important event. I encourage you to attend to enjoy this excellent city and the outstanding program being put together by Ron Lehman, Henry Halm, and their committee members. We are looking forward not only to the program but involvement of the past IMAST chairs as well as a historical display in the exhibit hall.

I hope all of you had a joyful holiday season, and 2018 is off to an excellent start. I look forward to seeing you at our upcoming meetings.

Ethics Corner

Ioannis Avramis, MD
Ethics & Professionalism Committee Member

In this issue’s letter from the ethics committee we wanted to try something new. We are going to present a fictitious case based on elements of real cases with ethical dilemmas. There will be a few multiple choice questions within the article. The response to these questions will be in the form of an electronic survey, please click on the "Done" button at the end of the article to register your responses. We hope to post the results in the next SRS Newsletter issue.

Create your own user feedback survey

Chair: Kamal N. Ibrahim Committee: Timothy S. Oswald; Ioannis Avramis (C); Eric J. Belin (C); Abdul M. Mohd Hussein (C); James M. Eule; Timothy A. Garvey; H. Robert Tuten; B. Stephens Richards III, Chair Elect; Jochen P. Son-Hing; Jacob M. Buchowski; David A. Hanscom

Historian Corner

George H. Thompson, MD
SRS Historian

This year, we celebrate the 25^th International Meeting on Advanced Spine Techniques (IMAST). Originally named the American-European Meeting on Pedicle Fixation of the Spine & Other Advanced Techniques, the first meeting was held July 1-2, 1994 in Munich, Germany.

IMAST was, in part, created in response to the pedicle screw litigation of the 1990s. The first meeting was held to teach attendees spine surgery techniques that could not be taught in the US due to the FDA restrictions during the litigation. Prior to the establishment of IMAST, there was an SRS-NASS Pedicle Screw Fixation Course, however, NASS elected not to be a part of IMAST. IMAST has grown to be an important component of the SRS educational program.

Did you know?
There have only been six IMAST Chairs:

1. Randal Betz
2. Lawrence Lenke
3. Todd Albert
4. Christopher Shaffrey
5. Ronald Lehman
6. Henry Halm

 

Chair: George H. Thompson Committee: Behrooz A. Akbarnia, Past Chair; Jay Shapiro; David B. Bumpass (C); Pooria Hosseini (C); Ahmed S. Mohamed (C); Hani H. Mhaidli; Andrew G. King; Acke Ohlin (E); Patricia N. Kostial (A)

Education Task Force Update

Kenneth MC Cheung, MD
Education Task Force Chair

The role of the Education Task Force is to help formulate a plan to enhance the education programs within SRS with reference to the latest adult learning principles.

As I reported in my presidential address in September in Philadelphia, we have developed our own deformity curriculum, our own brand with the Current Concepts Courses and we continue to reach a global audience by rotating our Current Concepts Courses and Hands-On Courses around the world. The next course will be held 12-14 April 2018 in Bordeaux, France. The course chairs and co-chairs Ibrahim Obeid, Kariman Abelin Genevois and Martin Repko have put together and outstanding program taking into account regional needs, please go to http://www.srs.org/ccsd0418 for more information.

Between 8-9 December 2017, a Chairs Training Course was organized for SRS educational leaders, course chairs, and prospective course chairs. We invited Dr. Joe Green, an experienced consultant in medical education to lead the course. During the meeting, concepts including Needs Assessment, Educational Design, and Role of the Chair were discussed with time given for each of the prospective chairs to reflect on how this new-found knowledge would impact on the way they organize their respective course. Overall, it was felt that the course provided some great ideas for improvement, there was general enthusiasm to make changes to the way we organize meetings, and a feeling that more of such courses need to be organized in future.

All of our future meetings will be influenced, so do look out for changes in our upcoming meetings and courses.

Chair Training Course Attendees

 

Chair: Kenneth MC Cheung Committee: Laurel C. Blakemore; Marinus de Kleuver; John R. Dimar; Lawrence L. Haver; Praveen Mummaneni; Luis Munhoz da Rocha; Rajiv K. Sethi; Daniel J. Sucato; Muharrem Yazici

Global Outreach Committee Update

J. Michael Wattenbarger, MD
Global Outreach Committee Chair

Members of the Global Outreach committee met at the Annual Meeting in Philadelphia. A large amount of the discussion centered around the role of the SRS in acting as a clearing house for spinal implants for developing world countries. After much discussion, it was concluded by the committee that procuring spinal implants for mission trips was up to the individual site sponsors and was outside the scope of the Global Outreach Committee and SRS. Committee member Dheera Ananthakrishnan has established a non-profit organization, Orthopaedic Link, to mobilize idle implant inventory from companies to qualified surgeons in the developing world. Their website (www.orthopaediclink.org) has more information on their mission and process.

