September 20, 2024
Past President Dr. Lawrence Lenke Ushers in the New SRS President at the Annual Meeting
Sep 10–14, 2024 | The 59th Annual Meeting of the SRS was held in Barcelona, Spain, this year. The meeting's program was created from the best submissions of more than 1,300 abstracts. Co-Chairs Ivan Cheng, MD, and Mitsuru Yagi, MD, PhD, along with the Annual Meeting Scientific Program Committee, did outstanding work in assembling a great program that featured an international and forward-thinking focus.
Dr. Lenke with Marinus de Kleuver, completing his tenure as the 2023-2024 SRS president
The SRS Annual Meeting began with the prestigious Hibbs Society meeting on Tuesday. Sessions during this time covered topics in pediatric and adult spine treatments and ‘New Technologies in OR Daily Life’.
The Pre-Meeting Course on Wednesday focused on the theme of Long-Term Outcomes of Spine Deformity Surgery, Update on Current Knowledge and Future Directions, planned by Brian Hsu, MD and Javier Pizones, MD, PhD, Annual Meeting Education Committee Co-Chairs. After presenting some valuable longterm outcome data that can help guide decision making, the precourse then turned towards the future. How can we learn and do better? Presentations included the role of sarcopenia and osteoporosis on adverse events; the impact of radiomics and machine learning on surgical planning; the behavioral patterns of mechanical complications; the role of knee pathology on compensatory mechanisms and updates on the effectiveness of T4-L1 hip axis correction.
The Opening Ceremonies on Wednesday evening started with a welcome by local host, Dr. Ferran Pellisé, and this year’s Howard Steel Lecturer, Bruno Dubois. It included a time to highlight award and research winners, thank donors and corporate partners, and present the Walter P. Blount Humanitarian Award to this year’s deserving recipient, Richard M. Hodes, MD.
Thursday morning kicked off with sessions from the scientific program, followed by the Harrington Lecture featuring Steven Glassman, MD, Professor of Orthopaedic Surgery at the University of Louisville, past President of the Scoliosis Research Society, former Chair of the Professional Society Coalition Task Force on Lumbar Fusion and one-time Program Chair for the North American Spine Society. Two Lifetime Achievement Awards were also presented—they went to Charlie E. Johnston, MD, and Nana Prof. Oheneba Boachie-Adjei Woahene II.
Friday was a day full of scientific sessions starting with the Hibbs Award-Nominated Papers for Best Basic/Translational and Clinical Research. Saturday marked the conclusion of the SRS Annual Meeting with additional scientific sessions and the Transfer of the Presidency to Laurel C. Blakemore, MD.
Dr. Lenke was involved in a variety of research presentations, such as:
- Optimizing Lower Instrumented Vertebra Selection in Adult Idiopathic Scoliosis Using Preoperative Upright and Supine Last Touched Vertebra
Josephine R. Coury, MD; Fthimnir Hassan, MPH; Gabriella Greisberg, BS; Justin Reyes, MS; Alexandra Dionne, BS; Yong Shen, BA; Joseph M. Lombardi, MD; Zeeshan M. Sardar, MD; Ronald A. Lehman, MD; Lawrence G. Lenke, MD - Creating Sustainability in Centers Performing High Volume Adult Spinal Deformity Surgery: Evaluation of the Maryland All-Payer Model
Andrew Kim, BS; Micheal Raad, MD; Richard Hostin, MD; Shay Bess, MD; Jeffrey L. Gum, MD; Breton G. Line, BS; Pratibha Nayak, PhD, MBA, MPH; Virginie Lafage, PhD; Renaud Lafage, MS; Kojo D. Hamilton, MD, FAANS; Peter G. Passias, MD; Themistocles S. Protopsaltis, MD; Lawrence G. Lenke, MD; Alex Soroceanu, MD, FRCS(C), MPH; Justin S. Smith, MD, PhD; Christopher P. Ames, MD; Bassel G. Diebo, MD; Eric O. Klineberg, MD; Alan H. Daniels, MD; Han Jo Kim, MD; Robert K. Eastlack, MD; Michael P. Kelly, MD; Munish C. Gupta, MD; Frank J. Schwab, MD; Christopher I. Shaffrey, MD; Douglas C. Burton, MD; Khaled M. Kebaish, MD; International Spine Study Group - Higher Intraoperative Blood Loss is Associated with Increased Risk of Intraoperative Neuromonitoring Data Loss for the Type 3 Spinal Cord Shape During Spinal Deformity Surgery
