President's Message

Peter O. Newton, MD
SRS President 2018-2019

Dear members of the Scoliosis Research Society,

As we come off a fabulous Annual Meeting in Bologna and work our way into the holiday season, I would like to congratulate Todd Albert for his spectacular year as SRS President. It is with great respect and humility that I begin my year of leadership for our organization. In 1966, 37 luminaries in the field began the Scoliosis Research Society focused on improving care for patients with scoliosis through research. Today we still share that desire and responsibility. We are much larger and more diverse organization, bringing great power for discovery from within our ranks.

Research, education and outreach form the basis of our mission. SRS membership continues to grow throughout the world and bring the SRS mission to more parts of the globe than ever before.

Your Presidential Line (myself, Paul Sponseller, Muharrem Yazici, and Todd Albert) along with Tressa Goulding and her staff, functions as a team with the four councils: Education Council Chair: John Dimar, Education Chair Elect: Suken Shah; Research Council: Marinus De Kleuver; Finance and Communication Council: Treasurer Abbott Byrd, Treasurer Elect Serena Hu; Governance Council: Secretary Laurel Blakemore. We have a number of goals this year and work has begun by all of our committees to enhance our educational offering, research opportunities and communication efforts. We also welcome Lawrence Haber, Ferran Pellise and Jim Sanders to the Board of Directors and give special thanks to those that rotated off our board: David Polly our past president, Mark Weidenbaum our past Secretary, Frank Schwab our past Research Council Chair as well as Directors at Large: Sigurd Berven, Douglas Burton and Hani Mhaidli. The Board clearly understands their job of setting strategy and maintaining fiduciary responsibility. Together we will strive to advance the SRS mission while ensuring we can do so for generations to come.

Mark your calendars for the two highlight programs of the SRS coming in 2019. IMAST will be held in Amsterdam, July 17-20, 2019. Henry Halm and Han Jo Kim are bringing a fresh look to the programing with specific tracks for both adult and pediatric specialists. In 2020, IMAST will be moving to Spring – more details to follow soon. The 54^th SRS Annual Meeting will be in Montreal, September 18-21, 2019. Burt Yaszay, the Education Committee Chair is arranging a variety of educational offerings including the premeeting course on “Surgeon Performance.” Firoz Miyanji and the Program Committee has restructured the abstract categories with revised paper submission requirements for the both IMAST and the Annual Meeting.  The deadline for submissions will remain February 1, 2019 both meetings this year. Please consider submitting your latest concepts to IMAST where “innovation” is the theme.

We will continue the work initiated by Ken Cheung to focus our educational platform. The Core Curriculum has been completed and we will begin the task of organizing content to create a clear and uniform approach of training in spinal deformity. This work is proceeding on several fronts and we hope to bring you fresh engaging methods to deliver educational content to both you, our members, as well as our future members.

This year will also involve a deep dive into our research programs. Marinus De Kleuver our Research Council Chair is leading a task force to critically evaluate our current strategies involving research. We invest significantly in promoting discovery in the field of spinal deformity and we hope to enhance our impact where we can. I look forward to sharing his task force’s recommendations. We will continue to fund 2 cycles of research grants per year and we are finalizing the details on a cooperative directed research grant offering with OREF and POSNA – stay tuned.

We have increased our footprint on the globe with members of our society from more than 60 countries. Communication in our global society both to patients, other healthcare providers as well as our membership is an increasing challenge. We are devoting more human resources to this effort and Yan Wang will be working with the Communication Committee this year to broaden our reach.

It is also clear that many of you work diligently every year to provide care and more importantly build sustainable systems to provide care in underserved regions of the world. This is critical work and the SRS will continue develop methods to share information and strategies to make your outreach work as productive as possible for all of you involved.

You can reach out to me or any of the SRS leadership team with ideas to enhance our mission and better our Society. Email anytime: pnewton.rady@gmail.com.The SRS functions largely due to the volunteerism of our members. If you would like to get more involved watch for the opportunity to volunteer for committee positions that will come in March 2019.

As we approach the holiday season, I thank you for your commitment to advancing care for patients with spinal deformity. Celebrate the season that brings together family and friends with joy and happiness. Please don't forget the SRS REO fund as you consider your year-end contributions. We greatly value your donations and we need your help to expand the reach of our educational material to patients and healthcare workers in all regions of the world.

Most sincerely,

Peter Newton, MD
SRS President

Obituaries

Paul D. Choi, MD
December 9, 1970 - January 26, 2018

SRS was recently informed of the untimely passing of Paul Choi, MD after a battle with lymphoma.

To read Dr. Choi's full obituary, please click here.

 

Joseph C. Flynn Sr, MD
April 29, 1924 - June 10, 2010

During the recent Annual Meeting, SRS was informed of the passing of Joseph C. Flynn, Sr., MD several years ago.

To read Dr. Flynn's full obituary, please click here.

