The Spine Times Amsterdam Issue 2

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AMSTERDAM /// TuesDAY, 29 May 2012 /// /// ISSUE 2

World Spine Care Organization

EuroSpine Program Committee

World Spine Care (WSC) was founded in 2008 as a multinational, non-profit charity organization focusing on a universal care for the devastation caused by spinal disorders in the developing world, inspired by Dr. Scott Haldeman, President and CEO. The organization consists of an inspiring and international spectrum of healthcare professionals including medical specialists, surgeons, chiropractors and physiotherapists who continually work on developing a universally applicable model for the care for spinal disorders.

What do we do?

Even though spinal disorders are amongst the most serious, often devastating, painful and debilitating health problems impacting rural communities in developing countries, there is often no effective spinal care available. The patients do not have access to neurologists, spine surgeons, rheumatologists, chiropractors or physical therapists. WSP‘s multidisciplinary aim is to work effectively and step-by-step with local healthcare partners, corporate and foundation partners, collaborating institutions in order to deliver and ensure appropriate care for those in need. WSC integrates the best available scientific evidence into the cultural, political, medical, and economic values of respective communities.

Current projects: In 2011 WSC launched the Shoshong project in Botswana which is currently the flagship assignment of the organization. The project does not only offer upto-date educational programs and significant research components, primary assessment and treat-

ment for the community but also follow-up care with specialized medical intervention. The second major project is the spine care clinic which opened in partnership with the Ranthambhore Sevika Hospital, in the town of Sawai Madhopur, India. The Sevika Hospital serves approx. 250,000 people of 96 villages and has not been able to treat any back pain complaints until now.

Main aims: Building Sustainable Capacity: The deployment of WSC clinics is key to building up capacity. Developing a Universal Spine Care Toolkit: WSC is researching the primary tools needed for the delivery of effective spinal care in the developing world. The WSC clinical model provides integrated, inter-professional protocols for screening, assessment and treatment of the full spectrum of spinal disorders. Education: Passing on knowledge is essential to the local healthcare system - the training of front line health care workers, exposure of local spine care professionals to specialist expertise brought in by WSC, and the provision of scholarships to exceptional local students in host regions. Furthermore WSC will provide community education on the prevention of spinal injuries and spine hygiene. This will enable the spine care centers to eventually be run by local practitioners. For more detailed information about the World Spine Care model and what you can do to help go to

Scores are scrutinized for aberrations, sometimes a wide range of scores with an overall high mean suggests controversy and this might represent a factor which would stimulate discussion after the podium presentation. We have a ‘Best of Show’ session where the highest scoring abstracts are grouped together – all of them are under consideration for the EuroSpine Award. Basic science papers are allocated to the most clinically relevant sessions to integrate the basic science advances better with clinicians. We found in previous meetings that pure science papers occupying a full session resulted in lower session attendance.

All abstracts submitted are reviewed ‘blinded’, meaning that identifiers of authors and institutes are removed. This reduces the risk of bias. Each abstract is reviewed by at least three or often even four reviewers. This improves the ‘fairness’ of the process and reduces the effect of personal preferences by the reviewers. Each abstract is scored from 0 to 15, with the highest score being the best. There are so many abstracts submitted that it would be impossible to review them all individually. This is the reason why we have categories for submission. There is a lead reviewer and 2 or 3 coreviewers for each section. There are five categories, growing spi- What are the numbers? ne and deformity, cervical spine, basic science, non-degenerative EuroSpine 2011 in Milan (trauma, tumor and fracture ) and • 878 submissions Accepted 86 full podium degenerative spine. • 75 short synchronous sessions • 98 e-posters

Spineweek Amsterdam 2012 • 498 submissions • Accepted 84 full podium • 58 ‘Quick fire’ short reports • 61 e-posters

Why the difference?

Phil J. Sell

After the blind review, which is carried out online, abstracts are ranked. Depending on the available podium time the highest scored abstracts of each category are accepted. Any papers scoring the same at the ‘cut-off ’ score will be discussed.

Well, it is probably a combination of factors. Spineweek is a combined meeting of many prestigious societies. Authors may submit to different societies. Unfortunately, multiple submissions of the same paper to different societies is not permitted. This might cost the dilution. The good news is that the chance of acceptance at Spineweek is much higher than in a dedicated SSE Congress. The average score of abstracts in Milan was 7.43 and

the average score in Amsterdam was 7.88. This is not a statistically significant difference.