At this year's Annual Meeting in Italy, members of the Global Outreach committee will be supporting Chairs Rajiv Sethi and Ahmet Alanay in a half day course entitled “New Paradigms in Global Complex Spine Care: What Can We Learn for Each Other?”

Any SRS member interested in volunteering for a global outreach mission is encouraged to visit the global outreach website and contact the site sponsor.

 

Chair: J. Michael Wattenbarger Committee: Ferran Pellisé, Past Chair; Andrew G. King; Elias C. Papadopoulos; Edward P. Southern; Vidyadhara Srinivasa; Theodore A. Belanger (C); Paul C. Celestre (C); Wing-Yee M. Chin-Ng (A); Michael J. Faloon (C); Najma Farooq (C); Pawel Grabala (C); D. Kojo Hamilton (C); Michael J. Hartman (C); Deniz Konya (C); Scott C. Nelson (C); Ripul R. Panchal (C); Ricardo A. Santos (C); Benny T. Dahl, WWC; Christopher J. Bergin; Hani H Mhadidli; Kan Min; Brian Hsu; Martin Repko; Gregory R. White; Dheera Ananthakrishnan, Orthopaedic Link Liason; Bettye A. Wright (E), Ex Oficio

Research Grants Committee Update

Leah Y. Carreon, MD, MSc
Research Grants Committee Chair

Grants awarded in the fall 2017 cycle:

Title	Primary Investigator	Total	Grant Type
Minimize Implants Maximize Outcomes Clinical Trial	A. Noelle Larson, MD	$47,824.00	Standard Investigator
Using Ultrasound and Health’ Records to Non-Invasively Identify Cases with Curve Progression or not in Children with AIS	Edmond Lou, PhD, PEng	$50,000.00	SRS-NuVasive Standard Investigator
Effect of Controlled Dynamic Spine Distraction on Intervertebral Disc, Growth Plates, Bone Quality and Spine Stiffness; An in Vivo Study on a Rodent Model	Pooria Salari, MD	$25,000.00	New Investigator
Prediction of curve progression in idiopathic scoliosis without treatment	Stefano Negrini, MD	$50,000.00	SRS-K2M Standard Investigator
Developing a 3D Marker Based Method for Assessing Pulmonary Function in Idiopathic Scoliosis	Kristen Nicholson	$25,000.00	New Investigator

Total approved funding: $97,824.00

During the most recent review cycle, a new review scoring and comment process was implemented. While there were some technical issues that occurred (and are being resolved), the new process provided a more even scoring pattern and more detailed comments on each application.

The upcoming application cycle (February 1-April 1) will use the modified application categories. Additionally, an agreement is in negotiation with the Cotrel Foundation to offer a basic science grant during the fall cycle.

 

Chair: Leah Y. Carreon Committee: Patrick T. Cahill, Past Chair; David F. Antezana; Morio Matsumoto; Vikas V. Patel; Dong-Gune Chang (C); Diana A. Glaser (C); Alexander P. Hughes (C); Charles G.T. Ledonio (C); Jean-Christophe A. Leveque (C); Michelle C. Marks (C); Dominique A. Rothenfluh (C); Hui-Ren Tao (C); Khoi D. Than (C); Feng Zhu (C); Ivan Cheng, Chair Elect; Marcel F. Dvorak; Frank LaMarca; Luis E. Munhoz da Rocha; Virginie Lafage; Jwalant S. Mehta; Robert A. Morgan; Jianxiong Shen; Shay Bess; Theodore J. Choma; James S. Harrop; Lukas P. Zebala; J. Abbott Byrd, Treasurer, Ex Oficio

Safety & Value Committee Update

Michael G. Vitale, MD, MPH
Safety & Value Committee Chair

The Safety and Value Committee continues to have a productive year. Committee Members are working on an invited, “state of the art,” review on safety in deformity surgery, to be published in the Spine Deformity Journal this spring.

