The Spine Times Issue No. 3

Page 1

ISSue 3 /// Friday, October 21, 2011 ///

150 years of national unity

Education Program

Milan, October 19-21, 2011

Introducing the new president

A Brief overview of the SSE education plan The Spine Society of Europe (SSE), together with the EuroSpine Foundation, wants to position itself as a major driving force in spine education in Europe. Two main objectives are defined: a) to deliver basic spine education to future spine specialist and b) to deliver continuing education to existing spine specialists. A European Spine Course Diploma and a European Spine Fellowship are established, receiving consistent accreditation from the EACCME (Figure 1). We must work to upgrade the level of knowledge of young spine specialists, and to integrate orthopedic and neurosurgical perspectives, for “a true European spine specialist” formation. At the present time, EuroSpine is sharing this

For continuing education, SSE is organizing one-day master courses based on case discusFive diploma modules are pre- sion for trained Spine Speciapared under standard moda- lists. lities to get consistent quality across Europe, with a future Finally, next year in March, constant review and improve- a new SSE-ESF educational ment process assured by SSE- project will start; the Education Week, where all the five ESF. diploma modules will be deliIn addition, a European Spi- vered with practical workshops ne Fellowship is launched this and cadaver labs. Please find year, with the first 4 grants for the booklet by the ESF in your a 6-months fellowship to be congress bags. spent in some multidisciplinary certified European spine cen- Details of the ambitious plans ters. This fellowship program can be seen on the ESF weboffers the opportunity for site (www.eurospinefoundyoung surgeons who have fi- We wait for your nished their board certification participation, either as delegate in orthopedic or neurosurge- or as faculty! ry, to work in an environment where spine surgery is the main Marco Brayda-Bruno surgical activity. project with over 20 national spine societies and EANS.

European Spine Diploma European Spine Course Diploma

European Spine Fellowship Diploma

Continuing education Master Courses


Surgical Training

Module 1 Basic Comprehensive Course

Module 2 Degenrative Challenges

Module 3 Trauma, Tumors and Infections

Module 4

Module 2 6 months or Professor Fellowship 12 months

Any symposium Travelling and On site

Module 3

Module 4

Spinal Deformities

Annual SSE meeting

Jean-Charles Le Huec, current Vice-President and upcoming President, was interviewed by Emre Acaroglu.

Dear Dr. Le Huec, welcome to Milano! How do you feel about this coming year? The society is growing and the numbers of responsibilities are increasing. EuroSpine is the biggest spine society with connections to all European national societies. Our role is now recognized at the UEMS in Brussels, which gives us credit to be an official partner for the spine disease treatment, mainly the surgical part. Do you foresee any major challenges? We have two important missions. The first one is the education provided by the SSE. The certificate of attendance that we deliver today could become an official European diploma, because the quality of the courses and the content have been evaluated and validated by an internal audit. The second mission is the registry, an European spine database which allows to create a benchmark of the spine disease treatment in the whole of Europe. Could you briefly outline your vision for the coming years of EuroSpine? The coming year is the year of aging in the EU and the SSE wants to become the first contact of the European Health Council for that. The aging spine is an important thing to manage as it inter-connects with a lot of problems, like low back pain and vertebral osteoporosis. Our registry can be open to non-surgical patients, allowing a larger analysis and helping to promote solutions. Active aging is different from healthy aging and this concept is not always well understood. Maintaining elderly people at home and allowing an active aging must be combined with healthy adapted aging solutions.

What would be the benchmark of your presidency? The society is now well structured with a good status, but we need to be proacRevisions and Complications tive. We will promote our society more using a renovated website, creating patient lines and so on. The executive committee and all the other committees Figure 1: An overview of the European Spine Education Project will have more interactions than in the past. I want to promote SSE as a reference for spine care, becoming the first contact at the European Union EuroSpine in numbers Council, but also providing guidelines (with the help of the European Spine This year‘s congress attracted participants from 81 countries. The most represented countries were Foundation) for all national societies. Connections with the industry must Italy (253), Brazil (177) and China (167). More than 2300 participants attended the congress tobe clear and honest, health technology assessment is necessary and we must gether with over 1300 representatives from 140 companies of the medical industry. The all-time promote innovations with enhanced collaboration. high of 600 submitted abstracts emphasized the overall relevance of the annual EuroSpine meeting. Module 5

