6 Spine Societies Highlighted during Spine Summit 2015: AOSpine, ACSR, CSRS, ISASS, SRS, SMISS
Meeting Highlights from the 31st Annual Meeting of the Section on Disorders of the Spine and Peripheral Nerves—Spine Summit 2015
During the 31st Annual Meeting of the Section on Disorders of the Spine and Peripheral Nerves (CNS) Spine Summit, prestigious leaders in the spine field summarized the history of the six international spine societies represented at One Spine, One World.
AO Spine, which began in June, 1992 is a global academically-oriented and collaborative organization. AOSpine supports 25 North American fellowships and has trained hundreds of spine surgeons, who contribute to research.
Michael Fehlings, MD answered the questions—what is the AO? Does AO mean “Always Operate," and what does AO Spine signify? He explained, “It’s actually a very remarkable organization that began on interdisciplinary principles around patient care, and it really involved initially related to principle fracture care around anatomic reduction, stable internal fixation in terms of spinal mobilization. So this is really a very radical concept, and it was really one of the first organizations that really embodied the concepts around knowledge creation and knowledge dissemination in an evidence-based medicine manner.” Furthermore, AO is a German term—Arbeitsgemeinschaft für Osteosynthesefragen, which means a fellowship based on friendship and trust.
Jeffrey Wang, MD explained, “AOSpine was created as one of the clinical divisions of the AO Foundation, which is a foundation based in Switzerland.” AOSpine International has the same infrastructure as AOSpine North American. The international regions are in Latin American, Europe, the Middle East, Africa, and Asia-Pacific. There are about 30,000 total members, which includes 23,000 associate members and 6,000 members across the five international regions.
AOSpine International has knowledge forums known as study groups in the areas of deformity, degenerative spinal disorders, spinal cord injury, trauma, biologics, and tumor. The organization publishes its original research and offers a registry, which is undergoing translation for worldwide participation. Dr. Wang mentioned other aspects about AOSpine International:
- Basic science research is funded (Spine Research Network).
- Journal publications, online journals, academic journals
- Fellowships throughout the world
Association for Collaborative Spine Research
The Association for Collaborative Spine Research (ACSR) was started in June, 2012. Now, instead of everyone traveling to meet, members meet virtually once a month. The association involves surgeons, residents, fellow, and nurses.
Alexander Vaccaro, MD commented the ACSR offers opportunities for younger neurosurgeons and orthopaedists to who want to be part of a vibrant and forward-moving association. "We’ve asked the older gentlemen to move aside to let the younger people come in,” stated Dr. Vaccaro.
ACSR is divided into sections: degenerative, trauma, oncology, deformity, and biologics. Each group meets and determines three studies they want to conduct with unlimited funding from data registries. ACSR works with AOSpine and any organization that wants to conduct collaborative research. The association has developed new classifications for the sub-axis cervical spine and has started to discuss a pelvic-sacral classification and an outcome measure for trauma.
Cervical Spine Research Society
Jeffrey Wang, MD introduced the audience to the Cervical Spine Research Society (CSRS). As the society’s name indicates, the focus of CSRS is to conduct research and exchange information about the cervical spine. In 1973, J. William Fielding, MD of Columbia University in New York proposed developing the society and later that year the first meeting was held at the Essex House. From the outset, international participation was encouraged.
Dr. Wang stated that the CSRS, "represents orthopaedics, neurosurgery, radiology, and leaders in the field, and certainly experts in the cervical spine.” The society has a European and Asia Pacific section. There is talk about branching into Latin America.
Currently, there are only 250 active members—and, that number is intentionally restricted. Dr. Wang stated, “We do require three letters of recommendation; you have to have demonstrated interest in research in the cervical spine; you have to have been an author presented on a paper or poster at the actual annual meeting before you can be considered for membership.” Furthermore, only a few membership positions are available each year.
International Society for the Advancement of Spine Surgery
The International Society for the Advancement of Spine Surgery (ISASS) started in 1999, became the Spinal Arthroplasty Society in 2000, and adopted its current name in 2010. The ISASS focuses on spine surgery and the spine surgeon. “The society is growing rapidly at 12% to 15% per year since 2000 and are well over 1000 members,” stated Gunnar B.J. Andersson, MD, PhD, the ISASS’ current president.
