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September 2019 | Educational Supplement

AOSpine and the Global Spine Congress (GSC): An in-depth look

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This educational supplement has been sponsored by AOSpine

Introduction

“Truly international”: An introduction to AOSpine AOSpine is the leading global academic spine community, creating, disseminating, and exchanging knowledge to promote excellence in patient care and outcomes. It all started in the late 1990s, when a group of spine surgeons realised the potential of a specialist organisation with a focus on the spine. Headed by John Webb, Max Aebi, and Paul Pavlov, and supported by the AO’s industrial partners, their initiative led to the creation of an AO Speciality Board for Spine Surgery in 2000. Its mission was to grow spine expertise as a key competence of the AO Foundation, a medically guided, not-for-profit organisation led by an international group of surgeons specialised in the treatment of trauma and disorders of the musculoskeletal system. Following a highly successful pilot period, AOSpine was formally established in 2003 and today, the community of surgeons, researchers, and allied spine professionals is over 35,000 strong. Chairperson Shanmuganathan Rajasekaran talks about his involvement with AOSpine and shares how being a member has influenced his surgical career. He also explores what makes AOSpine unique as a spine society, and how it stays relevant for its growing and increasingly global membership. How long have you been involved in AOSpine?

I have been involved in AOSpine for many years, beginning in 1997 with my first faculty position. Subsequently, I became a member of the Knowledge Forum Trauma in 2012 and then chair of the International Research Commission in 2015. I am the chair of AOSpine's International Board from 2018 to 2021.

What differentiates AOSpine from other societies?

AOSpine has many unique features. For one, many of the other major spine societies in the world are mainly regional or national and so much of their academic programmes and research is confined to a specific geographical or linguistic area. AOSpine stands out from these spine societies in being truly international. We have membership across all regions—North America, Latin America, Europe, Middle East, Africa, and Asia-Pacific. Our members see very different pathologies across these regions, because spine surgery is not the same in every part of the world, and because of this, every member can learn from other members. One may be a renowned surgeon in the western hemisphere but his or her knowledge on how to treat some major spine infections or multidrug resistant tuberculosis of the spine may be limited as they encounter these problems infrequently in their daily practice. Surgeons from developing countries have many cutting-edge developments that can be learnt from their peers. AOSpine’s meetings, such as the Global Spine Congress, allow surgeons to meet their peers from all over the world

How has AOSpine grown over the years, and have you noticed membership increasing more quickly in certain parts of the world? Currently, our membership is at around 6,000, and so we are one of the largest societies for spine surgeons and researchers in the world. Over the last few years, membership has increased more in the Asia-Pacific region, and I see two important trends. First, spine surgery is becoming more accessible and popular in the whole of the Asia-Pacific region. When I was a resident and then a junior doctor, patients were afraid and reluctant to have spine surgery. Outcomes were not good and so people were really worried about it. But now we have a large number of centres which are specialising in spine surgery all over the Asia-Pacific region. We have very good trained surgeons in all of these countries, the hospitals are well-equipped, and the safety level and outcomes of spine surgery are equal to the rest of the world. The number of spine surgeons in the Asia-Pacific region in countries like China, South Korea, India, and Japan is fast growing and so automatically, the membership from this region is also growing. Another observation is that we are seeing an increasing number of younger surgeons joining AOSpine. This is really exciting because they will be influencing the direction of spine surgery that is going to be practiced in the future.

How would you say AOSpine is catering for the younger generation?

Shanmuganathan Rajasekaran

and learn the entire spectrum of spine surgery from the experts. Apart from surgical techniques, there are many cultural influences on the practice of spine surgery. Affordability and acceptance of surgery vary across the world. The cost factor and the cost provider also vary widely. While in some countries healthcare is based on an insurance system, in others, like in India, for example, more than 80% of the population pay out of their own pocket. The result is that you will find some pathologies which are being treated at a cost of US$100,000 in some developed countries, and at US$15,000 in another country with the same results. So this interaction between physicians from very different parts of the world is exciting and not possible in any society other than AOSpine.

AOSpine has been continuously changing and reinventing itself to be of interest and relevance to the younger generation. Over the last few years we have noticed that younger surgeons want quick access to knowledge, which is why we introduced the Surgery Reference App and other forms of e-learning. AOSpine has a repository of knowledge available to surgeons on their mobile devices, for easy and fast access wherever they are. If you take a fracture, for example, surgery

AOSpine has been continuously changing and reinventing itself to be of interest to the younger generation.” September 2019

AOSpine and the GSC

Whatever your level of expertise, you will always be able to learn something new from AOSpine.â€?

