President's Message
Muharrem Yazici, MD
SRS President 2020-2021
As the President of SRS, this is the last newsletter article I address to you. After a long summer, I hope these words find you healthy and happy.
I was hoping to write something else in this article, I would like to write something else. I wish we could leave the pandemic behind and have had an Annual Meeting in St. Louis with all of our friends and colleagues from around the world. While many were still able to join us in person, we will need to look forward to 2022 to see the full realization of this dream.
The majority of our members, particularly those from outside the United States, were unable to attend our Annual Meeting this year, despite their strong desire to do so. A significant number of US members were forced to adjust their plans at the last minute. Despite the setbacks, we were pleased to be able to hold our Annual Meeting, albeit with a smaller number of in-person attendees.
We consider it a success that we were able to make this year's Annual Meeting in hybrid format after two IMASTs and one Annual Meeting where we had to perform entirely virtually. The meeting was held as planned, with the same content and format. According to the St Louis time zone, it will run continuously from 8 a.m. until 6 p.m. The entire program was recorded and is available on the BrightSpace platform.
With our past newsletters, we kept you up to date on what we did throughout the year. In the year-end report, all of our committee and Task Force chairs will share their one-year activities with you in written and short video presentations. As you can see from these reports, the coronavirus was unable to stop SRS. Despite the fact that the pandemic has kept us from getting together, SRS members' excitement and productivity have not waned. It would certainly not be an exaggeration to say that last year was even was even more prolific than the previous ones. After reading these reports, I trust you will agree with me.
All of our educational and social activities, as well as our financial condition, have been negatively impacted by the pandemic. SRS saw a decline in income as a result of not being able to hold any meetings for the past two years, however, we were able to manage the process without any major issues thanks to our robust financial structure and wise judgments taken in past years. The ability to convene a meeting despite a limited capacity will be a sign of a return to the good old days, both morally and financially. We are optimistic that normalization will speed with IMAST next spring.
I hope that our new President, Chris Shaffrey, who will address you in the next newsletter, will write articles that are more uplifting. Thank you for your continuous support and confidence throughout the past year. I'll see you in good days.
Adult Deformity Committee
Robert K. Eastlack, MD
Adult Deformity Committee
The ASD Committee had a productive year despite the pandemic headwinds, during which we put together a well-attended international webinar on Prevention of Proximal Junctional Kyphosis in Adult Spinal Deformity that included world experts on the topic. Additionally, we have been formulating educational symposia and sections for the upcoming IMAST and SRS meetings for topics such as cervical deformity, MIS deformity, osteoporosis management in ASD correction, and others.
The team has also been assisting the Education Recourse Center Committee with website content and formatting in the adult deformity realm, in order to optimize this resource for the membership.
The Committee is also working diligently on providing clarity on the various outcome measures available for adult deformity, and how to navigate these platforms in the new age of EMR integration. We will be providing instructional symposia on this topic in upcoming meetings, and have planned to give updated guidance to the membership through the website.
Another subgroup has been working toward building consensus guidance on ERAS protocols that will be based on published results, along with input from the top centers for deformity correction around the world.
Finally, we have generated several important reference review articles on various topics, including cervical deformity, sacroiliac joint dysfunction, and surgical site infection prevention in adult deformity, which will be available through the SRS website, and submitted for publication, as well.
Robert K. Eastlack, MD, Chair
Ethics Corner
John C. Quinn, MD
Ethics & Professionalism Committee Member
Artificial intelligence is in use today across a vast array of industries, including health care, banking, retail, and manufacturing. Machine learning algorithms have shown tremendous potential as tools to improve clinical decision making and patient care however, it must be recognized that use of these technologies present unique ethical challenges. A major challenge with implementation of machine learning tools in healthcare is ensuring that these algorithms are trained with high quality data that is sufficiently diverse and that societal biases such as those due to race, ethnicity and socioeconomic status aren’t reflected in the algorithms. Failure to do so may contribute to further propagation of socioeconomic disparities in healthcare if not recognized and accounted for in the design and development of these tools.