Module 5 /// friday, October 21, 2011 /// ISSue 3 ///

Page 2 Interviewing the award winners

Fratelli d’Italia (Brothers and Sisters of Italy)

Award Winner Antonius Rohlmann Antonius Rohlmann, Winner of 2010/2011 European Spine Journal/ Grammer Award for his paper „Loads on a spinal implant measured in vivo during whole-body vibration“ (together with Barbara Hinz, Ralph Blüthner, Friedmar Graichen and Georg Bergmann), was interviewed by Marco Teli.

We have read with great attention the messages of goodwill sent by the leading heads of state worldwide to Giorgio Napolitano, President of the Italian Republic, to celebrate the 150 years of the Unity of Italy. Leaders of the calibre of David Cameron, Nicolas Sarkozy or Barack Obama all expressed their great enthusiasm. Obama in particular referred to Garibaldi and his ideals, which today are the legacy of millions of American men and women of Italian descent and proclaimed March 17, 2011 a day of celebration to commemorate this anniversary.

You have won the Grammar award of the European Spine Journal this year. Congratulations! What would you like to say about this, was it a surprise? Yes, it was really a big surprise when I heard this! The chair of the committee called me on Sunday evening and told me about the award. I am very happy about it. Your study is on the effect of the frequency and direction of vibration on forces encountered by spinal implants. Why is this important to know? After surgery the patients want to know if it is dangerous for them to drive a car or to use public transport. Therefore it is important to know what loads are acting on the spine and how you can reduce these loads in order to reduce risk of implant subsidence and fail of the implant and the bone. Do you think this type of loading may be beneficial for fusion? Yes, I think also for bone fusion this information is important. It’s important for all people who are operated on the spine; they like to know whether they can drive a car. We could show that the risk is relatively low when they lean against the backrest. The loads are lower than when sitting relaxed. When you are standing freely in the bus, it might cause loads that are twice as high as during normal sitting. These loads are even higher than those during walking. What should the conclusion for our readers be? Do you think your results indicate any modifications in the general practice? I think we can tell our patients that they are allowed to drive a car very shortly after surgery if they lean against the backrest. We should advise our patients that if they use public transport, they should sit and lean against the backrest, so that the loads are low on their spine. Would you recommend using a brace after the operation – based on your results? We have also measured loads when the patients were wearing a brace. These results are not published yet but it seems that the loads are only slightly reduced by a brace. Therefore I think that it is not necessary in a normal case to wear a brace.

Many of the leading people relate to Garibaldi. But why is the „Hero of the Two Worlds“ so popular? Has this man become a legend in his own right? Were his deeds predestined to fail or the result of an international conspiracy? Certainly Italians owe him a lot because with his assistance the Italian Nation was finally born. Garibaldi was not the only protagonist of the „Risorgimento“ („Resurgence“), but he was perhaps one of the few who organized the „Expedition of the Thousand“ to Marsala with no prejudices. If this had not happened, our peninsula would still be a mere patchwork of six weak states today.

Pictured on horseback (his Brazilian wife Anita had taught him how to ride a horse), wearing his simple and unconventional style of dress - a poncho, a simple shirt, and a handkerchief around his neck, scruffy beard and hair - Garibaldi represented the aspirations of the new social classes. Audacity, passion, pride and free spirit: this is the Italian dream. Garibaldi was a fighter - side by side with the French in the Franco-Prussian war or in South America - struggling for freedom.

conditions in Sicily’s sulphur mines. Francesco Crispi‘s wife Rose Montmasson was an Italian patriot and is famous for being the only woman to have participated in the „Expedition of the Thousand“.