 

Keyvan Mazda, MD, PhD
August 22, 1959 - October 3, 2018

Dear Colleagues,

It is with deep sadness that we at Robert Debré Hospital (Paris, France) wish to inform the society of the sudden passing of Professor Keyvan Mazda, Chief of Staff of orthopedic pediatric surgery, on October 3, 2018. Keyvan was an naturally gifted surgeon, charismatic yet enigmatic, his booming voice recognizable to all. Passionate about music, watches, rugby and collector's rugs, he was interested and well-versed in an impressive array of topics beyond medical expertise. He enthusiastically undertook new challenges in the field of spine surgery, be it at Robert Debré or in his ancestral home, Iran, a country he cherished and in which he invested great efforts, such as the co-foundation of  the « Chain of Hope ».

Chief of Staff at Robert Debré since 2014, Keyvan was a strong leader, fair and generous, building a devoted team around him that he protected as he would his own family. He was equally close to the teams supporting his staff, ready to listen and give help, and was truly humble (despite the impression he could give on occasion). His intellectual curiosity made him a guaranteed presence at the annual meetings, where he could meet his numerous international friends. Keyvan was very proud to be part of the SRS and to represent our country in the spine community. He was also a true innovator, as one of the first to practice in France thoracoscopy on young children, and both adopting and becoming a strong advocate of the trans-sacral rods for pelvic fixation. Keyvan's international reputation was further established when he developed sublaminar bands, following the principles of posteromedial translation technique for scoliosis correction, implants now widely adopted worldwide.

Keyvan was proud of his students and in turn his students were equally proud of him. He was deeply attached to the traditions rooted in French surgery, and devoted to his mentors Pr Bensahel (founder of EPOS), Pr Deburge, Pr Dubousset and Pr Guillaumat. He leaves us with a feeling of profound loss, and the sense that much is left to be accomplished in his memory, yet also he has bequeathed to us the lasting legacy of a truly exceptional man.

Prof. Brice Ilharreborde
Pediatric Orthopaedic Department
Robert Debré Hospital
Paris Diderot University

 

Howard H. Steel, MD
April 17, 1921 - September 5, 2018

In early September, Howard H. Steel, MD passed away. He was one of the 2017 SRS Lifetime Achievement Award winners and created the Howard H. Steel Foundation Orthopaedic Foundation, which funds lectureships for several orthpaedic conferences, including our own.

Howard Steel was born in Philadelphia and raised in Atlantic City, NJ. He received his undergraduate education at Colgate University, majoring in chemistry. Following service in the Navy during World War II, he enrolled at Temple University School of Medicine and graduated in 2-1/2 years from their accelerated program. He later earned a Ph.D. in anatomy. He undertook an orthopaedic residency with Dr. John Royal Moore at Temple University Hospital’s Department of Orthopaedics and then remained on the attending staff.

Appointed Chief of Staff at Shriners Hospitals for Children-Philadelphia in 1966, he founded the first ever pediatric spinal cord injury unit in 1980. He was one of the early members of the SRS. He founded the Eastern Orthopaedic Association in 1970 and served as president for the first two years and managing director until 1976. He was a founding member of the Pediatric Orthopaedic Society, later to become POSNA.

Dr. Steel pioneered some of the most innovative surgical treatments for their time, many still in use today. He developed the triple innominate osteotomy for acetabular dysplasia. He took a non-traditional approach to extreme lumbar kyphosis secondary to lumboperitoneal shunt in patients with myelodysplasia, treating them with a hanging gravity correction cast. His Ph.D. dissertation entitled “Anatomical and Mechanical Considerations of Traumatic Interruption of the Atlanto-Axial Articulations” led to Steel’s Rule of Thirds. He also championed resection of the rib deformity in scoliosis for bone grafting and improvement in appearance.

His hemipelvectomy without amputation for treatment of malignant tumors of the pelvis spared patients the mutilation of hindquarter amputation. A group of grateful patients who underwent hemipelvectomy formed the Howard Steel Orthopaedic Foundation in his honor. Funds from the Foundation support lectures at multiple orthopaedic associations’ annual meetings, including the EOA, WOA, POSNA, AOA, and SRS. His only qualification is that the topics of the talks are non-medical, reflecting his belief in well-rounded knowledge on other life subjects. He was a life-long daredevil and athlete, a globe-trotter, a world-renowned authority on wine of the Rhine Valley and Madeira, a musician, and a great admirer of world languages. Dr. Steel was truly a Renaissance Man.

Dr. Steel was the beloved teacher, mentor, and true friend to three generations of orthopaedic residents and fellows. They learned from his presentations but mostly by observation of the elevated standards of the excellence that he demanded of himself, the compassion he showed for his patients, and the joie de vivre that he brought to work every single day. He engendered tremendous camaraderie and loyalty amongst his students and peers and obviously loved his profession.

Dr. Steel is survived by his wife Betty Jo and their 8 children.

Ethics Corner

David Hanscom, MD
Ethics & Professionalism Committee Member

Are We All Equals?

Scenario:

Dr. Jones’s behavior has become a concern of the hospital administration at the institution in which he practices. He has been very hard on the nursing staff, both on the inpatient ward and in day-surgery. There have been several documented exchanges in which he showed disrespect to the nursing staff, berated them in a public environment, used abusive language, and behaved in a very condescending manner. In fact, several nurses had recently resigned directly linking their decision to do so to Dr. Jones’ disruptive behavior.