On the educational front, the Safety & Value Committee will host a joint webinar with POSNA focusing on specific ways and examples through which we can improve the value of spine deformity care. The webinar is tentatively scheduled for June 12, with the following preliminary program.

• What is value, how is it measured, and why does it matter? - James Sanders, MD
• Improving value through team performance - CUSP - Michael Vitale, MD, MPH and Lisa McCloud
• Using lean process to improve AIS care value - Matthew Oetgen, MD
• Teams and lean to improve high cost OR throughput - John Flynn, MD
• Decreasing blood loss and the value proposition - Suken Shah, MD
• Standard work and minimizing cost in complex patients - Nicholas Fletcher, MD
• Improving value in adult spine care - Rajiv Sethi, MD

The committee has also finalized a list of core elements which we feel are important to optimize the quality safety and value of what we do, which includes:

1. Participation in local, regional or societal quality and safety committee.
2. Participation in a course or webinar relevant to spine safety.
3. Use of some risk severity score for spine
4. Use of preoperative interdisciplinary indications conferences
5. Use of standardized intraoperative checklist
6. Use of standardized care pathways

Committee members are now exploring ways to bring this list to the attention of SRS members. The next steps for this project will be to develop specific examples in each of the categories on the list. Committee members are also in talks with both malpractice carriers and payors on ways in which we can partner towards the common goal of improving quality, safety and value in spine deformity care.

 

Chair: Michael G. Vitale Committee: Rajiv Sethi, Past Chair; David S. Marks; Wael Alkasem (C); Brian K. Brighton (C); Fabio Ferri-de-Barros (C); Frank T. Gerow (C); Michael P. Glotzbecker (C); Yazeed Gussous (C); Michael J. Heffernan (C); Robert S. Lee (C); Addisu Mesfin (C); Robert F. Murphy (C); Rolf B. Riise (C); Matthew F. Halsey, Chair Elect; XueSong Zhang; Ahmet Alanay; Lloyd A. Hey

Coding Committee Update

R. Dale Blasier, MD, FRCS(C), MBA
Coding Committee Advisory Member

Complications of Spine Surgery in ICD-10

The ICD-10 tabular list of codes offers great granularity and variety in the description of complications which may occur associated with spinal surgery. The ICD-10 codes were initially developed for epidemiology but now have developed into a major mechanism for documenting medical necessity for medical or surgical treatment. Payers routinely consider ICD-10 codes in determining payment decisions for treatment of post-op complications.

Complication codes fall into several categories, these include:

• Generic complications of any surgery
• Complications after musculoskeletal procedures
• Intraoperative and post procedural complications and disorders of musculoskeletal system
• Intraoperative and postprocedural complications and disorders of nervous system
• Other surgical complications

It is worthwhile to look at these complications, and where they reside within the ICD-10 codeset.

Generic complications of any surgery during or after a procedure are listed in T81-T86.

Because these are listed in the T-section – these are considered injuries and require a 7^th digit (usually “A”). The seventh digit “A” should be appended if the complication is under active treatment. The seventh digit “B” should be appended if the complication is healing routinely. The seventh digit “S” should be appended indicating a sequela or late effect of a complication. These complications include:

• Shock T81.1
• Disruption of external surgical wound T81.31X (i.e. dehiscence of skin)
• Disruption of internal surgical wound T81.32X (i.e. dehiscence of fascia)
• Infection T81.4XX. This covers a wide variety of possibilities:
  • Intra-abdominal abscess following a procedure
  • Postprocedural infection, not elsewhere classified
  • Sepsis following a procedure
  • Stitch abscess following a procedure
  • Subphrenic abscess following a procedure
• Wound abscess following a procedure
• Retained foreign body T81.500 (i.e. instrument, sponge, unattached implant)
• Vascular injury T81.7
• Breakdown (mechanical) of internal fixation device of vertebrae T84.216
• Breakdown (mechanical) of internal fixation device of other bones T84.218
• Breakdown (mechanical) of other internal orthopedic devices, implants and grafts T84.418
• Displacement of other internal orthopedic devices, implants and grafts T84.42
• Infection and inflammatory reaction due to internal fixation device of spine T84.63 
• Complications of bone graft T86.83. There are several possibilities:
  • T86.830 Bone graft rejection
  • T86.831 Bone graft failure
  • T86.832 Bone graft infection (Use an additional code to specify type of infection)
• Infection and inflammatory reaction due to other internal orthopedic prosthetic devices, implants and grafts T84.7
• Pain due to internal orthopedic prosthetic devices, implants and grafts T84.84