AOSpine invests heavily in various forms of short- and long-term fellowship programmes

reference tells you how to classify it, the clinical signs you should look for, and what is the best option for treatment. We also observed that practicing younger surgeons benefit more from discussion of real case scenarios than didactic lectures. This has led to a complete restructuring of our courses to be filled with case-based discussions and practical hands-on training sessions. I have to congratulate our Education Commission for proactively getting the feedback from delegates and dynamically changing the course format to increase the value of our courses.

Minimally invasive spine surgery education: AOSpine endoscopy course

What are some of the key activities of AOSpine?

One of the main things people expect from a society is for it to be not just a knowledge provider, but also a knowledge creator. That is why the Knowledge Forums were established, covering five different areas: Trauma, Spinal Cord Injury, Deformity, Tumour, and Degenerative. The creation of the Knowledge Forums was really one of the most important landmarks in AOSpine history because it helped to achieve two aims. It brought together the key opinion leaders into the world of AOSpine. Each of the five Forums has a steering committee made up of 10 key opinion leaders from around the globe, who identify knowledge gaps and then come up with specific research projects to create new knowledge. For example, the Knowledge Forum Trauma has created a fracture classification which is the most accepted classification around the world. We have also come out with patient- and surgeon-related outcome measures. Over the last few years the Knowledge Forums have published nearly 150 papers in international September 2019

AOSpine Minimally invasive spine surgery education: micro-decompression course

AOSpine fosters a global member community of over 6,000 spine surgeons worldwide in over 120 countries

peer-reviewed journals. Looking to the future, an exciting initiative is the Global Diploma Project. In many parts of the world there is no provision for surgeons to have an accreditation for knowledge and training in spine surgery. AOSpine plans to have Diploma Examinations to evaluate theoretical

and case-based knowledge and provide certification. The first of the global diploma examinations will be held in 2020 at the Global Spine Congress in Rio de Janeiro, Brazil, and I am really excited about this. Also, something to look forward to is the AOSpine Clinical Expert Forums. Surgeons in their everyday practice are often faced with challenging situations where they would like to access the experience of experts in the field and know how they would manage this situation. We are now selecting important topics of interest and bringing together a group of experts who will describe how they would manage the situation. Specifically, this group will be constituted of specialists from all regions of the world so that the regional variations in management will also be addressed. I am positive that this initiative will be really very useful to surgeons at all levels of practice. Finally, in terms of education, the current trend is towards hands-on training. We are concentrating on surgical simulation courses, where people can receive training on endoscopic techniques and minimally invasive spine surgery.

How has AOSpine influenced your career as a surgeon?

Over the years, I have really valued AOSpine because it has allowed me to work shoulderto-shoulder with many of the spine surgeons whom I have really looked up to during my training and as a young consultant. There were many people whose names you recognised from journals or textbooks, but you never had a chance to work with them, and AOSpine brought all of us together with a chance to do collaborative work. Working closely with eminent and successful surgeons allows you to learn much more than just spine surgery. One has a chance to observe, discuss, and learn about various other issues, like time management, overcoming stress and professional fatigue. I have always come away from an AOSpine event knowing more than I did before and I think that whatever your level of expertise, you will always be able to learn something new from AOSpine.

Global Spine Congress

The Global Spine Congress—2019 and beyond One of the biggest gatherings for spine surgeons from all over the world, the Global Spine Congress is the official annual meeting of AOSpine. Introduced 10 years ago in 2009, the congress provides an outstanding forum to exchange ideas, and to learn about the latest research, techniques, and technologies in spine surgery, and is open to all surgeons, spine practitioners, allied health professionals, and researchers. The Global Spine Congress (GSC) just wrapped up another successful congress in May 2019 in Toronto, Canada, which 1,800 spine care professionals attended. This year, the GSC featured 210 expert speakers from countries around the world presenting in this ground-breaking scientific programme. The exhibition hall provided participants the opportunity to explore the latest tools, techniques and technologies through over 60 sponsoring companies. A record 1,501 abstracts were submitted. Here, Congress chairperson Jeffrey Wang talks us through the evolution of the GSC over the last 10 years and how it might develop in the future, as well as his highlights from this year’s congress, and what we can look forward to at GSC 2020 in Rio de Janeiro, Brazil. How have you been involved with the GSC over the years?

I worked with AOSpine back in 2009 to create the first meeting, of which I was the chair, and I have been chair of every meeting since then. It is something that I have been very proud of because it has grown so much over the years and it has been great to see how much it has matured. I feel like it is my passion and I have been fortunate enough to be involved in all of them thus far.

How has the GSC evolved since the first meeting?

