North American Spine Society meeting updates

The annual meeting of NASS was held at the Boston Convention Center from Oct 26 - 29 and Dr. Klein attended and reports the following highlights from the meeting:

The importance of sagittal balancing in obese, reconditioned patients with lax abdominal and para spinous muscle tone with degenerative disk disease and osteoarthritis. This can be accomplished with weight loss and reconditioning with good results rather than performing fusions with instrumentation. In patients with a BMI of 35 or better that require surgery, there is much better long term outcomes.

Instrumentation being designed today is based on minimal incision approaches.

There has been a resurgence of learning both decompression of the neural foramina and spinal canal via microscopic approaches with specially designed instrumentation. There is lengthy learning curve involved.

The long term results of total disk arthroplasty, focusing on preservation of motion has not proven to be better than the use of anterior diseconomy and fusion for cervical and lumbar degenerative disk disease with radiculopathy. 

Anterior lumbar interbody and transverse lumbar interbody fusions combined with posterior decompression with instrumentation appear to produce the best long results for treatment of symptomatic spondylisthesis, grades II-V. 

Biologics, both osteoconductive and osteoinductive, are still important for high risk patients who are at risk for developing pseudo arthrodesis due to smoking, osteoporosis, use of long term steroids and post-chemotherapy/radiation for malignancies.