When spoken to, Dr. Jones felt that the biggest problems simply centered around telephone verbal orders not being carried out in a timely manner, or that he’s asked too frequently for clarification, and he expects better. What can Dr. Jones do to recognize his contribution to this problematic setting, and work to improve himself?

Discussion:

It’s not uncommon for physicians to aggressively criticize what they determine is “unacceptable behavior”, which varies dramatically from person to person and on one’s mood. We, as a profession, need to be better than this. What are some of the primary factors leading to this behavior?

One is anxiety. Our self-image is based on a “can do” and bring it on” mindset. Weakness isn’t tolerated by our mentors, peers or even our patients. We are masters of suppressing anxiety and disguising it. However, it’s presence has contributed to a burnout rate well over 50%, and increasing.

A 2009 study showed that the compassion index of pre-med students was above the national average but by the 3^rd year of medical school, it had plummeted to well below the average. (1) This is well before the rigors of residency and the demands of surgical training. We receive little training in the area of stress management skills.

Another factor is the drive to be perfectionists. Physicians often respond to this by saying, “I’m not a perfectionist. I just have high standards.” Whatever term you would like to use, we have an idealistic self-image of what we would like to accomplish and who we want to be. We work long hours, delay gratification and in many ways sacrifice much of our life to achieve our professional goals. It’s this same drive that can also create unbecoming behaviors, and burnout.

With this concept of perfectionism, physicians will be hard on themselves, and on others. In the scenario illustrated above, the nursing staff became a point of focus. (2)

A third factor contributing to abusive behavior toward others is that physicians become and remain judgmental, often labelling individuals positively or negatively. When we do so, we are at risk of losing awareness of that person’s true qualities.

Getting back to Dr. Jones’ concerns of telephone orders, when he speaks to someone harshly or berates them, he’s unconsciously internally labeled them negatively in some way. In reality, the nurse on the other end of the phone is simply trying to do his or her job.

Solutions:

Awareness of the problem is the first step. Criticism is normalized in the medical culture and it may not seem problematic. Why am I being so judgmental of others? What am I anxious about? How is becoming upset about things you have little control over affecting the quality of your day?

What is the impact of your words on others and also how you appear to them. A leader who is reactive loses effectiveness and respect. You are the highly educated professional whose reassuring demeanor can go a long way towards allowing people to feel safe and do their job more effectively. Do you want to be perceived as someone who frequently loses control of your emotions?

Understanding the neurochemical link between anxiety and anger is critical. Anxiety causes you to act in a manner to solve a problem or threat and remain safe. It’s an unconscious survival response, which is much stronger than the conscious brain. If you lose control (anxious), your body will respond with more adrenaline (anger) in an effort to regain control. Anger is anxiety with a chemical kick. Neither are subject to rational control.

Once you understand this sequence, there are many ways to decrease this chemical kick and calm down this reaction. You can train your body to be less reactive to external stimuli, and as your body experiences endogenous oxytocin, dopamine, serotonin, and GABA versus adrenaline, cortisol, and histamines, you’ll calm down. It’s not difficult and is a learned skill. The essence of the outcome is play. If you have to be at work anyway, you can remain agitated with the unpredictability of the day or you can choose to embrace the variety and have a great time.

Getting back to the phone again, one of the basic approaches to improving communication with others is to reframe your reality. You have a well-paying job, an opportunity to help people, societal respect, many interesting challenges, and comradery with many staff and colleagues. When the phone rings, you  can choose to view it as opportunity to help someone or feel bothered and hassled. How do you view the person who is calling you and helping you to do your job? It’s going to ring regardless of how you relate to it. What is your choice?

 

1. Mohammadreza Hojat, et al. “The devil is in the third year: A longitudinal study of the erosion of empathy in medical school. Acad Med (2009); 84: 1182-1191.
2. Rosenstein, Alan H., et al. "Disruptive physician behavior contributes to nursing shortage: study links bad behavior by doctors to nurses leaving the profession. (Doctors, Nurses and Disruptive Behavior)." Physician Executive, Nov.-Dec. 2002, p. 8+.

 

Chair: B. Stephens Richards, III Committee: Kamal N. Ibrahim, Past Chair (E); James M. Eule; Timothy A. Garvey; H. Robert Tuten; Christian P. DiPaola (C); Sang D. Kim (C); Olavo B. Letaif (C); Jonathan N. Sembrano (C); Paulo J. Silva Ramos (C); Bekir Y. Ucar (C); Anthony M. Petrizzo; Jochen P. Son-Hing; Jacob M. Buchowski; David A. Hanscom; Steven D. Glassman, Chair Elect; Sherif M. El Ghamry; Hee-Kit Wong

Historian Corner

George H. Thompson, MD
SRS Historian

History at a Glance
Ten years ago, in 2008, SRS celebrated the first Lifetime Achievement Award winners. The first two individuals to receive this recognition were John E. Hall, MD and Jacqueline Perry, MD. Both Dr. Hall & Dr. Perry were Founding Fellows of the SRS and made many significant contributions to the field.

To view an interview with Dr. Hall (and many other), please visit the SRS Historical Archives website, found in the Members Only section. Unfortunately, SRS was unable to obtain a video interview of Dr. Perry prior to her passing in 2013.

