Attending this year’s Scoliosis Research Society (SRS) meeting in Kyoto was a blast from the past. While most spine meetings these days are thin on attendance and have more than their fair share of doom and gloomers, SRS in Kyoto was upbeat, tackling (or nailing or stapling) tough clinical subjects and riding a wave of new technology. I had to check my calendar. Was this 2004? Did ProDisc get sold last week to Synthes for $350 million? Was Charité just going to panel?
Nope, it’s still 2010—and SRS, the 45-year-old-dean of the spine societies, was full of attendees and apparently operating in an alternative universe from the rest of spine.
Dr. Behrooz AkbarniaTo understand this (or find the hidden Kool Aid stand) I pulled three former society presidents together and put the question to them. What is going on?
First up was Dr. Behrooz Akbarnia (SRS President – 2006 and the society’s longest serving board member) winner of the 2008 Walter P. Blount Humanitarian Award and author of more than 200 peer-reviewed articles.
Dr. Akbarnia leaned back, considered my question for a minute or two, smiled and started to talk.
“The concept for SRS started with Dr. David Levine from NYC and then grew when in 1965 John Moe (Dr. Akbarnia’s mentor), Paul Harrington (Harrington Rod), John R. Cobb (Cobb Angle) and Bob Winter (Atlas of Spine) got together in Minnesota to have an annual organized discussion about treating idiopathic scoliosis. Harrington came out of treating polio. Cobb came from the world of fusion. Really John Moe put those two together”
SRS came from the work of Harrington, Cobb, Winter and Moe?
“Yes, but wait, there’s still more”. Dr. Akbarnia started to tick off the hall of fame roster of spine research.
-
Clyde L. Nash – the great champion of nerve monitoring.
-
Yves Paul Cotrel – the developer of instrumentation for three-dimensional correction of scoliosis. Revolutionary in its time and became the early gold standard for scoliosis treatment.
-
Eduardo Luque – developer of the Luque Rod and system which substantially replaced the Harrington rod.
-
Jean DuBossett – along with Yves Cotrel, the great innovator of instrumentation for three-dimensional correction
-
C. J.Harvey – who taught generations of surgeons about segmental motion.
-
Kiyoshi Kaneda – creator of the Kaneda Anterior Spine instrumentation system for thoracic scoliosis surgery
I hope the society has a historian because this is really something. “Oh yes, by the way, Dr. DuBousset is around here somewhere and Dr. Kaneda is giving the Harrington lecture this year.”
I knew this was a blast from the past. Even the attendees are relics of the 1980s and 1990s. Dr. Akbarnia chuckled at that.
“Well, ” Dr. Akbarnia started to say, “The society has evolved tremendously and there has been a lot of progress treating scoliosis. For me, I’m focusing my research on early onset idiopathic scoliosis. There has not been much research concerning children under 10 years old. Spine fusion of the thoracic spine in children affects their future lung capacity.”
Of course. Children grow. Fusion doesn’t. If you fuse a child in an attempt to correct spinal deformity that section stays stuck in time. The rest of the child keeps growing. This is an impossible conundrum. How do you correct deformity and still allow growth?
I think I really like this society.
But then Dr. Akbarnia turned serious. “Everything we do for children with deformity is off-label. Only one device for children was ever approved—the VEPTRr. And that took 17 years to get through the FDA. This was due to dedication and commitment of Bob Campbell who has helped these children through innovation and advocacy and for this reason received the congressional recognition. The rate of technology change in deformity is accelerating. We’ve met with the FDA and this is a very serious and important issue.”
Dr. Akbarnia continued. “Our goals are to decrease complication rates. More surgeries (and growing children with metal implants have repeat surgeries) equal more complications. We’re looking at remote control links to grow rods in-vivo and several strategies to minimize fusions. In the future, we hope to employ less surgery and allow these children to grow normally.”
About this time Dr. George Thompson, winner of the 2008 Arthur H. Huene Memorial Award for Outstanding Contribution to the field of Pediatric Orthopaedics (President of SRS from 2006 to 2008 and an 11-year board member) joined the discussion.
“George, ” I said, “can you direct me to the exhibit hall, I’d like to see some of these cool new technologies.”