A particular challenge in the development of machine learning algorithms for ASD is the disparity in utilization of ASD surgery in racial and ethnic minority populations. While the population of the US has been growing more diverse there exists a dramatic racial disparity in the utilization of surgery for ASD. A recent analysis of the NIS database showed that of the 28,921 surgeries performed for adult spinal deformity between 2004 and 2014 25,953 (89.7%) were performed on Caucasians and 2968 (10.3 %) African Americans.4 This study also pointed out that while overall complication rates were similar that there was a significant decrease in complication rates over time among Caucasians patients that was not observed in African Americans patients. There also exists a paucity of data regarding the impact race/ ethnicity or socioeconomic status has on outcomes following surgery for ASD. While several studies suggest no such differences exist others provide some evidence that differences in ethnic/ cultural expectations may impact outcomes and patient satisfaction following surgery for ASD.5,6 These studies highlight potential challenges to the development of highly accurate algorithms that can be used across diverse patient populations.
Implementation of Artificial intelligence has the potential to revolutionize the way health-care is delivered. It is imperative however, that we recognize not just its strengths but also the limitations of this technology as we move forward with widely adapting this technology. In a recent article “Potential Biases in Machine Learning Algorithms Using Electronic Health Record Data” the authors describe some steps to be taken to minimize the impact health care disparities may have in the development of machine learning clinical tools.3 They suggest that in order to improve the accuracy and reliability of these machine learning algorithms across a diverse patient population that these algorithms be built and tested in socioeconomically diverse healthcare system. They also stress that key variables such as race, ethnicity, language and social determinants of health are being captured and included in algorithms and that these algorithms be tested routinely for discriminatory behavior.
Use of advanced computational tools and machine learning has shown significant promise in the advancement of treatment of patients with adult spinal deformity through the ability to identify risk at the individual level which represents a significant step forward in treatment. While there exists significant promise for use of these techniques it is important to recognize current limitations that exist and to further develop these tools for use in increasingly diverse patient population.
1. Joshi RS, Lau D, Scheer JK, et al. State-of-the-art reviews predictive modeling in adult spinal deformity: applications of advanced analytics. Spine Deform. 2021;9(5):1223-1239.
2. Ames CP, Smith JS, Pellisé F, et al. Development of Deployable Predictive Models for Minimal Clinically Important Difference Achievement Across the Commonly Used Health-related Quality of Life Instruments in Adult Spinal Deformity Surgery. Spine (Phila Pa 1976). 2019;44(16):1144-1153.
3. Gianfrancesco MA, Tamang S, Yazdany J, Schmajuk G. Potential Biases in Machine Learning Algorithms Using Electronic Health Record Data. JAMA Intern Med. 2018;178(11):1544-1547.
4. Wang KY, Puvanesarajah V, Xu A, et al. Growing Racial Disparities in the Utilization of Adult Spinal Deformity Surgery: An Analysis of Trends from 2004 to 2014 [published online ahead of print, 2021 Aug 18]. Spine (Phila Pa 1976).
5. Sanford Z, Taylor H, Fiorentino A, et al. Racial Disparities in Surgical Outcomes After Spine Surgery: An ACS-NSQIP Analysis. Global Spine J. 2019;9(6):583-590.
6. Yagi M, Ames CP, Hosogane N, et al. Lower Satisfaction After Adult Spinal Deformity Surgery in Japan Than in the United States Despite Similar SRS-22 Pain and Function Scores: A Propensity-Score Matched Analysis. Spine (Phila Pa 1976). 2020;45(17):E1097-E1104.
Chair: Steven D. Glassman Committee: B. Stephens Richards III, Past Chair; Jacob M. Buchowski; David A. Hanscom; Joseph F. Baker (C); Thomas M. Gavin (C); Frank T. Gerow (C); John F. Lovejoy III (C); Robert F. Murphy (C); John C. Quinn (C); Sherif M. El Ghamry; Hee-Kit Wong; S. Samuel Bederman; John P. Lubicky; Dale Blasier; Daniel J. Hedquist
The Scoliosis Research Society (SRS) podcast is aimed at delivering the most current and trusted information to clinicians that care for patients with scoliosis and other spinal conditions. From news in the world of spinal conditions, to discussions with thought leaders in the field, we aim to provide up-to-date, quality information that will impact the daily practice of spinal conditions. Listen to the latest episode.