There are a lot of societies that have meetings, but from the very first GSC we could see that this one was very international.

Discussions at GSC 2019 Toronto

Even at the 2009 Global Spine Congress, which was held in the USA, the largest proportion of delegates was actually from Europe. Also, it was great to see how it brought people together internationally. For example, often at a meeting like this very few delegates will attend the reception after spending all day in sessions, but the reality at the GSC is quite the opposite. Since 2009, attendance at the GSC reception has been very high, and this is indicative of the unique opportunity we offer delegates for international collaboration. I have seen that change over the years in a positive way—it has reached into the research in that we are seeing more submissions from an international basis, as under-represented areas

Jeffrey Wang, chairperson of the GSC

Serena S. Hu at the Women in Spine event at the GSC in Toronto 2019

finally have a platform to get their research out there.

What do you think differentiates the GSC from other congresses?

Firstly, the GSC comes to people. We are probably one of the few meetings that rotates the congress to a different region every year. Also, the AO Foundation, the overarching organisation of which AOSpine is a part, has been teaching and educating for 60 years and they have a unique style of doing this. What differentiates the GSC from other meetings is that we bring the AO flavour. It is hard to explain what this AO flavour is but essentially it is about personalised teaching,

Presentations in regional languages I think will allow for an even more international programme.” September 2019

AOSpine and the GSC

How to brand yourself: AOSpine Members-only session with Lali Sekhon, Yong Hai, Mohammad El-Sharkawi

organisation and key opinion leaders that we are trying to get involved in the meeting, are really excited and you can feel the passion. You are going to sense that when you are at the meeting and that is going to create some excitement. What I think people find the most interesting is the research, and the quality is going to be outstanding. We are likely going to break the record for the number of abstract submissions and so we are going to have the best of the best to be able to choose from. Also, huge advances in translation mean that we are going to be able to offer people the opportunity to present in Spanish and Portuguese. You cannot go to a region of the world and say that if you do not speak English then you cannot participate, and so I am very excited about this development.

What do you expect to see moving forward in the scientific programme?

See you at the GSC in Rio de Janeiro, Brazil, in 2020! From left to right: Nestor Taboada, Fernando Alvarado Gรณmez, Emiliano Vialle, Asdrubal Falavigna, Juan Emmerich and Jaime Segura

one-on-one teaching, and case-based teaching, which allows people to learn but it is also more interactive. We have tried over the last several meetings to bring that flavour to the GSC and so it is not just your didactic lectures, or your research presentations, but instead we are trying to group things together to promote discussion. In the future, we are planning to include more interactive symposia in the GSC. In Toronto, we actually brought this feature into the exhibit hall. It attracted a lot of attention and is definitely something that will appear at future meetings. We are all part of the same scientific community and we aim to encourage interaction, participation, discussion, and questions at every opportunity. We want to continue to look for novel ways to deliver this flavour and have people participate. We do not want just an audience, we want participants.

What were your highlights of GSC 2019?

We had a record number of abstracts, which September 2019

tells you that people want to present their research at this meeting. We also had a record number of attendees and so we are continuing to grow. We had new formats, including video talks on techniques, and interactive sessions in the exhibit hall, some of which were on new technologies, including virtual and augmented reality. For a topic like this you really need different formats because if you wait for people to do research in something like virtual reality, it takes time for that research to get done. If you can show people at an early stage how it can help you and get insight into the future, I think this will encourage future research.

Looking forward to 2020, what do you think will be particular about Rio?

There are a few things. First of all, whenever we go to Latin America, the Latin Americans are very passionate. They are very excited and very academic, and the attendance next year will set another record. The people that we are interacting with, the leaders in our

What always impresses me is that every year when I look back at the actual science that is being presented, the quality is outstanding and in the end, that is how I judge the academic part of the meeting. There is a lot of interaction and people have a good time but you want to be able to present the best science. Also, the research is becoming truly international and is not just dominated by one area or country, not just the Americans or the Europeans. If we focus on the Englishspeaking meetings or the English-speaking journals you are cherry-picking the best research from those areas, but presentations in regional languages will allow for an even more international programme.

What developments do you envision in the next five years for the congress? The GSC is going to continue to grow. The year after Rio de Janeiro we are going to China, and we have very high expectations for that meeting. We have a programme committee and we work with the leaders of AOSpine to help design programming and, while there is representation from all corners of the world every year, we also pay particular attention to the region that we are in. The ideas coming in for future meetings, such as research competitions between groups, more video interaction, and more live demonstrations, are really innovative. In summary, we are not afraid to think outside the box to deliver content in new ways.