2018 Member Deaths
In 2018, SRS lost several members, including two Founding Fellows and Past Presidents, John E. Hall, MD and Gordon W. D. Armstrong, MD. We also lost our dear colleagues Robert M. Campbell, Jr., MD; Henry V. Crock, MD, FRCS, FRACS, DSc; John M. Gray, MD; Ernest Letourneau, MD, CCBOM, DSC; Keyvan Mazda, MD, PhD; Min Mehta, FRCS; James E. Ricciardi, MD; Howard H. Steel, MD; David B. Stevens, MD.

Is SRS looking for items to add to the archives?
YES! Here is a list of specific items that SRS is looking to add to the archives. If you have any of these, or other items that you would like to donate, please contact Ashtin in the SRS Office, aneuschaefer@srs.org.

• SRS Annual Meeting Final Programs
  • 8^th - 1973
  • 25^th – 1990
  • 47^th - 2012
• International Meeting on Advanced Spine Techniques (IMAST) Final Programs
  • 1^st- 1994
  • 2^nd- 1995
  • 6^th- 1999
  • 11^th- 2004
  • 12^th - 2005
  • 15^th - 2008
  • 19^th - 2012
  • 20^th - 2013
  • 21^st – 2014
• Copies of the SRS Newsletter

Other items of interest:

• Photographs, videotapes, audio recordings, DVDs, CDs, etc. from meetings and other SRS related events.
• SRS related scrapbooks
• Newspaper clippings regarding SRS
• Other

Am I able to visit the SRS Archives?
Absolutely! It is a wonderful opportunity SRS would love all members to experience. If you would like to set up a visit, please contact Ashtin, aneuschaefer@srs.org, and she will help you coordinate your visit with the Archives staff.

 

Chair: George H. Thompson Committee: Kshitij S. Chaudhary (C); Chrisitan P. DiPaola (C); Janez Mohar (C); Brandon A. Ramo (C); Andrew G. King; Acke Ohlin (E); Patricia N. Kostial (A); Matthew J. Mermer; Jay Shapiro, Chair Elect

2018-2019 Committee Leadership

Congratulations and a warm welcome to the following SRS members on their appointments as committee chairs for 2018-2019.

Frank F. Rand III, MD - Adult Deformity Committee
Matthew E. Cunningham, MD, PhD - Awards & Scholarships Committee
Brian Hsu, MD - Bylaws & Policies Committee
Samuel K. Cho, MD - CME Committee
Yan Wang, MD - Communications Committee
Laurel C. Blakemore, MD - Core Curriculum Task Force
Todd J. Albert, MD - Corporate Relations Committee
Rick C. Sasso, MD - Development Committee
Burt Yaszay, MD - Education Committee
Teresa Bas, MD, PhD - Education Resource Committee
Kenneth MC Cheung, MD - Education Task Force
B. Stephens Richards, MD - Ethics & Professionalism Committee
Michelle S. Caird, MD - Fellowship Committee
Ron El-Hawary, MD - Fellowship Task Force
J. Abbott Byrd III, MD - Finance Committee
J. Michael Wattenbarger, MD - Global Outreach Committee
Peter F. Sturm, MD - Growing Spine Committee
Karl E. Rathjen, MD - Health Policy Committee
George H. Thompson, MD - Historical Committee
Henry F.H. Halm, MD - IMAST Committee
Han Jo Kim, MD - IMAST Committee
Todd J. Albert, MD - Long Range Planning Committee
William F. Lavelle, MD - Morbidity & Mortality Committee
Todd J. Albert, MD - Nominating Committee
David A. Hanscom, MD - Non-Operative Management Committee
Mark C. Lee, MD - Patient Education Committee
Michael G. Vitale, MD, MPH - Pediatric Device Task Force, joint project team with POSNA
Firoz Miyanji, MD, FRCSC - Program Committee
Ivan Cheng, MD - Research Grant Committee
Marinus de Kleuver, MD, PhD - Research Task Force
Matthew F. Halsey, MD - Safety & Value Committee
Haluk Berk, MD - Translation Committee
Joshua M. Pahys, MD - Website Committee
Benny T. Dahl, MD, PhD, DMSci - Worldwide Course Committee
John R. Dimar II, MD - Education Council
J. Abbott Byrd III, MD - Finance & Communications Council 
Laurel C. Blakemore, MD - Governance Council
Marinus de Kleuver, MD, PhD - Research Council

 

SRS Core Curriculum

Laurel C. Blakemore, MD
Core Curriculum Task Force Chair

Under the leadership of the SRS Education Task Force, the Core Curriculum Task Force was charged with the task of defining a comprehensive competency-based core curriculum for use in spinal deformity training. This work would serve as the basis for SRS educational efforts including worldwide courses, and ensure consistency in post-training societal education.

A Delphi process which included 139 spinal deformity educators and experts from throughout the world completed multiple rounds with a remarkable retention rate of 89%. The participants defined the body of knowledge in the practice of spinal deformity into ten comprehensive Knowledge Domains (KDs). Within each Knowledge Domain are included an average of fourteen Learning Objectives (LOs). Each LO is a brief, clear statement of what the learner will be able to perform at the conclusion of the learning experience. LOs 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.