Whats New? The debates in Milan were well attended and the feedback was positive. There are only two debates for this meeting: ‘Is discography dead in this decade’ and ‘Surgical management of early cervical myelopathy Not yet… not yet ….too late!’

What’s the future? If you have ideas for Liverpool 2013 or would like to join the review process we would like to hear from you. Come to the EuroSpine booth and speak with us. Philip J. Sell, chair of the 2012 Program Committee

2012 Program Committee: - Phil J. Sell, UK, chair - Jörg Franke, Germany - Selcuk Palaoglu, Turkey - Thomas Blattert, Germany - Barend van Royen, NL - Josef Grohs, Austria

Co-Reviewers: - Dietrich Schlenzka, Finland - Ashley Cole, UK - Jorge Mineiro, Portugal - José Casamitjana, Spain - Tim Pigott, UK - Dimitros Korres, Greece - Markus Schultheiss, Germany - Thomas Zweig, Switzerland - Lester Wilson, UK - Kai Scheufler, Austria - Michael Grevitt, UK - Marinus Kleuver, NL - Mark Lorenz, USA - Helmut Hiertz, Austria

AMSTERDAM /// TuesDAY, 29 May 2012 /// /// ISSUE 2

EuroSpine Lunch Symposia 2012

Discover the canals and the city

Tuesday, May 29 Hall G104-105 „Hot case - cold case“ - Cervical arthroplasty Chair: Michael Mayer, Munich, Germany A new interactive format of the EuroSpine Lunch-Symposium: No more „Frontal-Teaching“ – instead complete interactivity between the moderators, panelists and the audience! This will be the new format for the EuroSpine Lunch Symposium on „cervical disc replacement“ this year. The lunch symposium on Tuesday May 29, 2012 will contain case presentations, panel discussions (Bertagnoli, Kandziora, Papavero), audience’s opinion through an Audience Response System (ARS), questions from the Spine Tango team and finally fact checks and summarizing statements to the most controversial issues in total cervical disc replacement.

The 165 canals provide Amsterdam with the certain atmosphere which you can best embrace on a canal cruise (they usually take an hour and leave from Damrak at the Central Station) or while strolling around the streets and bridges. The waterways provide an attractive border to the artsy locals of the Museum Quarter, the Jordan and the Pijp – offering shops, galleries and authentic cafés.

The two moderators Michael Mayer and Ralph Kothe are excited and optimistic that this new format will be successful and are looking forward to welcome you as part of this „experiment“. 12:45 - 14:00 Interactive Case Discussion Moderator: Michael Mayer, Munich, Germany Co-Moderator: Ralph Kothe, Hamburg, Germany

The most picturesque of the canals is the Prinsengracht, lined by shady trees and funky houseboats. As you wander up to this area, you‘ll find the tall spire of the Westerkerk and the famous

Round Table: Luca Papavero, Hamburg, Germany Rudolf Bertagnoli, Bogen, Germany Frank Kandziora, Frankfurt, Germany Wednesday, May 30 Hall G104-105 Paediatric Craniocervical Conditions Chair: Claes Olerud, Uppsala, Sweden

Anne Frank Huis. Smaller canal areas which are worth visiting include the historic Brouwersgracht and retail area of Leliegracht. Discover the antique district around Spiegelgracht and Herengracht to see the splendid 17th century canal houses. Walk to the Begijnhof and embrace the silence and the beauty of the garden to find some peace of mind and soul in the midst of the hectic city center. After a challenging day, recreation can be found at Vondelpark, which offers an abundance of lawns, ponds and footpaths. Also worth visiting is the famous Red Light District with its no-

torious reputation. Located in a rough triangle formed by the Central Station, it is the oldest part of the city. Along its streets, the multi-cultural community of prostitutes, junkies, carpenters and cops form a surprisingly laidback atmosphere.



