 SAS8 Conference Highlights
Presidential Address - SAS8 Miami - May 7, 2008
Karin Büttner-Janz MD, PhD Dear Spine Community,
Dear colleagues from all-over the world,
Ladies and gentlemen, It is a great pleasure for me to welcome all of you to this 8th Annual Global Symposium of our Society. I say THANK YOU to every colleague for coming to this meeting, for your contribution. I thank all industry people who are working for us surgeons and basic scientists on 70 booths here, in this beautiful city Miami. Last but not least I would like to thank our two local hosts, Tom Errico and Rolando Garcia, and the whole program committee, firstly the program chairs, the over-all chair Henry Halm, the chair for clinical science Rick Guyer, and the chair for basic science Hans Joachim Wilke. The SAS program is prepared at the highest scientific level - SAS ever had; and I am able to say that, considering my attendance at all SAS meetings since the foundation of the society. I am happy to speak to you today as the President of the Spine Arthroplasty Society. 26 years ago, when the development of the first total disc prosthesis started in Berlin, the disc which is still in use, and which introduced a worldwide new treatment strategy to stabilize a degenerated disc with pain relief at same time, I couldn’t imagine, that a quarter of a century later many motion retaining products would be on the market or in development, a big industrial spine sector would be born, and that our society would be in high responsibility for patient’s spine care all-over the world. At this meeting very interesting study results were and will be presented. They do not always demonstrate successful and final solutions, they also show the responsibility of the spine community for further improvement of patient outcomes, for related health care costs and that we always have to challenge if the clinical results have fulfilled the expectations. Thinking back to the beginning of the Spine Arthroplasty Society, the “men of the first hour” are never to be forgotten. These are the internationally based founders of SAS: Charlie Ray, Stephen Hochschuler, Gary Lowery, Rudi Bertagnoli, Thierry Marnay and Michael Mayer. Also not to be forgotten are the Viscogliosi brothers for two reasons: They were responsible for starting the “big business” with motion preservation devices, for creating the interest of industry in these implants. Secondly they supported SAS first years after foundation, which was important for the survival of the society. The influence on the scientific program at the Annual SAS Global Symposiums does not happen any more for some years now; SAS became a financially independent scientific and educational society. The first SAS meeting was organized by Michael Mayer in Munich in 2001. The first SAS president was Charlie Ray, who is still very active with 80 years, who is an inventor, and who created the first by-laws of SAS. Now he has reviewed my revision proposals of the by-laws, to adapt the by-laws to the present situation, and to care for future of the tasks our society has. The second SAS president was Thierry Marnay, also an inventor as everyone in the room knows. Thierry’s SAS meeting in 2002 in Montpellier is unforgettable. Very close to Stephen Hochschuler’s and Gary Lowery’s meeting in Phoenix in 2003 the Charité Artificial Disc was purchased by Johnson & Johnson; it was the second transaction after the Prodisc, with an unbelievable high value. Rudi Bertagnoli explained at his SAS meeting in Vienna in 2004 that SAS is the “mother society” above the local SAS chapters. He was active, to support Prof. Park to found the first SAS chapter located in Asia. As you know, in January this year the first very successful APSAS meeting happened. During the SAS presidency of Stephen Hochschuler and a year later of Hansen Yuan, several important steps in SAS development were taken, and several new devices came on the market for implantation. We should always remember Stephen Hochschuler’s words from the Montreal SAS meeting: “We have to be real careful; we cannot become so excited about new technology that we forget the basics.” That is really true, we always have to take in consideration for example fusion surgeries, where indicated. Hansen Yuan with much energy personally influenced the foundation of the SAS Online Journal which is on a good way to hopefully become indexed very soon. Additionally, the name of SAS was extended by Hansen Yuan with “International Society for the Advancement of Spine Surgery”. Since then our society avows itself as responsible for the spine surgeons in this world. At the same time the new SAS logo was proposed - by me - and accepted by the other Board Directors of SAS, after getting some unsuitable examples created by designers. What is the Spine Arthroplasty Society today and in future? I would like to tell you my thoughts: 1. The term “Spine Arthroplasty” stands for “Replacements or Substitutions in Regions of the Spine where Motion should be maintained”. That definition includes all procedures and technologies, all implants and substances which directly keep the Functional Spinal Unit age-related and related to the individual normal; or which directly treats the sick, painful Functional Spinal Unit. Directly means focused on the Functional Spinal Unit, it doesn’t mean for example a treatment using any physiotherapy, intravenous injections or infusions to reduce pain. 2. According to its structure, SAS is an accepted international global organization, with 2 regional chapters in Asia and further chapters in preparation. Again we have an increased number of attendees at our Annual Global Symposium and the number of industry participation has increased too. Other organizations are interested to corporate with SAS, for example the AOSpine. The first exchange of interests was done. I believe that SAS should corporate with further international spine societies and also with big and important national spine societies, if it improves the education and if it is in the general interest of the members on both sides. The internal structure of SAS is characterized by several committees, who are working more or less effectively. In some committees an improvement is needed to do more than to describe the target. 