The Core Curriculum Task Force has reviewed the content of the 2018 Annual Meeting and highlighted presentations based on the ten Knowledge Domains. The Core Curriculum is available on the SRS website. Future directions include the development of Assessment Tools which can be to assess learning outcomes for SRS educational efforts as well as development of content based on the curriculum structure which can be utilized by educators for development of spinal deformity courses and curricula.

Domain I: Foundation Knowledge – Alpaslan Senkoylu, MD

Foundation Knowledge (Domain I) was a component of nearly all sessions of the Annual Meeting in Bologna. One example was the Half-Day Course entitled “Achieving Excellence in the Management of Severe Pediatric Spinal Deformity” which was moderated by Drs. Cahill and Yaszay. Part 1 was about “Understanding the Development of Severe Scoliosis” including three impressive lectures. Dr. James Sanders gave first two lectures about all aspect of growth in early years and peri-pubertal period. These two presentations demonstrated learning objectives concerning development and anatomy of Foundation Knowledge Domain (I.1.1. Learner will be able to describe the normal embryologic development and growth of the spine and neural axis and their relation to function). The third topic was “Looking at Growth in 3D”. Dr. Stefan Parent’s discussions highlighted learning objective I.1.3. (Learner will be able to identify basic anatomy, biomechanics and alignment (including 3-dimensional alignment) of the spine.)

Domain II: Early Onset Scoliosis – Suken A Shah, MD

The Lunchtime Symposium on Early Onset Scoliosis – Expert Roundtable, chaired by James Sanders, MD and Ron El-Hawary, MD was a hybrid of presentations, panel solicitations and vibrant discussion involving the audience and falls into Core Curriculum Domain II. Topics included proximal junctional kyphosis (prevention strategies and treatment options), sagittal alignment (what is “optimal” for young children and what is acceptable?) and when should strategies other than growth modification be employed in EOS (Learning Objective II.3.3: Learner will be able to list the risk, benefits and complications of various growth friendly implant and correction strategies (e.g. distraction based, compression based, growth guided.)) These treatment challenges of EOS were outlined by cases, backed by evidence and further developed by lively academic debate.

Domain III: Adolescent Idiopathic Scoliosis – Stefan Parent, MD, PhD

The Hibbs Award session was the theater of a contrast between new innovative methods vs. long-term outcome of uninstrumented curves in selectively fused AIS patients. These two papers are part of knowledge domain III – Adolescent Idiopathic Scoliosis. Dr Firoz Miyanji first reported on a prospective multicenter consecutive series of 28 patients having undergone anterior vertebral body tethering with a minimum of 2 years of follow-up. The authors reported good outcome in reaching clinical success they also reported an 18% reoperation rate which demonstrates a need to further study these innovative techniques. Burt Yaszay then presented the results of 51 patients with 10 years of follow-up who underwent selective spinal fusion. At ten years, most compensatory curve matched the instrumented Cobb while only 10% of patients showed significant progression over the same period. Both papers generated significant discussion and will certainly be the focus of further work over the years to come. Of note, Dr Yaszay won the Hibbs Award for Best Clinical paper. Congratulations!

Domain IV: Neuromuscular Scoliosis – Suken A. Shah, MD

The Lunchtime Symposium on Neuromuscular Spine Deformities: The Spine is Only a Small Piece of the Big Puzzle, chaired by Olavo Letaif, MD and Muharrem Yazici, MD, was a collection of experts who highlighted the importance of a multidisciplinary approach to the care of these medically complex patients and falls into Core Curriculum Domain IV. Topics took a global view of the NM patient and included preoperative workup, specific principles to ensure success in these patients, effects of co-morbidities on decision-making, and innovations of disease modifying treatment and rapid recovery pathways. (Learning Objective IV.1.3 Learner will be able to discuss the impact of medical comorbidities associated with the most common etiologies of NMS. Learning Objective IV.2.2 Learner will be able to describe the role of preoperative optimization including interdisciplinary care teams. Learning Objective IV.3.7 Learner will describe use of measures to improve safety in NMS surgery and minimize perioperative complications.) These guidelines will help us optimize care of patients with neuromuscular patients and prevent complications.

Domain V: Cervical Deformity – Lindsay Andras, MD

In the free paper session on Saturday morning, there was an informative session on cervical deformity. Much of this work focused on predicting outcomes and risk stratification. In Paper 132 Hyun et. al. investigated a cervical spine deformity classification focused on T1 slope minus cervical lordosis and C2-C7 sagittal vertical axis. Using regression models, they predicted that a threshold C2-C7 SVA (value
of 40.8 mm and 70.6 mm) and TS-CL (value of 20° and 25°) correlated with moderate and severe disability following posterior cervical fusion with a mean of 7 years follow up. Paper 133 by the ISSG compared outcomes of primary vs revision procedures for cervical deformity. Interestingly, they found that while both groups had significant improvement in disability scores and neurologic symptoms, the recovery of myelopathy was worse in the revision group at 1 year but similar by 2 years. Additional work from the ISSG described a surgical invasiveness index for cervical deformity. This newly developed CD invasiveness index was strongly predictive of high blood loss, operative time and extended length of stay. Sciubba et. al. then looked at risk factors for identifying patients requiring discharge to inpatient rehab or skilled nursing facilities and found that severe preoperative cervical malalignment, age >59, fusions >8 levels and EBL >900cc were all predictive factors of inability to be discharged directly home. (Learning Objective V.3.2 Learner will be able to describe indications, risks and benefits of surgical treatment options.