Prinsengracht 281



Nieuwezijds Voorburgwal 373

C VONDELPARK near Vondelstraat and Eerste Constantijn Huygensstraat

Spine model change brings cost savings and efficiency with sustainable development - New trends Over the past fifty years, innovation has driven the evolution of orthopedic and spinal implant technologies. Sophisticated instrument and implant systems have achieved broader indications, better outcomes and faster OR times. However, this evolution also involved increased complexity and cost, running contrary to the realities of today’s healthcare economic challenges. The need for more cost-effective, safe and efficient surgical systems started a new wave of innovation which extends outside the operating theatre.

12:45 - 13:00 Introduction, embryology and anatomy Claes Olerud, Uppsala, Sweden 13:00 - 13:15 Os Odontoideum Heiko Koller, Bad Wildungen, Germany 13:15 - 13:30 Rotary Subluxation C1-C2 Adrian TH Casey, London, UK 13:30 - 13:45 Klippel-Feil / Assimilation of C1 and other Congenital Abnormalities in Kids Philippe Bancel, Paris, France 13:45 - 14:00 Kyphotic deformity in Neurofibromatosis Heiko Koller, Bad Wildungen, Germany

It is interesting to consider the current model of preparing an orthopedic set for surgery. Sets are delivered from a sales rep’s car or via overnight delivery from an industry loaner facility. The hospital then adopts all responsibility (cost and risk) for getting

EuroSpine Meeting Website from the scientific program and venue information to the latest Discover EuroSpine’s new web- news and multimedia content. site www.eurospinemeeting. com, especially designed for the The ePosters are also available annual EuroSpine congresses. It online at epostersamsterdam. features all relevant information

the set “surgery ready.” The costs and burdens of those processes have forced many hospitals to outsource these activities. Upon completion of the surgical procedure, the burdens continue. Post-op cleaning and decontamination is required to prepare for the next surgery, or for return to the manufacturer. There is a real concern about safety in the current model of field replenishment, minimal quality control of instruments and lack of viable traceability programs lead to significant risk for the hospital, surgeon and patient. These shortcomings are receiving increased scrutiny from regulatory authorities around the globe. The implementation of Unique Device Identification (UDI) standards is now a question of “when” rather than “if.” European measures issued by

Commissioner John Dalli in February 2012 are moving quickly towards defined requirements for implant traceability. The challenges of cross-contamination are a priority for hospitals and surgeons alike. The risk of faulty cleaned and sterilized equipment has been exacerbated by the emergence of highly complex instrumentation, often provided without dismantling and cleaning instructions. These processing challenges have been linked to post-op infection rates that have remained stubbornly high. Such clear shortcomings in the existing model beg the industry for answers, and are inevitable. In order to support new concepts some companies offer a complete lumbar pedicle screw system in lightweight, sterile, traceable and single-use surgical kits. In fact, a set of instruments and implants ... continued on page 4


Did you know that the name Amsterdam originates from the first built dam on the Amstel river in the 12th century. Did you know that the first documentation of the name “Amstelledamme” occurs in the toll concession of Floris V, Count of Holland, dated October 27, 1275.

Did you know that the first documented Jewish settlement in the Netherlands goes back to the 12th century and that Amsterdam was one of the biggest centers of Jews in the 18th century counting almost 20.000 people. Did you know that the Golden Age of Amsterdam

was the period of 1585 until 1672 and that the Royal Palace (Dam Square) as well as the Westerkerk date back to that time. •

Did you know that Amsterdam suffered badly from the economic recession between 1795-1813 and that only a few houses survived cause of the lack of maintenance.

Did you know that the world’s first same sex marriage took place in Amsterdam in 2002.

Did you know that you find 206 paintings by Van Gogh and 22 Rembrandts in Amsterdam.

Did you know that you can visit 51 museums in the city.

Did you know that although Amsterdam is the official capital city of the Netherlands, the Parliament is located The Hague.

Did you know that Amsterdam counts as much as 175 different nationalities and that almost 50% of the population are immigrants or children of immigrants.

AMSTERDAM /// TuesDAY, 29 May 2012 /// /// ISSUE 2

City MAp of amsterdam







a great culinary feast awarded with one Michelin star

up and above

authentic Indonesian bling-bling

In the center of Amsterdam you will find Hotel NH Barbizon Palace, with the beautiful restaurant Vermeer, awarded with one Michelin star.