Corporate Relations Committee
Paul Sponseller, MD, MBA
Corporate Relations Committee
One of the charges of the Corporate Relations Committee is foster responsible relationships with industry partners that promote the mission of the SRS. Ten companies are providing support to SRS in 2021, through industry modules at IMAST, marketing, workshops at AM and/or educational or research grants.
Due to lingering COVID-19 concerns, members of the Presidential Line have been completing virtual visits to each of the Double Diamond Companies. We hope to return to headquarter visits in 2022. Those discussions have been very productive in identifying areas of mutual concern and ways that SRS and the companies can work together for better patient care, whether through education, research or advocacy.
We typically recognize these sponsors at various levels of support as listed below:
| $300,000+ USD | Double Diamond | |
| $150,000 - $299,999 USD | Diamond | |
| $100,000 - $149,999 USD | Platinum | |
| $50,000 - $99,999 USD | Gold | |
| $25,000 - $49,999 USD | Silver | |
| $0 - $24,999 USD | Bronze |
Thank you to our 2021 Supporters!
Double Diamond Level Support
Diamond Level Support
Platinum Level Support
Gold Level Support
OrthoPediatrics
Silver Level Support
Bronze Level Support
ATEC Spine
Orthofix
Pacira BioSciences Inc.
Global Education in Spine Deformity Committee
Ahmet Alanay, MD
Global Education in Spine Deformity Committee
Since 2020 Annual Meeting, there have been three virtual Worldwide Courses (China, Russia, and Mexico.) All were successful in regards to attendance - China and Russia were virtual whereas Mexico was in-person. The WWC Subcommittee, in collaboration with the Egyptian Spine Association, will offer a virtual 90-minute session during their Annual Meeting on November 25 or 26 TBD.
The Nijmegen Hands-On Course was rescheduled from June 2021 to October 27-29, 2021, and will be the first SRS Hands-On Course since 2019. The course includes 17 confirmed faculty, 10 supported lab stations, and 30 participants from 18 Countries. Registration sold out early on August 20, 2021. As of August 30, there are five individuals on the waiting list to attend in-person. The Singapore Hands-On Course scheduled for November 17-19, 2021 has been postponed to October 27-29, 2022. The second course planned for 2022 is tentatively scheduled for June 20-24, 2022 in Bordeaux, France.
As a result of rescheduling all in-person Current Concepts after March 2020, Poland, Taiwan, and Chile were postponed, CCSD Subcommittee decided to create a virtual CCSSD which will employ a blended virtual learning format, hosted on the SRS online platform, Brightspace. The CCSD Subcommittee programmed the Global CCSD in accordance with the SRS Core Curriculum's Knowledge Domains and intends to draw from the recording of these talks for future blended formats. A discussion and strategy for future blended formats will be discussed once outcomes from this first fully-virtual course are ascertained.
The rest of the CCSD venue contracts are being finalized and the program planning will begin quickly following the SRS Annual Meeting.
Ahmet Alanay, Chair, Saumyajit Basu, Chair-Elect
The iExperience training objective is to help you acquire competencies so you can confidently perform Early Onset Scoliosis surgical and non-surgical procedures safely, reliably, and reproducibly. These media-rich courses include direct instruction, animation, surgical techniques, interactive feedback with practice, and self-assessment. Learn more.
Communications Committee
Yan Wang, MD
Communications Committee Chair
A crucial task of communication committee is to promote the mission, vision, value and benefits of SRS.
In this June, we worked with the Research Promotion and Overnight Committee to plan the marketing of 2022. As another significant task is innovating in new methods of communication to SRS global membership and worldwide spinal deformity patients, the communication committee has continued to work consistently over the year with high quality podcasts.
In addition, an SRS Podcast has now published 17 podcasts. These are highlighting the SRS Annual Meeting and IMAST award winners, including several prominent SRS researchers and “Patient Dialogues”. All the podcasts are available on the SRS website, iTunes, and Google Play.
The SRS social media presence has been getting more attention from the Presidential Line in the past year. Over the last six months, Drs. Brooks and Cho have worked with the Spine Deformity Journal to discuss bringing a weekly update to the SRS social media followers. The Social Media Subcommittee, housed under the Communications Committee, discussed to ask fellow Communications Committee members to assist with reviewing articles and providing social media content so the work could be divvied up to not be too onerous.