Women were not the only protagonists in the building of the Italian Nation: we must also mention Mazzini, Cavour and Victor Emmanuel II, the „Gentleman King“. Ironically, in those years malaria was a common element of unity apart from the Expedition of the Thousand. This disease Women from every social class was spread from Piedmont to adored him. They were attrac- Tuscany, from Lazio to Sicily. ted by his charm as a man and Cavour and Victor Emmanuel as a leader. Ana Maria de Jesus died of it. Ribeiro da Silva (better known as Anita Garibaldi) was of And now what is left for us afBrazilian descent and is reco- ter 150 years? As a nation, we gnized as the Heroine of the remain to be young, as stronTwo Worlds since she followed gly desired by our forefathers. her husband in numerous batt- Men and women have been les in Brazil, Uruguay, France fighting for unification, inand Italy. Lady Shaftesbury, an dependence, the constitution English aristocrat, met Gari- and in a word, freedom. Our baldi and begged him to give task now is to defend those vaher a lock of his hair. Jessie lues that are still so important White Mario was an English today. patriot who had become a naturalized Italian and participa- We are grateful to Toniella and ted as a nurse in four milita- Augusto Lamartina for their ry campaigns with Garibaldi. great contribution in writing From 1890 she investigated this article. problems regarding pellagra in the country areas resulting Claudio Lamartina from the impoverished diet of the farm workers and working

Award Winner Leena Ristolainen Leena Ristolainen, Winner of the 2011 Full Paper Award for her paper „The natural history of Scheuermann´s kyphosis – A comparative study after 37-year follow-up“ (together with J.A. Kettunen, M. Heliövaara, U.M. Kujala, A Heinonen and D. Schlenzka) was interviewed by Sophie Haslinger. Congratulations, Dr. Ristolainen! You have won the full paper award of EuroSpine this year. What would you like to say about this, how do you feel? I am so surprised about this price. I didn’t understand that I could have it. Your study is one of the view studies on the natural history of Scheuerman’s kyphosis with a large control group. Why is it important to know the natural history? It is important to know what happens when you don’t treat Scheuerman’s kyphosis, so you must know the natural history of it.

Meeting of EuroSpine Board and Administration with this year‘s PCO AIM and the 2013 Liverpool PCO Mondial together with representatives from Zimmer, Medtronic and Depuy J&J to discuss the Eucomed guidelines and their integration into future EuroSpine meetings.

watch the Interviews Online

What should the conclusion for our readers be? Do you think your results indicate any modifications in the general clinical approach to Scheuerman’s kyphosis? Scheuerman patients can manage well in their lives, although they have quite a lot of pain and difficulties and restrictions in activities of daily living. What are we indicating? I think surgeons may think twice if they are going to operate Scheuerman’s kyphosis, especially if their kyphosis is quite small. One needs to ask if it’s worth to operate, because they can manage in their lives so well. It can be a quite big operation. Watch the full interviews on

Watch all interviews on or scan these QR-codes to watch them directly on your smartphone!

Antonius Rohlmann

Interview Ciaran Bolger

Interview Leena Ristolainen

Interview Jean-Charles Le Huec

ISSue 3 /// Friday, October 21, 2011 ///

Page 3 BRIEF HISTORY OF SPINAL SURGERY IN ITALY Giro d´Italia Part 3/3 by Pietro Bartolozzi

thic scoliosis were improved. Thanks to improved stabilization methods, surgeons began For a while, the GIS published to face spinal secondary and an official magazine contai- primary tumours with brilliant ning papers presented at the results in Bologna, Rome, and Milan. annual congress. In those years began the experience of anterior spinal surgery imported from North American, English, French and Hong Kong Schools.

A comment can be made about years ranging from 1950’s to 1980’s: they were years of affirmation of vertebral instrumentation and spinal stabilization in response to pathological situations characterized by deformity or instability. Arthrodesis was the essential target to obtain a definitive result.