No Exhibit Hall
“We don’t have an exhibit hall.” I must have looked surprised because he leaned forward, looked me in the eye like the former Army Major he is and said; “Have you ever heard of evidence based surgery?” “Yes Sir!” “Well, that is what SRS is about. This is an academic meeting. We don’t want distractions. Now, please don’t misunderstand me. We work as a team with industry to solve clinical problems. But at this meeting, we’re all here (industry included) to learn.”
Dr. Thompson continued: “SRS is internationally recognized for its prestige and excellence. That is why we attract so many clinicians and researchers from outside the U.S. We made a conscious decision many years ago to build SRS into an international source of information about deformity surgery. One meeting in three, for example, is outside the U.S. We even have a tiered dues system to accommodate clinicians in other countries. Today the SRS membership comes from 45 countries.”
After talking to those young whipper snappers I decided it was time to find a more mature, cooler perspective—and some lunch.
The lunch line was nearby so I stood behind some folks from Iran and the Ukraine and worked my way to a very pleasant Japanese woman who handed me a flat, pink flowered box with chop sticks taped to the side. As I was walking over to a chair to find out what was inside who should be meandering by but just the grown-up I was looking for—Dr. Courtney Brown (SRS President 1999, board member for nine years, former Treasurer).
“Courtney!” I said. “No exhibit hall. Packed meeting rooms. New technology excitement. What’s the deal?”
He laughed. “Yeah, I see what you mean. But, that’s SRS. About the exhibit hall, it’s been a longstanding policy of the society to not have company exhibits. Oh we were offered the opportunity. And when our budgets were tight, we were tempted and we had extensive board discussions about it.”
“In fact” Courtney continued, “it was Lew Bennett who gave us the idea. He was working for Sofamor Danek at the time and he told me ‘We as a company would prefer to give you dollars in the form of a grant so that our sales reps would NOT have to rush out at the break to try to peddle product. We want to attend the meetings and learn from the lectures. We want to understand better what we’re trying to do.’”
I then asked Dr. Brown about the FDA. “This is a very serious issue. Almost everything we have which is standard of care for children with deformities is off-label. The is a very significant problem which the FDA must find a way to address because to not address it is to block development of important and critically necessary treatment.”
There was only one thing left to do. Go where the crowd was. The lecture hall.
At the podium was this year’s Harrington Lecturer, Dr. Kiyoshi Kaneda from Hokkaido University School of Medicine in Sapporo, Japan. Dr. Kaneda is the Arthur B. Steindler Award winner in 2000 and the winner of the Wiltse Lifetime Achievement Award in 2004. Dr. Kaneda is the inventor of the Kaneda system for anterior spine surgery. His talk was “The Role of Anterior Surgery in Treatment of Scoliosis and Thoraco-lumbar Spinal Fractures.”
Dr. Kiyoshi KanedaNow 74 years old, Dr. Kaneda worked with many of the developers of today’s scoliosis treatments while a visiting clinical fellow with John Hall at Harvard, Professor John Moe and Dr. Robert Winter at the Twin Cities Scoliosis Center. Dr. Kaneda started using the anterior approach with a single rod system developed by Zielke—which was itself an improvement from the Dwyer wire system. But Kaneda noticed that there were problems and published the results of his experience in 1991. The Zielke approach was not maintaining correction of the sagittal deformity.
So Kaneda designed a dual rod system which is today known as the Kaneda Anterior Instrumentation system and has become a standard of care internationally for anterior spine surgery.
We caught up with Dr. Kaneda to, first congratulate him but to also get his perspective on SRS. “I attended my first SRS meeting in 1976 and joined in 1983, ” he said. “This society is where many researchers from many countries can come together to talk about problems. Sometimes in other meetings papers can be superficial, but SRS presentations and podium papers have more of a clinical focus which I find very useful.”
Other Japanese based clinicians who’ve also contributed significantly to the advancement of research and education are Dr. Nobumasa Suzuki, Dr. Kuniyosi Abumi, Dr. Manabu Ito, Mr. Morio Matsumoto, Mr. Yutaka Nohara and Dr. Toshihiko Yamashita.
Sometimes hope and vision come from some of the most unexpected places. If spine care is to get out of its doldrums, it could take a page from SRS. Get back to clinical research and innovation. In effect, get back to what made spine such a dynamic sector in the first place.