A sincere thank you to co-chair Ron El-Hawary who lead the podcast task force so successfully and the dedicated members of the 2020-2021 Communication Committee:
Committee: Chair:Yan Wang, VidyaSrinivasa, James S. Harrop, WaelAlkasem (C), Jaysson T. Brooks (C), Jason PY Cheung(C), Jae Hwan Cho (C), Grant D. Hogue (C), Walter H. Truong (C), Vidyadhar V. Upasani (C), Michelle C. Welborn (C), Todd Milbrandt, Karen S. Myung, Hui-Ren Tao, Elias C. Papadopoulous, Jean-Marc Vita, Michael G. Vitale
Morbidity and Mortality Committee
G. Ying Li, MD
Morbidity and Mortality Committee Chair
Members of the M&M committee have been working with the Platforms for Performance and Outcomes Task Force during the past year on strategies to refocus the committee to better serve the needs of the SRS membership. There are plans to rename the M&M committee to reflect the broader role of the committee, and its new focus on outcomes and benchmarking. The PPO Task Force has recommended creation of a SRS app that will have a number of features, including the ability for members to collect and submit data. Members will be asked to submit a minimum data set to allow for simple benchmarking and this will eventually replace the requirements to enter M&M data.
The M&M committee has also been working on a report of the 2013-2019 M&M data. The manuscript is near completion and will be submitted to Spine Deformity in the fall. Notable differences between this report and the previous report of 2009-2012 data include the cessation of collection of visual acuity loss data after 2015 and collection of unintentional return to the operating room data starting in 2017.
The 2020 M&M data was reviewed by the committee on our recent call. Overall, less cases were logged in 2020 compared to 2019 (40464 vs 48754 cases), likely due to decreased activity related to the COVID pandemic. Complication rates appeared similar between 2019 and 2020.
Stay tuned for future updates as the M&M Committee continues our transformation.
Committee Members: G. Ying Li (Chair), John France (Past Chair), Luis Munhoz Da Rocha (Chair Elect), Carlos Abreu de Aguiar, Ravi Bains, David Cohen, Lori Dolan, Emmanuelle Ferrero, David Gurd, Bachar Harfouche, Robert Huang, Konya, Jean-Marc Mac-Thiong, Vishal Sarwahi, Justin Seale, Sanjeev Suratwala, Kelly Vanderhave, Caglar Yilgor
The 29th IMAST is comprised of the latest science in the field, presented as paper (podium) presentations, E-Posters, symposia of invited lecturers, debates, and case discussions. Presenters will represent the best of the SRS membership, as well as non-members, from an international group of physicians and researchers. Click here to learn more about Abstract Submission.
Platforms for Performance & Outcomes (PPO) Task Force
Justin Smith, MD, PhD
PPO Task Force Members
The Platforms for Performance and Outcomes (PPO) Task Force was created by the SRS Board of Directors to explore solutions to three important strategic needs of the SRS: (1) desire for registry/quality improvement (QI) tools, (2) future directions for the SRS Morbidity and Mortality (M&M) Committee, and (3) enhancing research opportunities for our membership.
Based on a 2018 SRS survey, the number one priority of the membership was for registry/QI tools, with one member noting, “The variability is going to kill us”. Registry/QI tools can not only help to address the tremendous variability that exists in deformity care, but can also aid in improving overall safety and outcomes. In addition, these tools can provide objective evidence of the effectiveness and benefits of spinal deformity treatment. As the leading society focused on spinal deformity worldwide, the SRS has a strategic need to play a role in the registry domain. The PPO Task Force comprehensively reviewed existing global initiatives aimed at QI of spinal care. However, the Task Force could not identify any current existing initiative that would meet the very diverse needs and expectations of our global membership and recommended that the SRS should develop and maintain its own registry/QI tools. Recognizing the importance of collecting data in a compliant manner from its global members, the PPO Task Force also recommended creation of the Data Compliance Committee.
The M&M Committee has provided valuable data over several decades, but it is in need of a new direction to continue to serve the SRS effectively. Assessment of treatment and outcomes has evolved beyond focused assessment of morbidity and mortality into broader patient-reported outcomes measures, overall safety of care, and value assessments. The PPO Task Force proposed that the M&M Committee evolve into the Outcomes and Benchmarking Committee. This rebranded and refocused committee could oversee the efforts of the SRS to provide new registry/QI tools for the membership.
