ExMex: Fighting the main cause of spine pain

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The Experts Meet Experts (ExMEx) Sessions have become an integral part of the EFORT congresses. On 19-20 November, the first ExMEx Forum in Barcelona will deal with sagittal plane deformities and lumbo-sacral fusion. The EFORT congress organisers spoke to Enrique Caceres Palou for Interventional News and he pointed out some of the highlights of the upcoming forum.

EFORT Congress: Why did you choose sagittal plane deformities and lumbo-sacral fusion as the focus of the first ExMEx meeting in Barcelona?


Caceres: Most patients with coronal and sagittal imbalance in spine consult our practitioners when they have problems as adults. In most patients, both ageing and iatrogenic factors contribute to fixed sagittal imbalance.


EFORT Congress:How common are these deformities in Europe?


Caceres: Sagittal imbalance is the main cause of spine pain in adults. Besides that, in countries with a high prevalence of osteoporosis, the number of patients with sagittal imbalance is increasing. The four main causes of sagittal imbalance in adults are:

– idiopathic scoliosis;

– degenerative sagittal imbalance;

– posttraumatic kyphosis; and

– ankylosing spondylitis.


EFORT Congress: The correction of fixed sagittal and coronal imbalance by osteotomy will be touched on during the first day of the forum. Which different techniques will play a role in this discussion?


Caceres: We will describe three different procedures in this meeting: Smith- Petersen osteotomies, pedicle subtraction osteotomies and vertebral resection osteotomies.


All of these techniques will be detailed during the cadaver session in the lab. The first workshop will focus on the posterior elements resection in multisegmental locations. The second shows the resection of all the column elements at the pedicle level, and the third workshop will include a complete vertebral body resection with anterior augmentation.


EFORT Congress: Lumbo-sacral fusion is the headline of the second day of the forum. What problems make this surgical procedure so challenging?


Caceres: In patients with sagittal imbalance – especially in adults – the incidence of pseudoarthrosis is very high. This is why the lumbosacral fusion technique is very challenging.


Attendees of the lab session will practice different methods to fix the instrumentation in the lumbosacral area. Iliac screws in combination with S1 fixation will be tested in different modalities.


EFORT Congress: Tell us about the faculty of the meeting?


Caceres: It will consist of members of the Spanish Spine Society (also known as Grupo de Estudio de Enfermedades del Raquis, or GEER) as well as the most renowned surgeons specialised in adult sagittal imbalance in the world, including G. Lenke from the United States, R. Sorensen from Norway, J. Kostuick from Canada, W. Dick from Switzerland and L. Ferraris from Germany. M.I. Miguel, A. Combalia, J.R. Rodriguez, H. Mainly, G. Acebal, J. Bago and myself represent the Spanish Spine Society.


EFORT Congress: How many specialists may attend the meeting?


Caceres: We hope that around 125 experts on spine surgery will come to the meeting in the morning. Only a limited number of assistants can register for the lab session.