For the anterior spinal surgery dedicated instrumentations were developed and the cervical spinal surgery was improved by the use of stabilization instrumentations; we have to remember on this subject the During those same years the progresses made by the School development of imaging technologies such as CT and MR of Pavia. allowed to obtain not only In the early 80’s instrumented greater diagnostic accuracy spinal stabilization using Har- but also the development of rington technique was propo- minimally invasive techniques sed as a solution for vertebral such as discectomy done with fractures; in the same time Roy microscopic techniques, or the Camille proposed a new tech- possibility to do a biopsy or a nique using pedicular screws vertebral reconstruction with and from that date started the a trans-pedicular approach. diffusion in Italy, with always more frequency, of dedicated In the 2000’s started new hard challenges: functional recoveinstrumentations. ry of vertebral segments faced Another new technique was with the use of cervical and introduced in Italy in the same lumbar disc prostheses or agperiod, the Luque technique: gressive surgical treatments with the use of sub laminar for the correction of deforwires, treatment results of par- mity especially in the elderly ticular situations (difficult to with instrumentations suitable solve with previous available for severe osteoporotic conditechniques) such as neuropa- tions.

Medal Lecture 2011 The Medal Lecture of this years‘ congress was given by Angelo Zomegnan, director of the famous Giro d‘Italia, one of the biggest and hardest bicycle races worldwide.

The Giro features an impressive set of numbers: During its 23 days 21 stages are completed. The race visits 17 of the 20 Italian regions and is nearly 3.500 km long. It is not only a competition, it is a „novel

in the most beautiful country in the world“ is also reflected by its concepts: Made in Italy, Tradition, Culture, Fashion and Brotherhood. To strengthen the global impact of this event, the race 2010 started in Amsterdam, the city of bicycle riders. The media numbers of the historical edition of the race in honor of the 150th anniversary of the Italian unity in 2011 proof this global status: More than 2.100 media operators visited the race, it was broadcasted in 168 countries and more than 11 million people watched it live.

In order to have become such an important part of the bicycle world, the event needs to Before becoming director of without an end“, says Zomeg- be „a perfect combination of this huge event in 2004, Angelo nan. The first race was held sport and show“, as Zomegnan Zomegnan was a journalist for in 1909, only 6 years after the concluded his lecture. Gazzetta dello Sport for over first Tour de France. The motto 20 years. „The hardest race in the world Susanna Bonfiglio Program-Highlights for Friday, October 21 On Friday morning two debate sessions will be held in the plenary hall, discussing the topics “My treatment for cervical radicular pain is the best treatment!” (08:30) and “How to treat a L1 burst fracture without neurological symptoms?” (09:15).

2011 will present the outcomes of their studies. The EuroSpine 2011 congress ends at 17.30 in the plenary hall with closing remarks of next year’s President, Jean-Charles Le Huec.

If you have time in between the lectures, don’t forget to visit the exhibition halls and get an At 10:30 Ahmet Alanay and Jean-Charles Le overview of the latest trends and technological Huec will chair the lectures on “The Best of developments. Show papers” in the plenary hall. The authors of the highest scoring abstract submissions as well as the winner of the Full Paper Award

AIM Group International

Eurospine 2011 team AIM Group International is one of the leaders in the organisation of events and conferences, founded 50 years ago. Our philosophy is summed up in: dynamism, reliability, flexibility.

General Coordination Rossella Salvoni

Sponsorship Management Valentina Giordano

Registrations Simona Segneghi, Elisabetta Di Felice

Venue & Services Coordination Fabrizio Rizzi

Exhibition and Services to the Sponsors Elena Aili & Chiara Henin

Hotel Accommodation Chiara Guarino, Maria Rosaria Cavaliere

SSE Lunch and Happy Hour Symposia Margarita Lofthouse /// Friday, October 21, 2011 /// ISSue 3

Page 4 LA MITJA 2012 A half-marathon taking place in Granollers/Barcelona in February 2012

La media maratón GranollersLes Franqueses-La Garriga ha sido y sigue siendo considerada por la Federación Española de atletismo como una de las pruebas atleticas más importantes del calendario. En esta prueba participan conjuntamente atletas de la mejor elite mundial, el vencedor de 2005 fué Haile

