The Back Bulletin
March, 2022

The Return of International Spine Conferences

by: Dr. David Wong
After a 2-year covid induced suspension, improved vaccination rates allowed for an international meeting restart in November and December 2021.
The first international meeting was the Brussels International Spine Symposium (BISS) in November, 2021. The International faculty from the United States (including Dr. Wong), France, Switzerland, Italy and Spain were able to attend in person.
The topic for BISS this year was “The Failed Spine.” Lectures on this controversial subject ranged from the psychological impact of persistent pain to the cost of revision surgery and strategies for repeat decompressions and fusions in the cervical and lumbar spine as well as the sacro-iliac joint. Dr. Wong gave talks on revision lumbar fusions, identifying patients with the best prognosis for revision surgery, evaluating leg pain after an operation and strategies for dealing with surgical infections. 
A highlight was the five-course meal at Dr. Robert Gunzberg’s (Past President of the International Society for the Study of the Lumbar Spine and Editor in Chief of the European Spine Journal) home by his gourmet cooking club rather than the typical faculty dinner at a hotel.
In December, 2021 the North American Spine Society (NASS), the Royal College of Surgeons of Ireland, and the Arab Spine Society co-sponsored the Spine Diploma Course Modules 1 & 3 in Dubai, United Arab Emirates. 72 orthopaedic and neurosurgery residents, spine fellows and junior staff physicians from Europe, the Middle East and Africa attended. Seven NASS faculty participated, led by NASS Past Presidents Dr. JJ Abitbol and Dr. David Wong.  
In addition to the lectures, there was a hands-on lab teaching the participants the finer skills of spinal surgery using the operating microscope as well as instrumentation systems such as pedicle screws and rods for lumbar fusion. Anatomic artificial models were used for the lab. The high-tech models can simulate surgical issues such as bleeding and spinal fluid leakages and detection of misplaced pedicle screws. The technology includes an artificial intelligence capability which monitors and analyzes each operator’s technique and the probability of attaining a good decompression of the nerves, as well as avoidance (or not) of complications.
The delayed (by Covid) World Expo 2020 was open in Dubai during the course. Dr. Wong was able to tour the 1,000+ acre site with pavilions from 192 countries as well as 10 themed pavilions devoted to the Expo 2000 motto “Connecting Minds, Creating the Future.” He came away very impressed with the exhibits and his personal pedometer logged around 15,000 steps at the Expo.
Clearly, Covid is still with us. However, Denver Spine Surgeons remains committed to research and education. The Brussels Symposium and the Dubai Diploma Course were excellent first steps in the international education effort. Hopefully the planned North American and International meetings and courses for 2022 will be able to proceed without further interruption. 

Patient Spotlight: Ken Gonzalez

“The most painful part of my surgery was removing the bandages from my skin,” is not what you’d expect to hear from a spine surgery patient eight weeks after surgery, but Ken Gonzalez says it’s true.
The 63-year-old electronics engineer had been enjoying his active lifestyle, and had even come out of retirement to work part-time due to a shortage of engineers. But his low-grade back pain that had been around for years, brought on by years of abuse from tackle football, skiing and dirt and street motorcycle riding, was becoming more present. Then Ken noticed he couldn’t shift his motorcycle with his left foot, and he was constantly tripping over it if he didn’t concentrate on picking it up. And it was becoming increasingly difficult to play his guitar because he had pins and needles in his fingers. 
Ken stuck it out for a while, but when he couldn’t stand or walk for more than 15 minutes without stretching for relief, he started researching spine doctors. Ken’s cousin, an executive for a medical device company, recommended Dr. Sanjay Jatana.
Ken immediately liked Dr. Jatana, and Dr. Jatana recognized Ken needed a spinal decompression surgery. Ken was comforted by Dr. Jatana’s experience and liked the “Cadillac team” around him. Ken was actually excited to have spine surgery and underwent an L3-5 lumbar decompression surgery on January 18 of this year.
Ken was surprised that the pain, the dropped left foot, and his tingling fingers all disappeared immediately after surgery. If it weren’t for the stubborn bandage on his back, he would have called the experience pain-free.
Ken’s recovery is ahead of schedule. He’s back at work. He is back on his motorcycle, properly shifting with his left foot now. He’s skiing again – cross country for now, and back to downhill hopefully next year. Reflecting on the process, Ken stresses the care he felt from every person on Dr. Jatana’s team, Ken says he owes his 5-star result to his 5-star doctor.
Dr. David Wong, Dr. Steve Theiss, and Dr. Zo Ghogawala at the World Expo Dubai

Denver Spine Institute 30th Annual Winter Meeting 
18th Annual John McCulloch Memorial Lecture 

Beaver Creek, Colorado - January, 2022

Different meeting formats this year included debates (treatment of ossified ligaments in the neck and fusion for lumbar spinal stenosis and associated slippage/spondylolisthesis), case studies (your worst case and your most challenging case) as well as normal lecture format (indications for spinal cord stimulation for chronic neck pain, sacro-iliac fusion etc.)
Dr. Alex Vaccaro was the McCulloch Memorial Lecturer this year. Dr. Vaccaro is the Richard Rothman Professor of Orthopaedic Surgery and Neurosurgery at Thomas Jefferson University in Philadelphia and President of the Rothman Spine Institute. He is a team physician for the Philadelphia Eagles NFL football team. Dr. Vaccaro has had a long-time interest in spinal cord injury to the extent that he obtained a PhD on the subject. In order to better understand the economic side of medicine when he became President of the Rothman Spine Institute, he also obtained an MBA. 
Dr. Vaccaro chose a timely and controversial topic for the McCulloch lecture:  “Return to Play Criteria Following Cervical Spine Injuries in Collision Sports.” Pros and cons of issues such as proper on-field evaluation, imaging and rehab as well as criteria and timing for return to play for injuries such as “stingers,” temporary quadriparesis, neck sprains and fractures were addressed in the talk.
The other invited guest speaker this year was Dr. Han Jo Kim from the Hospital for Special Surgery in New York. He presented talks on surgical principles for scoliosis/kyphosis deformity surgeries, both primary and revision as well as tips, tricks and traps to avoid.
Dr. Ghiselli participated in the “challenging cases” portion of the meeting and moderated other sessions. Dr. Wong discussed the economics of spine care into the future and delivered the tribute talk on John McCulloch.
All-in-all, a very successful restart to in-person conferences. All participants were engaged in the animated discussions on the various topics and came away with a better understanding of the complexities of spinal treatments and some strategies to implement in their own practices. 

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