Research efforts have been increasingly driven by study groups and collaborations among surgeons and centers that typically require basic data collection and storage infrastructure. However, since most members worldwide do not have ready access to these resources, the Task Force noted that the SRS has the potential to play a major role in facilitating organic collaborative research efforts worldwide by providing access to basic research tools.
Based on the above strategic needs of the SRS, the PPO Task Force proposed that the SRS develop a multi-functional app with a potentially very broad range of applications, including registry/QI tools. This app could facilitate basic data collection from the membership to enable de-identified benchmarking. This data collection could be overseen by the newly created Outcomes and Benchmarking Committee (formerly the M&M Committee) and ultimately replace the current M&M data submission requirement, while providing considerably more valuable, clinically relevant output for the membership. In addition, this app could provide options to facilitate organic research efforts for members who wish to use these features. Such strategic changes will require time to create and adapt to but promise to provide more powerful data and tools for our members. Stay tuned for updates on this topic by the leadership over the coming year.
The PPO Task Force includes five members (Drs. Shay Bess, Steve Glassman, Kenny Kwan, Ferran Pellisé, and Justin Smith) and four advisors (Drs. Ying Li, Michelle Marks, Christopher Shaffrey, and Michael Vitale).
Research Promotion and Oversight Committee (RPOC)
Rene M. Castelein, MD, PhD
RPOC Chair
In 2019, the Research Promotion and Oversight Committee (RPOC) was installed by the Board of Directors of the SRS, with following charges:
1. Develop process and track grant submission and results histories from 2014 onward. This should include all research funded by SRS, including peer-reviewed grants, Directed Research projects, large projects such as ASLS, jointly funded efforts such as SRS-Cotrel grant and named grants such as the proposed Biedermann grant.
2. Prepare a report by Annual Meeting 2020 to be shared with membership which will show how research funds were spent and results from funded efforts.
3. Work with Research Grant committee and SRS staff to include wording regarding compulsory annual reporting for up to two years after conclusion of funded projects. This should apply to all SRS Funded research efforts, including jointly funded efforts.
4. Develop and initiate a database of grant recipient productivity.
5. Develop policies and procedures for continuation of research tracking in future years.
6. Work with Communication Committee, Education Committee, Website Committee and others to organize innovative ways of sharing and disseminating outcomes from SRS funded projects.
7. Work with Development committee to highlight SRS research in Development (fund-raising) efforts.
The Committee met several times online and the Proposal Central System was launched for all active grants, new report reviews and the outcome collection process. Implementation of this system went well, it showed to be well designed and straight forward to work with. All active grants 2020 and before have now been loaded into the system, which was a big effort for which the staff should be complimented.
Furthermore, to highlight the role of the SRS in supporting research, the Grant Outcome Symposium was organized as a first event and held on March 6, 2021. For this occasion, a selection was made out of different projects that had not been presented at the Annual Meeting or the IMAST meeting. For this symposium 769 participants registered and it scored 319 unique viewers that actually attended. It was well received as demonstrated by 126 that responded to the event survey, results can be seen in the table underneath.
| Did this webinar meet its description? | 99% Yes |
| I intend to participate in the next Symposium | 93% Yes |
| I would recommend this webinar to a colleague | 98% Yes |
| I am more likely to apply for an SRS grant after viewing this webinar | 58% Yes, 4% No, 34% Not applicable |
Considering this first Grant Outcome Symposium an experiment, the conclusion was that it is worth continuing into the future and preparations are under way for the 2022 version.
The Chairs of the Communication, Podcast, Social Media, & Development committees met online to discuss how each committees activities could be better aligned in order to highlight the SRS research activities, these meetings are scheduled to continue into the future.
During an online meeting on September 11 2021, the Chairmanship was transferred to Carol Wise.
René Castelein (Chair), Douglas C. Burton (Past Chair), Carol A. Wise (Chair Elect), Ivan Cheng, James S. Harrop, Stefan Parent, Rajiv K. Sethi, Hongda Bao, Chirag A. Berry, Benjamin D. Elder, Masayuki Ohashi, Jonathan N. Sembrano, Ajoy Prasad Shetty, Mun Keong, Mitsuru Yagi, Kenny Kwan, James O. Sanders, and Qianyu Zhuang.