Restaurant Ciel Bleu, yet another one Michelin star restaurant, is one of Amsterdam’s most remarkable dining spots. Located on the 23rd floor of the Hotel Okura it offers a panoramic view of Amsterdam’s city centre. The breathtaking view together with the personal hospitality creates a unique atmosphere. The ambitious kitchen offers what is best described as “Cuisine Creative” – a little French with seasonal products and characterized by innovation. The combination of the unique creations on the plates with the perfect wine and the view complete an amazing experience.

The restaurant is located on the up-and-coming Amstelveenseweg, slightly hidden in the Red Light District. Its clean interior and cool crowd do not detract from the fact that the food is exquisite.

Ferdinand Bolstraat 333 Tel.: +31 (0)20 678 74 50 Price: €€€€ - €€€€€

Amstelveenseweg 158-160 Tel.: +31 (0) 20 675 5000 Price: € - €€

The kitchen is a creative composition of tastes, textures and temperatures by chef Christopher Naylor. A stimulating experience you should not miss. An extensive wine list with more than 300 wines from all over the world, offers a wide variety of choices. Sommelier Simon Veldman can offer the guest a suitable wine package. Worth every cent. Prins Hendrikkade 59-72 Tel.: +31 (0)20 556 48 85 Price: €€€€ - €€€€€


One of the best Asian Restaurants in Amsterdam with an authentic and spicy kitchen. Prepare for an enormous selection of delicacies such as marinated meats, fragrant curries and crunchy salads as well as spices and flavor explosions.





internationally French

visit Jamie Oliver in Amsterdam

Restaurant Te Pas at the Lijnbaansgracht offers great French cuisine with a twist.

One of the many Jamie Oliver restaurants around the world serves an amazing array of fresh modern Italian dishes. The former warehouse location is huge and spacious, with lively graffiti art adding a hip tone to the minimalist environment. In the evening, a special tasting menu is offered with Oliver’s own dishes boasting only the freshest, local ingredients.

The restaurant is run by two brothers – while one is running the kitchen the other takes care of service and atmosphere. Since the restaurant is located near the Leidseplein and the Museumplein, one can combine a rewarding dinner with a visit to the theatre, the Concertgebouw, the Rijksmuseum or the Van Gogh Museum.

Lijnbaansgracht 274 Tel.: +31 (0) 20 773 59 90 Price: €€ - €€€

Fifteen Amsterdam combines good food, hospitality and friendliness to train young people to cook – a project that should be supported. Jollemanhof 9 Tel.: +31 (0) 900 343 8336 Price: €€

AMSTERDAM /// TuesDAY, 29 May 2012 /// /// ISSUE 2

ISSLS - Welcome message

Continued from page 2

On behalf of the Executive Commitee and the Members of the International Society for the Study of Lumbar Spine, better known as ISSLS, I am looking forward to welcome you to our 39th annual meeting that is a part of SpineWeek 2012 in Amsterdam.

for a single level lumbar fusion weighs a mere 2kg (4 lbs.). Being sterile packaged, the technology is surgery-ready at a moments notice, with no waiting time between cases. A versatile instrument kit can accommodate open and MIS surgical techniques. The efficiency of this model when compared with existing technologies is striking. The system can be provided in traceable and sterile kits that allow the surgeon to customize the implants selected to the patient’s needs, while providing full traceability for each instrument and implant used in the case. The traceability program is optimal and puts no additional burden on the hospital. The risk of improperly cleaned and sterilized equipment is eliminated with new, pre-sterilized technology available for every case. The risk of out-of-calibration instruments is eliminated and the incidence of lost/stolen instrumentation is also dramatically reduced. Of course this creates the problem of the green technology with all those single use instruments thrown away in the trash boxes. The choice of recyclable, highperformance polymers and establishment of a manufacturing process utilizing no toxic materials and low pollution protocols produce fewer carbon emissions. Conversely, the repeated cleaning, decontamination and systematic sterilization of traditional instrumentation consumes thousands of cubic meters of water and thousands of kilowatts annually (300 liters and 40 kilowatt/hours per sterilisation for one cycle). Reverse logistics (returning the sets) of 15kg and more of instrumentation and implant trays

tigious ISSLS Prize for Lumbar Spine Research, The ISSLS MacNab/LaRocca Research Fellowship Award, The ISSLS Clinical Travelling Fellowship, The ISSLS Wiltse Lifetime Achievement Award and The International ISSLS Fellowship Award. I would strongly urge you to join us at our ISSLS sessions during the SpineWeek. We have a single plenary session that integrates our broad membership and important visitors. You can be sure to listen to some fascinating research and new ideas presented along with vigorous discussion. A few highlights of the ISSLS sessions include:

