“A great buzz in the air” around coverage, advocacy and academia at NASS 2016

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This years’ Annual Meeting took place from 26-29 October in Boston, USA, and featured an extensive programme of scientific presentations, world-class speakers, and a bustling technical exhibition. Commenting on the highlights of this year’s meeting, past president Chris Bono told Spinal News International, “This year’s Annual Meeting was terrific and very busy. There was a great buzz in the air about how much NASS is doing for its members, particularly in coverage and advocacy efforts. Compared to the past few years, attendance was up and participation increased.”

The first day of the conference saw a memorable talk by Pulitzer Prize-winning journalist, Bob Woodward, who discussed the role of the US president in directing healthcare policy. Part of the Health Care Outlook and Advocacy Symposium, the talk followed in-depth policy and advocacy reviews from David Wong (Denver, Colorado), Gregory J Przybylski (Edison, USA) and NASS Advocacy Council chair John G Finkenberg.

Academic highlights of the day were found in the Best Papers session, during which three papers sought to clarify the questions on the management of patients with cervical myelopathy. Guidelines, and two studies of a registry sought to address when, and what, surgical intervention is optimal in the treatment of the condition.

Thursday’s Best Papers session covered two hot topics in spinal medicine; disc regeneration and the realignment of the distorted spine. Describing the possibility of regeneration as a “holy grail”, lead author on the former paper, William Mark Erwin (Krembil Research Institute, Toronto, Canada) and colleagues write, “Here we have for the first time, identified and characterised the necessary and sufficient factors secreted by notochordal cells (TGFB1+CTGF) that, following a single injection, can regenerate the degenerative disc in a preclinical rat-tail model of degenerative disc disease.”

The latter paper, on pelvic incidence, questioned whether the value’s mutability should be reconsidered. “We need to stop thinking of PI as a fixed value,” lead author Place told the NASS Daily News. “The foundation of the spine is clearly mobile.”

2015-16 NASS president Chris Bono
2015-16 NASS president Chris Bono

Thursday also featured this years’ presidential address from Chris Bono. His talk focused on ensuring good outcomes for patients by implementing strategies to minimise variability. “Big data,” he said, was a key way in which progress can be made. “It is predictive analytics that are going to change the way we are going to deliver spine care.” Speaking to Spinal News International, Bono highlighted the ways in which NASS has helped to improve coverage of spinal procedures in the USA. “I am extremely proud of the achievements we have made in coverage, which continues to be an example of how great an influence NASS can have on the insurance industry,” he said.

A highlight of the day was a talk from presidential guest speaker, theoretical physicist and futurist, Michio Kaku (New York City, USA), who discussed the ways in which technological innovation was transforming medicine through digitisation. “Success is all about understanding the technology wave and learning to ride it,” he said, “You can ride the wave and succeed, or you can fall off the crest and wipe out.”

Friday’s Best Papers saw a focus on disc replacement and socioeconomics. Papers covered long-term follow-up of cervical and lumbar disc replacement patients, as well as questions surrounding the financial burden of various treatments for cervical radiculopathy and cervical myelopathy. A highlight of the session was a paper discussing the impact of missing data in registry studies. The authors gave evidence to show how missing data can skew, and potentially invalidate, results gathered from national databases.

Upon conclusion of this years’ meeting, Spinal News International asked Chris Bono how he predicts the conference will evolve in the future. “If you had asked me two years ago, I would have predicted that the attendance at the meeting would continue to decrease slowly. This would have been a product of increasing practice constraints, increasing availability to on-line and electronic education materials, and decreasing practice reimbursements,” he said. “However, I am greatly encouraged by the attendance and participation in this year’s meeting and hope that it will be a trend going forward.”

Commenting on his proudest moments at the helm of the society, Bono said, “I think one of the biggest achievements during my presidency has been changing the perception that NASS is a “nonoperative society” or a “surgical society”, and instead a “society for spinal care” that can represent all involved specialties.”

“Another shining light has been healing some damaged bridges between the society and a large group of surgeon-members and industry,” he told Spinal News International. In the future, he hopes, more will be done to tackle the complex world of bundled payments, saying, “I would like to see NASS direct research efforts in addition to funding individual investigators—there is still work to be done in determining care pathways for bundled care.”