In addition to looking at outcomes and risk stratification, there were also discussions on surgical techniques for managing complex problems. In Paper 136, Zhang et al presented the management of cervical kyphosis in neurofibromatosis with halo gravity traction and posterior only approach. They reported 92% correction and no loss of correction with stable neurologic function at mean follow up of nearly 4 years. Additionally, in the half day course Dr. Bangping Qian presented a case of ear on shoulder deformity and management with C7 PSO that is nicely outlined in the program. (Learning Objective V.3.3 Learner will be able to describe age-based correction strategies including approaches, fixation and bone grafting options)

Domain VI: Adult Spinal Deformity and Domain VII: Degenerative Spinal Deformity – Praveen V. Mummaneni, MD

The Thursday afternoon Half-Day course entitled “Adult Spinal Deformity: an International Exchange on the Safety and Efficiency of Current Techniques” was directed by Dr. Munish Gupta and Dr. Yan Wang.  The two knowledge domains covered in this session included Adult Spinal Deformity (Domain VI) and  Degenerative Spinal Deformity (Domain VII). Two platform talks from this session particularly captured the essence of the learning objectives for these knowledge domains. 

Dr. Stephen Lewis gave a talk entitled “Intraop Positioning and Neuromonitoring to Avoid Complications”. This talk gave succinct pearls focused on two learning objectives in Domain IV. Specifically, Dr. Lewis addressed patient positioning to optimize spinal alignment and minimize complications from patient positioning (like nerve palsy) as well as intraop techniques for neuromonitoring to improve safety (Learning Objective VI.3.4 Learner will describe use of measures to improve safety in ASD surgery and minimize perioperative complications). The talk gave pearls to the audience on how to deal with neuromonitoring alerts. 

A second talk in this session by Dr. Juan Uribe entitled “Lateral approach can avoid 3 column osteotomies” was also well recieved. This talk focussed on objectives in Domain VII (Degenerative Deformity). Dr. Uribe discussed anterior and posterior treatment options to restore spinal balance. He also discussed how to select fusion levels and when to stage the procedures (Learning Objective VII.3.5 Learner will be able to discuss anterior and posterior treatment options including different types of osteotomies). The concepts in this talk were novel and Dr. Uribe demonstrated with case examples the restoration of sagittal balance with anterior column release as an alternative to PSO. 

Domain VII: Kyphotic Deformities – Saumyajit Basu, MD

An abstract which attracted a lot of attention during the SRS Annual Meeting which fits in extremely well with the currently proposed Knowledge Domain VIII: on Kyphotic Deformities was Paper 115: A New Classification for Scheuermann’s Kyphosis, presented by David Bumpass, et al. This is the first time that a new classification system for Scheuermann’s Kyphosis was introduced keeping in mind 3 variables including the apex of the deformity (thoracic or thoracolumbar), the last-touched sagittal vertebra (LTSV), which might be any of T12 to L4), and pelvic incidence (PI). Cluster analysis was done and excellent inter-observer reliability was noted. The importance of the abstract lies in the fact that this would help in dictating a treatment especially regarding choosing the lower end of fusion. Thus clear guidelines of the knowledge domain of kyphotic deformities can be well established.

Domain IX: Spondylolisthesis – Stefan Parent, MD, PhD

The Annual Meeting scientific program kicked-off Wednesday afternoon with a session on both adult and pediatric deformities. Two papers discussed a controversial topic namely in situ fusion vs. reduction for spondylolisthesis (Domain IX). In Paper 16 by Anders Joelson et al. the authors presented the results of long-term outcome 30 years following in situ fusion for spondylolisthesis with good quality of life for patients operated with this technique. Although they did not have pre-operative radiographs and quality of life for all of these patients, they concluded that long-term outcome of in situ fusion was good. Paper 17 by Hubert Labelle reported on a single center consecutive series of 30 patients with high-grade spondylolisthesis that underwent reduction and circumferential fusion. Their results showed a significant improvement in both radiographic features and sagittal balance as well as a significant improvement in HRQoL with minimal complications.

Domain X: Acquired Deformities – Ferran Pellisé, MD

With the exception of Paper 93 presented by Kai Cao et al, who nicely reported on surgical treatment outcomes of fixed post-traumatic kyphosis, most papers and presentations dealing with “Acquired Deformities” (Domain X) were not included in the general abstract sessions. Different aspects of ankylosing spondylitis (AS) and spinal tuberculosis (TB) were covered in half-day courses and poster presentations.