Founded in 1974, over the past 37 years, ISSLS successfully achieved its aim to bring together individuals worldwide who have richly contributed or who have a high interest in the study of the lumbar spine in both health and disease. ISSLS is unique with its truly multidisciplinary and international membership. Our members come from 28 different countries and constitute a wide spectrum of expertise including anesthesiology, basic research, chiropractic, engineering, internal medicine, neurosurgery, orthopedic surgery, physical therapy, physical medicine, psychiatry, psychology and radiology. The natural advantage is that ISSLS meetings form a fertile ground for cross-pollination of ideas as it attracts the cutting-edge research from all sub-specialities concerning the lumbar spine.

1) ISSLS Prizes for Lumbar Spine Research - Presentation of Award papers (Thursday 7:30 a.m.; Auditorium) 2) Harry Farfan Presidential Lecture on “High Quality Care at Low Cost – is it a reality?” by Dr. Devi P. Shetty, leading cardiothoracic surgeon and medical economist, Bangalore, India (Thursday 8:40 a.m.; Auditorium) 3) ISSLS Presidential Address by Dr. S. Rajasekaran on “ Publish to Flourish – Is it corrupting Science?” (Thursday 9:20 a.m.; Auditorium) 4) Debates on Fusion Length in Degenerative Lumbar Scoliosis (Friday 4:00 p.m.; Forum) and the Etiology of Disc Degeneration (Friday 4:40 p.m.; Forum) 5) Invited lectures on Biology of Disc Degeneration (Tuesday 4:00 p.m.; Forum), Classification of Spinal Stenosis (Wednesday 10:30 a.m.; Forum), and Relationships between Industry and Researchers (Friday 11:10 a.m.; Forum) We are looking forward to your participation in the ISSLS sessions.

S. Rajasekaran

Dr. S. Rajasekaran President - ISSLS

Apart from the high quality annual meetings, ISSLS promotes scientific research with its pres-

Imprint The Spine Times is a free congress newspaper published by EuroSpine. Publishing House: EuroSpine, The Spine Society of Europe Judith Reichert Schild Seefeldstrasse 16 8610 Uster-Zürich Switzerland

requires significant cost and environmental impact on the process. The lightweight, efficient and single-use model can significantly reduce the per-surgery consumption rate. As a result, the energy balance appears to be in favor of a single-use model. In summary this new single use model providing the same quality of implants with single use instruments allows to save energy, to employ nurses in the OR instead of cleaning instrument sets with respect of environment. This new concept decreases the global health care costs, it offers the highest safety in terms of sterility and is always ready to use. Key messages: all implants follow the same tests before coming onto the market but other simple parameters have to be analyzed today because of: sterility, environment impact, and safety.

sterilization produce high carbon emissions returning the sets of instrumentation and implant trays brings significant costs

Safety viable traceability of implants, multiple sterilisation

B) Possible solutions: Sterility: single-use surgical kits of instruments, always ready to use

A) Problems:

Environmental impact


recyclable, no toxic materials for instruments

cleaning and decontamination of instruments, time consuming for nurses

Environmental impact decontamination and systematic Contact:

Safety full traceability of implants Jean Charles Le Huec, EuroSpine President Contributors: Andrea Berner, Jean Charles Le Huec, Phil J. Sell, S. Rajasekaran

Publisher: Jean Charles Le Huec (EuroSpine President) Haluk Berk (EuroSpine Secretary)

Photographs: EuroSpine Society, Martin Steiger, Shutterstock.

On-Site Editors: Emre Acaroglu, Thomas Blattert


Editor-in-Chief: Christian Lendl

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Burning Questions Thank you for your active participation in the first interactive voting process. As more than 50% of the colleagues want Spine Surgery to become an independent, board certified specialty, would you vote for a hormonized, panEuropean curriculum and certification protocol?

YES: To participate you just have to scan one of the QR-codes (according to your designated answer) with your smartphone. The results will be published in the next issue.


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