3. The field of the Spine Arthroplasty Society is historically known as a platform for innovations to preserve mobility of the spine. At the Annual Global Symposiums of SAS there is always an exchange on high level regarding new developments, in addition to the special session for Innovative Technologies. Innovations are also demonstrated in industry workshops and are discussed aside. Every year attendees are coming to the SAS meeting to gain knowledge especially on the new devices. We will continue with that tradition, but also take care with all devices, technologies and procedures which are not new anymore, but belong to the “Spine Arthroplasty Family” and have step by step become standard. 4. In regard to the involved spine professionals, SAS is mainly but not only the scientific and educational platform for spine surgeons worldwide. Under the aegis of SAS are the basic spine scientists next to the spine surgeons. The importance of their work is tremendous, since it depends on whether the device can be implanted in human or not. Because most of their research is funded by, or inside of industry, these colleagues should never forget their responsibility for their results which should be as much as possible independent, on highest scientific and ethical level. They should have at least the courage and present asap if any device or device combination could be dangerous for the use in humans. The investment into the development of motion retaining devices is huge, also for that reason the biomechanical results have highest value and interest. But SAS likes to include more than spine surgeons and basic scientists. Our society attempts to involve and to work closely together with all colleagues who are doing minimal invasive surgeries and other procedures which can be used for optimal, direct on the Functional Spinal Unit oriented treatment of patients. The Spine Arthroplasty Society also likes to work as close as possible with the colleagues who do research for example in genetics, on stem cells and on early procedures and technologies for prevention and early treatment of painful degeneration of the Functional Spinal Unit. The general target is to create step by step an algorithm for the prevention and treatment of painful degeneration of the FSU, directly focused on the origin of the degeneration and directly focused on the treatment of the sick structure of the Functional Spinal Unit. We are still at the beginning, only a small step in ahead. That makes our work highly interesting as well as responsible at the same time. 5. We also have to care for the education of the young generation scientists to achieve the next steps. Their thoughts and work have to be even more specialized without leaving the general overview. From personal experience I very well know how long it takes to become really experienced in spine surgeries and motion retaining devices. Therefore I suggest to design a SAS fellowship program for SAS members who are not older than 35 years, who have done scientific work on the spine, who make an application including a certificate from their “spine teacher” sending it to the SAS president. The fellows should be paid for visiting a “famous spine scientist or surgeon”, to learn more. 6. Without the healthcare industry SAS wouldn’t be alive. In motion retaining of the spine physicians and industry depend on each-other. As international scientific and educational society SAS can not directly support any one company, for example in reimbursement issues. SAS is responsible to help companies to have the platform for the presentation of their for example FDA-regulated studies. SAS is well suited to force the discussion about the advantages of motion retaining devices compared to former traditional treatments. SAS is also a good platform for the presentation of the new ideas addressing the preservation of spinal motion. Further the SAS Directors can send official statements to official institutions with the aim of starting regulations, to find solutions in general for spine care issues, related also to industry. 7. In the new by-laws of the Spine Arthroplasty Society is to read that SAS is dedicated to restoring pain-free natural mobility – with the purpose to advance spine care through education of spine surgeons, basic scientists, and associated professionals following the highest scientific and ethical standards; with the goal to improve patient care and treatment outcome - by presenting results of new research, and clinical advances through updating basic skill and knowledge, the presentation of latest methods and devices available for preserving pain-free spinal motion, and other appropriate options for patients with degenerative or traumatic spinal conditions. The SAS Annual Global Symposium 2008 is doing important steps to fulfill the purpose and goal our society has in the long run, with a highly qualified scientific program of more than 100 oral presentations and many industry workshops. But as said, we are still far away from our goal, individually as well as generally - as society. In Germany people sometimes say “There is much to be done – let’s wait.” We can’t wait! For example next generation devices are now in development, they can maybe show even more impressively that motion retaining devices have a better outcome than traditional fusion surgeries. We have learned from the past to improve the future. New implants, materials, technologies and procedures should increase ease and accuracy, should reduce the recovery time and improve the outcome, should exclude as much as possible long-term problems and revision surgeries. Here are not only the surgeons and other physicians and researcher involved, it is also a daily task of industry people, it is also their responsibility, and we as surgeons often depend in our quality on the quality of the industry people’s work. I would like to emphasize these words, because we are now coming to the Presidential Guest Speaker Hans Schlegel. It is a big honor for us that he followed our invitation to speak about his personal experience in the space. His work depends probably much more on technical pre-conditions than ours. Hans Schlegel performed in February this year a spacewalk of nearly 7 hours to help to prepare the Columbus laboratory for its scientific work, and to replace an expended nitrogen tank. I highly appreciate to get more information about your courage, your assignment, your extreme responsibility. Thank you very much for joining us, Hans.
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