Complications after musculoskeletal procedure M96.0 – M96.6

These probably should be labelled “complications after spine treatment”, but they are not. These are listed in the M chapter and are considered diseases and do not require a seven digit. These include:

• Pseudarthrosis after fusion or arthrodesis M96.0
• Post laminectomy syndrome M96.1
• Post radiation kyphosis M96.2
• Post laminectomy kyphosis M96.3
• Postsurgical lordosis M96.4
• Post radiation scoliosis M96.5
• Fracture of bone following insertion of orthopedic implant, prosthesis or bone plate M96.6

Intraoperative and post procedural complications and disorders of musculoskeletal system, not elsewhere classified M98.6

These complications describe injury to a musculoskeletal structure which result from a procedure which may or may not be musculoskeletal in nature.

• Intraoperative hemorrhage and hematoma of a musculoskeletal structure M96.81
• Accidental puncture and laceration of a musculoskeletal structure M96.82
• Post procedural hemorrhage of a musculoskeletal structure M96.83
• Post procedural hematoma or seroma of a musculoskeletal structure M96.84
• Postprocedural hematoma of a musculoskeletal structure following a musculoskeletal system procedure M96.840
• Postprocedural hematoma of a musculoskeletal structure following other procedure M96.841
• Postprocedural seroma of a musculoskeletal structure following other procedure M96.842

Intraoperative and postprocedural complications and disorders of nervous system, not elsewhere classified G97

These are found in the G chapter. They are considered diseases and not injuries.

• CSF leak from spinal puncture G97.0
• other reactions to spinal lumbar puncture including headache G97.1
• intraoperative hemorrhage and hematoma of a CNS structure complicating a procedure G97.3
• intraoperative hemorrhage and hematoma of a CNS structure following a CNS procedure G97.31
• intraoperative hemorrhage and hematoma of a CNS structure following other procedure G97.32
• inadvertent durotomy during a procedure G97.41
• puncture of other CNS organ during a CNS procedure G97.48
• puncture of other CNS organ during other procedure G97.49
• Postprocedural hemorrhage and hematoma of a nervous system organ or structure following a nervous system procedure G97.51
• Postprocedural hemorrhage and hematoma of a nervous system organ or structure following other procedure G97.52
• Other intraoperative procedural complications of the nervous system G97.81
• Other postprocedural complications of the nervous system G97.81

Other surgical complications:

• Acute blood loss anemia D62
• Ileus K56.7
• Acute embolism and thrombosis of unspecified deep veins of lower extremity (specific to involved vein) I82.40 (i.e. VTE. Codes differ according to which vein is involved)
• Urinary retention R33.9

There is a wide variety of conditions described in ICD-10 which can be used to document post-op complications of spine surgery. They are not all described in this article. Often the language used to describe these conditions is not obvious, so it is hoped that exposure to the language of the conditions in this article will aid in the search for the correct ICD-10 code.

To access past Coding Corner articles in our Members' Only section of the website, please click here.

 

Chair: Barton L. Sachs Committee: Mathew D. Hepler, Past Chair, Advisory; William K. Koeck (C); Kathryn McCarthy Mullooly (C); Matthew E. Oetgen (C); Michael S. Chang; Walaa Elassuity; R. Dale Blasier, Advisory; John Frino

Growing Spine Committee Update

James O. Sanders, MD
Growing Spine Committee Chair

The SRS Growing Spine Committee has several priorities this year. Educationally, the committee has a webinar planned for June on challenges in early onset scoliosis including whether we actually help lung function, the anesthesia risk in children, and selection and challenges of the various early onset scoliosis growth friendly devices. Additionally, we are working with the E-Text Committee on updating the early onset scoliosis content and also with the Education Task Force on proper growing spine content for the Core Curriculum.

From the research side, the committee is exploring ways of using the M&M database to learn more about early onset deformity perioperative issues. The committee is beginning to find what is known and priorities for what must still be learned about early onset deformity to develop quality shared decision making tools. Finally, the committee is exploring ways to meet the SRS research mission through positive interaction with the existing growing spine study groups and registries.

