Editor's Column: Beyond North America

By William Sullivan posted 03-19-2018 03:05 PM

This past December I was honored and privileged to participate in the First Annual Saudi Spine Society Conference in Riyadh, Saudi Arabia. NASS was invited to participate by the organizers after preliminary discussions at our past annual meetings as well as during other spine meetings in the Middle East. I attended as part of a NASS delegation including First Vice President Jeff Wang, Treasurer Eeric Truumees, Clinical Research Director Scott Kreiner, CME Committee member Patrick Hsieh, Executive Director Eric Muehlbauer and staff liaison Brad Repsold.

I cannot express how impressed I was with the organization, content, research presentations, point/counterpoint discussion, audio-visual systems, accommodations and general hospitality of our fantastic hosts. Although this was their first meeting, the Saudi Spine Society definitely fulfilled their motto of “Promoting Excellence in Spine Care.” Like NASS, they are a multidisciplinary society dedicated to excellence across all aspects of spine care, and it was wonderful to work with another organization dedicated to a similar mission.

The first day of the conference included a NASS presentation on Evidence-Based Medicine training. Nearly 50 members of the Saudi Spine Society participated in the online modules as well as in-person training on the first day of the meeting. Days 2 and 3 included best papers, original research and podium presentations including a symposium discussion on Spinal Cord Injury (high rates in Saudi Arabia) and the Role of Medical Societies in Professional Development. Without trying to brag, NASS' participation was extremely well received, and, in fact, crucial to the success of the meeting overall. Our hosts provided excellent food, entertainment, exciting driving (ask your next President about this), and exposure to natural and man-made wonders.

As NASS continues to cultivate relationships with societies around the globe, this was important outreach beyond North America in expanding our partnerships, membership, research, education and quality spine care.

This edition of SpineLine begins as usual with the Commentary section and Dr. Resnick's message From the Desk of the President. In it, he provides an excellent overview of NASS, includes a summary of current issues and outlines his “Goals and Ojectives” as president. He also reminds us of some NASS history, as well as the qualities that set us apart from other organizations. Reading it, I was taken by how much NASS' organization seems to serve as a model for others such as the Saudi Spine Society and other multidisciplinary groups.

Also in our Commentary section, the discussion continues on a recent controversial JAMA article, “Effect of radiofrequency denervation on pain Intensity among patients with chronic low back pain: The Mint randomized clinical trials.” As you may recall, Drs. Stout, Guo and Schofferman (NASS members) contributed a Literature Review Commentary on this article in the September/October 2017 issue of SpineLine, “Lumbar and sacral radiofrequency neurotomy: fatal flaws of a recent RCT.” The JAMA authors have responded to their commentary in a Letter to the Editor, and we have also included an Authors' Reply. As you will see, this remains a controversial topic, and also underscores the differences in research methods, role of interpretation and importance regarding insurance coverage.

The Current Concepts section in this issue includes an Invited Review on “Risk Stratification and the Future of Spine Surgery” by Emily Miller, MD, and co-authors. Watch for more on this timely topic in a future SpineLine podcast featuring a conversation with Dr. Miller on her research and what members should take away from this article. Stay tuned!

Chad Craig, MD, et al provide “The Value of Cervical Total Disc Arthroplasty” in the Value in Spine Care feature. As we look at new (now not so new) technologies and compare them to other techniques, devices or treatments, this information can, we hope, provide support for a variety of treatments related to spine care. Rounding out this section, Anoop Galivanche and Jonathan Grauer, MD, provide a Literature Review Commentary on “Multidisciplinary Evaluation Leads to Decreased Utilization of Lumbar Spine Fusion: An Observational Cohort Pilot Study.” This pilot study, while having significant limitations, may provide a framework for development of programs for appropriate utilization of spine fusion. I doubt there are many surgeons who want to do inappropriate fusions, and perhaps programs like this can provide input for improved care and outcomes. It remains to be seen if they are feasible across many locations, markets and institutions, and if there are better outcomes with fewer costs.

The Socioeconomics & Policy section includes a Coding article on “2018 CPT Code Changes for Spine Procedures” from our Coding and Billing experts Bill Mitchell, MD and Scott Horn, DO. You'll also find, “Correction: Coding for Corpectomies,” from Karin Swartz, MD, and Allison Waxler. This is meant to clarify a NASS Coding Committee position discussed in the September/October 2017 issue. As you might expect, coding is often a fluid issue!

The Advocacy team also provided two articles in this issue, including “Issues Facing the Value-Based Payment Modifier Program” from outgoing Advocacy Committee Chair, John Finkenberg, MD, and Jordan Abushawish. The second is a commentary from relatively new NASS Advocacy staffer, Daniel Stanford on “A Look Ahead to Midterm Elections.”

The NASS News section is full of good news for and about NASS members. Congratulations to all those listed in “NASS Members Complete Training.” I encourage these and all NASS members to consider voluteering for a NASS Committee. See “Opportunities to Get Involved and Grow Your CV” for a list of NASS Committees and their wide-ranging, interesting work. Wrapping up this issue, check out the Back Page Q&A with member, Zorica Buser, PhD.

As usual, thank you to all of the contributors, section editors and especially NASS staff for their dedication in providing another edition of SpineLine. As always, we are receptive to any comments or suggestions that will help make a difference…

This column first appeared in the January/February 2018 issue of SpineLine. To read more from that issue, click here