Current and future projects

AOSpine, the only truly global spine society AOSpine fosters a global community of over 35,000 spine care professionals in 189 countries, and 6,000 members in 120 countries. It is the largest and only truly multinational spine society in the world and currently stages over 200 educational events every year on all continents for over 12,000 participants from around the globe. It covers all pathologies, and the different stages in a spine surgeon’s career. As the leading global academic community for innovative education, AOSpine invests heavily in the various forms of long- and shortterm fellowship programmes and observation opportunities, providing additional experience in surgical techniques for fully trained orthopaedic surgeons and neurosurgeons interested in spinal surgery. Learn from the best

Based on the philosophy of lifelong learning, the AOSpine curriculum provides continuous acquisition of the necessary knowledge and skills that will aid lifelong career progression for three levels of experience: principles, advanced, and masters. It combines expert face-to-face educational events with distance learning and self-directed study resources, creating a framework for the best teaching methods and techniques based on skills, learning outcomes, and surgeons' needs.

of access, visualisation, navigation, instrumentation, biologic augmentation Technique—Microsurgery, neural protection, decompression, stabilisation Training—Simulation, observation, mentorship Testing the boundaries—MISS for deformity, robotics It is independent of a surgeon’s background and training level, and available types of resources that a surgeon has access to, such

The Minimally Invasive Spine Surgery (MISS) curriculum – AOSpine's latest innovation

Launched at the Global Spine Congress Toronto in May 2019, the MISS curriculum is competency-based and aimed at surgeons with little or no experience with MISS, as well as surgeons with basic procedural techniques. The key objectives of the MISS curriculum are based on the following focus areas: Target—Optimised patient selection Technology—Optimal combination

Roger Härtl, MISS Task Force Leader, launches the new AOSpine curriculum at the GSC Toronto

The AOSpine Knowledge Forums generate knowledge by way of clinical studies, and the publishing of evidence-based recommendations. They identify knowledge gaps, assess best practices, formulate evidence-based studies, develop classifications, and more

AOSpine offers over 200 educational events every year for over 12,000 participants worldwide

as operating tools, and resources. Therefore, this curriculum is the perfect pathway for surgeons into MISS. Learn more about the MISS curriculum on aospine.org/ MISScurriculum.

AOSpine Knowledge Forums: driving research, discovery, and innovation in spine

AOSpine is the premier knowledge provider in the field of spinal surgery and at the forefront of preclinical and clinical research. It also conducts its research independent of industry. While taking a global approach, AOSpine's research is translated into specific regional needs by involving spinal experts worldwide. AOSpine’s preclinical research is focused on musculoskeletal regeneration and postoperative spinal infection. The clinical research is driven by the AOSpine Knowledge Forums. These are five key opinion leader-driven working groups generating knowledge in the spinal pathologies of tumour, deformity, spinal cord injury (SCI), trauma, and degenerative disease, aiming to spark expertise by way of clinical studies, and the publishing of evidence-based recommendations. AOSpine Knowledge Forums identify knowledge gaps, assess best practices, formulate evidence-based studies, develop classifications, and more. The results are published and disseminated in the most influential journals and at conferences all over the world. Their output ensures that AOSpine remains the leading innovator of spine care worldwide. To date, the AOSpine Knowledge Forums have published 148 papers, won 28 awards and nominations, and initiated 51 studies, of which 17 are completed to date. September 2019

AOSpine and the GSC

Global Spine Journal—AOSpine’s official scientific journal

Global Spine Journal (GSJ) focuses on the study and treatment of spinal disorders, including diagnosis, operative and nonoperative treatment options, surgical techniques, and emerging research and clinical developments. GSJ is a member of the Committee on Publication Ethics (COPE) and indexed in PubMed Central, Scopus, and Emerging Sources Citation Index (ESCI). It is an open access, peer-reviewed journal. GSJ targets an international audience and has authors, reviewers, and deputy editors from different countries all around the world, specialised in the spine. Get exceptional insights from the GSJ Focus Issues

GSJ Focus Issues provide you with insights into topics such as: clinical practice guidelines for the management of degenerative cervical myelopathy and traumatic spinal cord injury, spinal infections, spinal trauma, rare complications of cervical spine surgery, and more.

Access articles by topic, sorted from A–Z

GSJ aims to provide readers with a more organised and efficient way to read articles on certain topics. Discover topics with article collections handpicked by the editors, such as: spinal deformity, spinal tumours, minimally invasive spine surgery, spine trauma, and many more.

Listen to GSJ podcasts on the go

Discover podcasts on topics such as "Essentials on How to Write a Paper" by deputy editor Michael Fehlings, and many