Yong Qiu (Nanjing, China) defined the indications, advantages and outcomes of asymmetrical pedicle subtraction osteotomy in AS patients with thoracolumbar kyphoscoliotic deformity during the Half-Day Course focused on An International Exchange on Safety and Efficacy. Poster 245 from the same institution (Drum Tower Hospital, Nanjing) showed that in AS patients osteotomies located closer to or at the preoperative apex of the deformity have highest chances of achieving ideal postoperative apex re-location. Poster 248 by Samir Dalvie et al showed that posterior pedicular spinal stabilization is sufficient to achieve circumferential fusion in AS patients suffering 3-column spinal pseudoarthrosis.

Poster 284 presented by Arjun Dhawale et al, suggested an algorithmic approach with consideration of neurology, spinal stability and cord compression to manage TB spondylitis with myelopathy. The study confirmed that multiple vertebral involvement and MDR TB are risk factors for complications. Poster 159 by Saumyajit Basu et al, analyzed 24 patients and concluded that craniovertebral junction TB with atlantoaxial instability but without major neurodeficit has excellent results with conservative management (transoral biopsy/aspiration and halo-vest immobilization).

Overall these papers nicely covered different learning objectives concerning prediction of outcomes and complications as well as guidance in the treatment decision making process for acquired spinal deformities.

 

 

Awards & Scholarships Committee Update

Matthew E. Cunningham, MD, PhD
Awards & Scholarships Committee Chair

The members of the Award and Scholarship Committee had a great discussion at the Bologna Annual Meeting, with the majority of committee members in attendance. We reviewed the global distribution of the awards and impact that the scholarships have had on providing a financial mechanism to deformity surgeons from hardship areas to attend the annual meeting and gain vital information to benefit the people in their countries. We discussed having recipients of all scholarships submit a report describing their experience and how it will impact their practice upon their return. We also reviewed the process of application for scholarships and fellowships, and suggestions were raised to firstly consolidate the deadlines as much as possible and to secondly have applicants to more than one funding vehicle to rank their preferences. In 2018-2018 there were 18 fellowships awarded (for a total of $197,000) and 31 scholarships (totaling $77,500). We anticipate a very competitive application cycle for the upcoming 2018-2019 North American Traveling Fellowships, and next year’s awards.

 

Chair: Matthew E. Cunningham Committee: Michael T. Hresko, Past Chair; Hak-Sun Kim; Cristina Sacramento Dominguez; Jianxiong Shen; John M. Wattenbarger, Global Outreach; Firoz Miyanji, Program; Nelson Astur (C); Dong-Gune Chang (C); Nick Sekouris (C); Ajoy P. Shetty (C); Anuj Singla (C); ZeZhang Zhu (C); Mohammed M. Mossaad (E); Anthony S. Rinella; Alpaslan Senkoylu, Chair Elect; Justin P. Tortolani; Burt Yaszay; Kenneth J. Paonessa; Joseph H. Perra; David H. Clements, III; Hee Kit Wong

Long Range Planning Committee Update

Todd J. Albert, MD
Long Range Planning Committee Chair

The Long Range Planning Committee met at our Annual Meeting in Bologna. Dates and locations have been secured for 2019, 2020 and 2021 and suggestions have been discussed through 2025. Staff is currently researching options and gathering information.

The 2019 Annual Meeting will be held in Montreal, Canada from September 18-21 and the IMAST meeting will take place in Amsterdam from July 17-20. In 2020, the Annual Meeting will be in Phoenix, Arizona from September 9-12 and the IMAST Meeting is tentatively scheduled for Athens, Greece in April. Consideration was made to have all future IMAST meetings from 2020 and on moved to April to improve attendance, not conflict with European holidays and make it potentially more palatable for American surgeons to attend.

In 2021, St. Louis, Missouri has been approved for the Annual Meeting on September 18-26. Dublin, Ireland is the tentative site for IMAST with contracts to be signed and dates to be locked in. Proposed sites in 2022 are Hong Kong or Sydney for the Annual Meeting and the southeast United States, potentially Miami for IMAST. In 2023, Seattle has been the confirmed for the Annual Meeting on September 6-9 and Barcelona, Spain suggested for IMAST. More specific information will be shared once contracts are signed and dates are locked in.

We look forward to seeing as many of our fellow members as possible to participate in these important educational endeavors of our Society.

 

Chair: Todd J. Albert Committee: Kenneth MC Cheung, Past Chair; Henry F.H. Halm, IMAST; Michael J. Wattenbarger, Global Outreach; Peter O. Newton, Chair Elect; Benny T. Dahl, WWC

Non-Operative Management Committee Update

David A. Hanscom, MD
Non-Operative Management Committee Chair

The non-operative committee is being organized into two task forces. One group, headed by Nigel Price, will be creating a framework to organize the current literature on adolescent idiopathic scoliosis bracing. The role of bracing across the age spectrum continues to evolve. Brace designs are becoming international. Scoliosis specific exercises are also being incorporated into spine care. We’ll work on sorting this out with the goal being to provide a resource for the clinician to make the brace choice for a giving patient.

The other section will be organized by David Hanscom to create a document that reflects the literature regarding what care is effective and should be implemented before recommended for adult deformity surgery. At the moment, most papers that compare surgery to non-operative care are essentially looking at “non-care”. The group is also looking defining the indications for adult deformity surgery. Other sections include sleep, stress, physical conditioning, osteoporosis, nutrition, medication stabilization and the neuroscience of chronic pain. The intent is create a working draft that can be built upon in the coming years.