 

Chair: James O. Sanders Committee: Scott J. Luhmann, Past Chair; Nigel J. Price; Amer F. Samdani; Mehmet B. Balioglu (C); David M. Farrington (C); Sumeet Garg (C); Matthew A. Halanski (C); Jan E. Klamar (C); Aroldo C. Legarreta (C); Andre L. Loyelo Barcellos (C); J. Naresh-Babu (C); Javier Pizones (C); Benjamin D. Roye (C); YingSong Wang (C); Andre Luis F. Andujar; Teresa Bas; Jeff B. Pawelek (A); Peter F. Sturm, Chair Elect; Ron El-Hawary; Colin Nnadi; Eric D. Shirley; Lawrence L. Haber; Romasz Kotwicki; William A. Phillips

Communications Committee Update

Vidyadhara Srinivasa, MS, DNB, FNB
Communications Committee Chair

Greetings! The Communications Committee has been successfully delivering the quarterly Newsletter of the SRS on time as before. The Newsletter is aimed to disseminate information about SRS activities and opportunities in order to increase engagement of all SRS members in society activities. We are working with the Website Committee in promoting the value and benefits of SRS (research, education, etc.) through the website, newsletter, and other communication avenues.

We assess and refine the committee articles schedule with input from Council and/or Committee Chairs in order to publish the appropriate number of reports from committees based on activities and coincide with activity levels during the year (i.e. timing of awards or scholarships, fellowship decisions, research grant selections, etc). We are in the process of innovating new methods of communication to global membership and worldwide patients. We are keen on re-discovering ourselves on social media such as WhatsApp, LinkedIn, etc in addition to Facebook.

 

Chair: Vidyadhara Srinivasa Committee: John P. Lubicky, Past Chair; Justin S. Smith; Nelson Carvalho (C); Christina Hardesty (C); Ajay Kothari (C); Hillard Spencer (C); James Harrop; Yan Wang, Chair Elect; Brain G. Smith, Ex Officio

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, 12 chapters are undergoing revision in an effort to keep the information fresh and up to date. Two new chapters have been completed and will be uploaded soon - “Risk Stratification for Adult Deformity” and “Genetic Prognostic Testing in Adolescent Idiopathic Scoliosis.” In addition, we are consolidating E-text content to limit the total number of chapters.

A major initiative for the committee has been to reorganize the E- text to comply with the 10 knowledge domains as defined by the Educational Task Force. We are in the final stages of this reorganization, which will serve as the platform for future SRS related educational endeavors.

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

 

Chair: Amer F. Samdani Committee: Paloma Bas Hermida (C); Hamid Hassanzadeh (C); Kristopher M. Lundine (C); Baron Zarate Kalfopulos (C); Mohammed M. Mossaad; Teresa Bas, Chair Elect; Robert K. Lark

Website Committee Update

Todd Milbrandt, MD, MS
Website Committee Chair

The website committee has been working through previous initiatives. We continue to monitor the look and feel of the new website and its impact on our readership. In addition, a manuscript is in progress documenting that change. The committee also continues to update and upgrade the current site and would encourage our members to submit problems they see with the site to me. Our social medial task force has assembled a proposal for an Annual Meeting Lunchtime Symposium which has been accepted as a Webinar for Professionals later this year. We successfully recorded more interviews with the Patient Education committee for the website and are editing these for future publication on the website. The final initiative is the SRS Surgical Video Theater. We are gathering bids for building a specific area of the website dedicated to video (both educational and surgical technique). Stay tuned for how you might be able to contribute to this exciting website enhancement!

 

Chair: Todd Milbrandt Committee: Ron El-Hawary, Past Chair; Timothy R. Kuklo; Ahmad Nassr; Alan H. Daniels (C); Christina K. Hardesty (C); Michael P. Kelly (C); A. Noelle Larson (C); Jung-Hee Lee (C); Domingo Lombao (C); Paul Park (C); Denis Sakai (C); Zeeshan M. Sardar (C); Byron F. Stephens (C); David H. Clements III, CME; Amer F. Samdani, E-Text; George H. Thompson, Historian; Sanjeev J. Suratwala, Patient Ed; Suken A. Shah, Education; Peter D. Angevine; Lloyd A. Hey; Robert P C Huang; Harold J.P. Van Bosse; Michelle S. Caird; Joshua M. Pahys, Chair Elect