Interview with Haluk Berk Gebreselassie, y corredores populares hasta un número que en este año se pretende que llegue a los 10.000. Si consideramos que un corredor capaz de correr una media maratón no es un corredor ocasional sino un deportista que entrena continuamente, nos hemos propuesto un trabajo de investigación que pretenda conocer de la manera más rigurosa posible los efectos ,adversos o beneficiosos, sobre el raquis. Contamos con la colaboración de la comisión organizadora de la media maratón que de forma desinteresada nos permitirá realizar unas encuestas a

los corredores populares que serán realizadas on line y harán posible un estudio estadistico exhaustivo del que esperamos obtener datos de interés para los profesionales de la columna vertebral. Agredecemos en gran manera el soporte de EuroSpine. EuroSpine is endorsing the event and the survey, „Relationship between Back Troubles and Running“, conducted by two of our members: Doctor Frederic Font Vilà and Doctor Federico Balagué. Frederic Font is in the same time an active participant of the marathon.

Haluk Berk, Secretary of the EuroSpine Society, was interviewed by Emre Acaroglu. This is your second EuroSpine annual meeting as a Secretary. Has it been a good experience for you so far? Yes, it has been a very good experience for me. The meeting is evolving and getting bigger in many ways. We have looked at the abstracts that have been sent and the quality is getting better. We can say that not only the numbers attending our meetings are increasing but the quality as well.

Dates to Remember Membership Fee Payment

Task Force Research Course Fundamentals of research: Learning to design Please be aware that members who have forgot- my own clinical studies ten to pay their dues for three consecutive years Monday, February 27 - Friday, March 2, 2012, have received a payment reminder before the Istanbul, Turkey meeting. Maximum Attendees: 24 participants (priority The Deadline for Payment is Monday, October will be given to SSE members) 31, 2011 if you do not want your membership to Registration Deadline: end. Find out more about membership renewal Tuesday, January 31, 2012 on Future Annual Meetings SpineWeek / EuroSpine 2012 May 28 - June 1, Amsterdam, The Netherlands Local Hosts: B. van Royen, M. de Kleuver, W. Peul Abstract Submission Deadline: Tuesday, November 15, 2011 Early Bird Registration Deadline: Tuesday, January 31, 2012 EuroSpine 2013 October 2 - 4, Liverpool, UK Local Hosts: Tim Pigott, Martin Wilby, Gordon Findlay EuroSpine 2014 October 1 - 3, Lyon, France Local Host: Jean Charles Le Huec EuroSpine 2015 September 2 - 4, Copenhagen, Denmark Local Host: Finn Christensen

Module Courses 2011 Budapest Basic Comprehensive Module European Spine Course Diploma (Module 1 in English) November 10 Trauma, Tumors and Infections European Spine Course Diploma (Module 3 in English) November 11-12

How about being the secretary of EuroSpine, is there anything new in terms of EuroSpine that our readers may like to know? There are structural changes. We will propose new committees to the general assembly. A patient line group became a committee and as international relations are increasing, we made a committee that will deal with global relations. Also E-learning is getting very important in our digital era, we have to keep pace and so E-learning will be a committee along with the website. We will develop the digital ways of being the society. Our members will have the opportunity to go to our member’s site and will have many opportunities for their educational activities. Shall we finish this by inviting everybody to participate in the committees for the sake of their communities and societies? Yes, we will have many members needed for the new committees. We need new blood – working young spine surgeons! Watch the full interview on

Dubai Basic Comprehensive Module European Spine Course Diploma (Module 1 in English) November 26 Trauma, Tumors and Infections European Spine Course Diploma (Module 3 in English) November 27-28 Program and registration:

Inspired discussion after the Medal Lecture.

Imprint The Spine Times is a free congress newspaper published by the EuroSpine Society.

Publisher: Ciaran Bolger (EuroSpine President) Haluk Berk (EuroSpine Secretary)

Publishing House: EuroSpine, the Spine Society of Europe

Local Hosts: Marco Brayda-Bruno, Claudio Lamartina

Contributors: Emre Acaroglu, Pietro Bartolozzi, Susanna Bonfiglio, Marco BraydaBruno, Maria Carolina Guidotti, Sophie Haslinger, Claudio Lamartina, Marco Teli

Editor-in-Chief: Christian Lendl

Photographs: Martin Steiger, Shutterstock

On-Site Editors: Emre Acaroglu, Marco Teli



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