Finally, we are considering taking on surgeon performance in the operating room. The goal is optimizing performance in or out of the operating room. A rested surgeon having a great time is going to execute better than a tired and distracted one. This topic crosses over into several different committees and we’ll see where it goes.

We are working on getting the smaller work groups organized and focused by the end of the year and some drafts available by early spring.

 

Chair: David A. Hanscom Committee: Howard M. Place, Past Chair; Linda P. d'Andrea; Kamshad Raiszadeh; Marilyn L.G. Gates (C); Ann M. Hayes (C); Turgut Akgul (C); Sabrina Donzelli (C); Jesse G. Eisler (C); Didik Librianto (C); Yutaka Nakamura (C); Stefano Negrini (C); Scott R. Rosenfeld (C); Claudio Vergari (C); Avraam Ploumis; Nigel J. Price, Chair Elect; Elian M. Shepherd; Kevin M. Neal; Michael L. Schmitz; Brian G. Smith; Theodoros B. Grivas, Advisory; Joseph P. O'Brien, Advisory

Translation Committee Update

Haluk R. Berk, MD
Translation Committee Chair

SRS strategic plan states “The purpose of the SRS is to foster optimal care for all patients with spinal deformity” as core purpose and patient advocacy as core value. Therefore aligned with SRS mission and vision patient information distributed by SRS experts in diverse cultures and languages is utmost important. Translation committee is responsible for translating patient education materials to other languages. Doing so, committee works in accordance with patient education committee and web-site committee. Tremendous work was done under the leadership of Munish Gupta and Andre Louis F. Andujar.

Currently 14 different language sites are active. Current task would be to complete AIS handbook and EOS FAQs translations and increase the visibility of Patient information and its translations. Therefore I encourage fellows to browse patient information web sites in their native language. Your feedback will help us to refine translations.

We welcome new members: Martin Gehrchen, Danish; Pawel Grabala, Polish; Sajan K. Hegde, Indian; Richardo A. Santos, Portugues.

 

Chair: Haluk R. Berk, Turkish Committee: André Luís F. Andújar, Past Chair; Massimo Balsano, Italian; Ernesto S. Bersusky, Spanish; Youssry El-Hawary, Arabic; Noriaki Kawakami, Japanese; Nosrat Javidan, Persian; Eung-Ha Kim, Korean; Sergey Mlyavykh (C), Russian; Janez Mohar (C), Slovene; Bangping Qian, Chinese, Chair Elect; Joshua M. Pahys, Website; Avraam Ploumis, Greek; Monchai Ruangchainikom (C), Thai; Ahmed M. Shawky, German; Martin Gehrchen, Danish; Pawel Grabala (C), Polish; Sajan K. Hegde, Indian; Richardo A. Santos, Portugues

Worldwide Course Committee Update

Benny T. Dahl, MD, PhD, DMSci
Worldwide Course Committee Chair

The three main activities for the Worldwide Course Committee continues to be the traditional Worldwide Courses (WWC), the Current Concepts in Spine Deformity Courses (CCSD) and the Hands-On Courses (HOC).

Since the last newsletter a very successful traditional WWC course was held in Beijing in June, confirming the commitment of the SRS to maintain a close relationship to the Chinese spine community.

In August a CCSD was held in Buenos Aires, Argentina in collaboration with the Argentine Society of Pathology of the Vertebral Column (SAPCV). The course was very successful with more than 200 attendees.

The second HOC of the year was held in Hong Kong in September and was as usual very well attended with positive feed-back from both faculty and attendees.

During the Annual Meeting in Bologna, Italy the meeting in the WWC committee was very well attended with a through dialogue about the future activities of the committee. There was general agreement that the ongoing work with the core curriculum of the SRS should be implemented in future courses. New members of the committee were welcomed and Dr. Saumyajit Basu from Kolkata, India was unanimously confirmed as chair elect of the WWC, taking over as chair in relation to the Annual Meeting in Montreal, Canada in September 2019.

In 2019 the first combined Current Concepts in Spine Deformity and Hands-On Course is planned to take place in Istanbul, Turkey May 8-11. This initiative is based on feed-back from the attendees on previous Hands-on-courses and the organizers have done an impressive job combining these two types of courses.

The additional activities in 2019 include courses in India, Mexico, Barcelona, and Japan confirming that the WWC is continuously working to support the mission of SRS as being the international leading society in the spinal deformity community.

 

Chair: Benny T. Dahl Committee: Morio Matsumoto; Firoz Miyanji; Yat Wa Wong; Burt Yaszay, Education; J. Michael Wattenbarger, Global Outreach; Dean Chou (C); Alexandre F. Cristante (C); Mohammadresza Etemadifar (C); D. Kojo Hamilton (C); Manish K. Kasliwal (C); Deniz Konya (C); Robert S. Lee (C); Jonathan N. Sembrano (C); Kwadwo Poku Yankey (C); Feng Zhu (C); Saumyajit Basu, Chair Elect; Steven M. Mardjetko; Martin Repko; John A.I. Ferguson; Hossein Mehdian; Timothy S. Oswald