The four principles behind the advancement of spinal surgery


James Yue, associate professor, Department of Orthopaedic Surgery, Yale University School of Medicine, New Haven, Connecticut, USA, is a programme chair for the annual meeting of the International Society for the Advancement of Spine Surgery (ISASS12; 20–23 March 2012, Barcelona, Spain). He talks to Spinal News International about the need for “C.U.R.E”.

As a co chairman of this year’s ISASS meeting in Barcelona, Spain and committee member of ISASS, which focuses on the advancement of spinal surgery, what have been the major advancements in spinal surgery in recent years?


Major advances include disc replacement surgery, minimally invasive procedures, the treatment of the ageing spine with interspinous devices, robotic and navigational surgery, the use of biosynthetics and stem cell therapies, as well as the treatment of osteoporotic compression fractures. 


What are the themes of ISASS12?


The core principals of ISASS12 curriculum centres around the conference’s four-letter logo:  C.U.R.E, which stands for “care, utilisation, research, and education”. The conference begins on Tuesday 20 March with an opening reception and the educational sessions start the following day (until the Friday). In my view, of the different symposiums, the most innovative and interesting include ones on navigation and robotics, the past, present, and future of biologics, the evidence base for total disc replacement, and difficult spinal presentations (rheumatoid arthritis). I think the sessions on sagittal balance and deformity, cervical complications and cervical trauma, and biology and biomechanics in spinal disorders will be as equally thought provoking and educational. 


As one of the overall programme chairs for the meeting, what do you look for when choosing studies to be presented?


I look for papers that include all four of our core principals of C.U.R.E. The longer term follow-up papers that provide level 1 data as well as the smaller pilot studies both contribute to our knowledge and understanding of the treatment of spinal disorders. This year we have an entire section dedicated to medical economics and care efficiency as well as efficacy. 


You are moderating a session on clinical cervical therapies at ISASS12. Most of the studies seem to focus on total disc replacement. What so far, do we know about total disc replacement in the cervical spine?


We have seven year prospective data on total disc arthroplasty in the USA. Data shows maintenance of improvement in all outcome categories including the neck disability index (NDI), the visual analogue scale (VAS), and the SF36 (a quality of life score). In some trials, superior outcomes compared to fusion have been seen. Patient satisfaction continues to be high and reoperation rates low.