Dr. Andersson mentioned the society’s dramatic growth, including more than 500 abstract submissions from different countries. The ISASS’ journal became part of PubMed very recently. Furthermore, the ISASS has a not-for-profit arm, the International Advocates for Spine Patients.
In closing, Dr Andersson stated, “ISASS is all about access. We want to make sure that patients have access to spine surgeons, and we want to make sure that spine surgeons have access to the best possible technology in the interest of their patients.”
Scoliosis Research Society
“When we think of the Scoliosis Research Society [SRS], most people think of this: the treatment of adolescent idiopathic scoliosis. But the SRS also deals with many, many other conditions: congenital, Scheuermann's kyphosis, adult intramuscular, ankylosing spondylitis. And perhaps this might be a better reflection of the domains of expertise that this society has focused on over the past 50 years,” stated David W. Polly, Jr., MD.
The SRS was started in Minneapolis, MN in 1966 because of the disappointing results of treatment at that time. The founding members were the who’s who of orthopaedic deformity surgery. Harrington instrumentation created new problems, and it was necessary to find ways to solve and prevent them. Dr. Polly stated, One of those problems were intraoperative increased neurologic complications, specifically paralysis, associated with the treatment of scoliosis. And this led to the development of the morbidity and mortality process within the society.” The web-based registry system evolved from the card punch mechanism.
“So there have been iterative developments in the techniques we use for the treatment of spinal deformity, and these have paralleled instrumentation systems that have allowed us to do better jobs in treating these patients,” Dr. Polly said. Lawrence Lenke, MD taught his peers how to view the spine in a systematic way—both the coronal and sagittal planes to better understand scoliosis treatment. Dr. Lenke’s work led to the concept of classification system modification.
Dr. Polly shared, “When I started in this process, I remember a leading professor said why would I ever want to share my data with my competitors? And what we've realized is that the critical piece is to collect enough data to get to the right answer instead of worrying about our competitors.”
Other points Dr. Polly discussed included:
- Patient reported outcomes are critical. The SRS developed a validated patient-specific and disease-specific questionnaire.
- The sagittal plane is the focus of understanding most spinal disorders today.
- A classification for adult spinal deformity is not yet “comprehensive or predictive.”
- We are getting better at spinal osteotomy, but much remains to be determine how best to utilize the procedure. As Dr. Polly put it, “… we’ve got to figure out how to get this right.”
- Genetics is not yet there.
- “Another bugaboo remains early-onset scoliosis.”
The SRS has about 1500 members of which about one-third are international. The focus is—as Dr. Polly stated, “What is the best treatment for spinal deformity, and how do we make it better?”
Society for Minimally Invasive Spine Surgery
The Society for Minimally Invasive Spine Surgery (SMISS) was founded in 2007. It is a not-for-profit academic society for surgeons with a special interest in minimally invasive spinal surgery. The society’s first annual meeting in 2008 gathered 112 physicians. The outcome of that meeting resulted in the development of a website allowing patients to obtain “… better quality scientific information about minimally invasive surgery as compared to what they might find at other sources,” commented D. Greg Anderson, MD.
Dr. Anderson stated, “In 2009, we started to work on our membership, and we reached 99 members by that point. In 2010, we branched out into some cadaver training, which was initially associated with our annual meeting. And in 2011, we started to pilot something called our Core Curriculum.” The society started mostly with North American spine surgeons, and since has reorganized to include international surgeons.
SMISS’ Continuing Professional Development (CPD) recognizes that for even very experienced surgeons, new techniques require time to learn. “We brought professional educators into the society to help us understand the facets of learner-oriented education,” Dr. Anderson indicated, and the barriers that may impede becoming proficient in techniques.
Dr. Anderson explained how electronic lectures, case series assessments, webinars, and cadaver labs are part of the principle-based modular curriculum to help surgeons gain proficiency in surgical techniques.