Chun Wai Hung, MD; Fthimnir Hassan, MPH; Nathan J. Lee, MD; Steven G. Roth, MD; Justin K. Scheer, MD; Joseph M. Lombardi, MD; Zeeshan M. Sardar, MD; Ronald A. Lehman, MD; Lawrence G. Lenke, MD - Accurate Scoring System Predicts Cord-Level Intraoperative Neuromonitoring (IONM) Loss During Spinal Deformity Surgery: A Machine Learning Algorithm
Nathan J. Lee, MD; Lawrence G. Lenke, MD; Varun Arvind, MD, PhD; Ted Shi, BS; Alexandra Dionne, BS; Chidebelum Nnake, BS; Mitchell Yeary, BS; Michael Fields, MD, BS; Matthew Simhon, MD; Anastasia Ferraro, BS; Matthew Cooney, BS; Erik Lewerenz, BS; Justin Reyes, MS; Steven G. Roth, MD; Chun Wai Hung, MD; Justin K. Scheer, MD; Thomas M. Zervos, MD; Earl D. Thuet, BS; Joseph M. Lombardi, MD; Zeeshan M. Sardar, MD; Ronald A. Lehman, MD; Benjamin D. Roye, MD, MPH; Michael G. Vitale, MD, MPH; Fthimnir Hassan, MPH - Complementary Performance of Somatosensory Evoked Potential (SSEP) as Intraoperative Neuromonitoring in Spinal Deformity Surgery—Results from a Prospective Multicenter Study
So Kato, MD, PhD; Lawrence G. Lenke, MD; Kristen E. Jones, MD, FAANS; Sigurd H. Berven, MD; Christopher J. Nielsen, MD; Saumyajit Basu, MS(orth), DNB(orth), FRCSEd; Michael P. Kelly, MD; Justin S. Smith, MD, PhD; Samuel Strantzas, MSc, DABNM; Stephen J. Lewis, MD, FRCS(C) - Intraoperative Neuromonitoring Has Poor Correlation with Postop Neurological Deficits in Non-Cord Level Adult Deformity Surgery
Zeeshan M. Sardar, MD; Alekos A. Theologis, MD; Ganesh Swamy, MD, PhD; Go Yoshida, MD, PhD; Michael P. Kelly, MD; Thorsten Jentzsch, MD, MSc; Samuel Strantzas, MSc, DABNM; Saumyajit Basu, MS(orth), DNB(orth), FRCSEd; Kenny Y. Kwan, MD; Justin S. Smith, MD, PhD; Ferran Pellisé, MD, PhD; So Kato, MD, PhD; Munish C. Gupta, MD; Christopher P. Ames, MD; Kristen E. Jones, MD, FAANS; Anastasios Charalampidis, MD; Brett Rocos, MD, FRCS; Lawrence G. Lenke, MD; Stephen J. Lewis, MD, FRCS(C) - Cost-Effectiveness of Operative Vs Nonoperative Treatment of Adult Symptomatic Lumbar Scoliosis with Eight Year Follow-Up
Leah Y. Carreon, MD; Steven D. Glassman, MD; Justin S. Smith, MD, PhD; Michael P. Kelly, MD; Elizabeth L. Yanik, PhD; Christine Baldus, RN; Vy Pham, MD, MPH; David Ben-Israel, MD; Jon D. Lurie, MD, MS; Charles C. Edwards, MD; Lawrence G. Lenke, MD; Oheneba Boachie-Adjei, MD; Jacob M. Buchowski, MD; Charles H. Crawford III, MD; Stephen J. Lewis, MD, FRCS(C); Tyler Koski, MD; Stefan Parent, MD, PhD; Virginie Lafage, PhD; Munish C. Gupta, MD; Han Jo Kim, MD; Christopher P. Ames, MD; Shay Bess, MD; Frank J. Schwab, MD; Christopher I. Shaffrey, MD; Keith H. Bridwell, MD - Optimization is a Moving Target: A Continuous Modifiable Frailty Index Reflecting Optimization Prior to Complex Adult Spinal Deformity (ASD) Intervention
Peter G. Passias, MD; Ankita Das, BS; Justin S. Smith, MD, PhD; Renaud Lafage, MS; Bassel G. Diebo, MD; Alan H. Daniels, MD; Jamshaid Mir, MD; Tobi Onafowokan, MBBS; Kojo D. Hamilton, MD, FAANS; Breton G. Line, BS; Thomas J. Buell, MD; Juan S. Uribe, MD; Michael Y. Wang, MD; Richard G. Fessler, MD; Pierce D. Nunley, MD; Neel Anand, MD; Michael P. Kelly, MD; Themistocles S. Protopsaltis, MD; Robert K. Eastlack, MD; Gregory M. Mundis Jr., MD; David O. Okonkwo, MD, PhD; Khaled M. Kebaish, MD; Alex Soroceanu, MD, FRCS(C), MPH; Justin K. Scheer, MD; Jeffrey Mullin, MD; Praveen V. Mummaneni, MD, MBA; Dean Chou, MD; Han Jo Kim, MD; Richard Hostin, MD; Munish C. Gupta, MD; Lawrence G. Lenke, MD; Douglas C. Burton, MD; Frank J. Schwab, MD; Christopher P. Ames, MD; Virginie Lafage, PhD; Christopher I. Shaffrey, MD; Shay Bess, MD; International Spine Study Group - Early Reoperations Do Not Adversely Affect Long Term Pain and Activity Scores in Adult Deformity Patients
Sarthak Mohanty, BS; Fthimnir Hassan, MPH; Nathan J. Lee, MD; Justin K. Scheer, MD; Chun Wai Hung, MD; Steven G. Roth, MD; Erik Lewerenz, BS; Joseph M. Lombardi, MD; Zeeshan M. Sardar, MD; Ronald A. Lehman, MD; Lawrence G. Lenke, MD - Impact of Durability on Potential to Achieve Cost/Qaly Within the Willingness-To-Pay (WTP) Thresholds for ASD Surgery: It is Impossible Unless We Avoid Reoperations
Jeffrey L. Gum, MD; Pratibha Nayak, PhD, MBA, MPH; Richard Hostin, MD; Breton G. Line, BS; Shay Bess, MD; Lawrence G. Lenke, MD; Renaud Lafage, MS; Justin S. Smith, MD, PhD; Jeffrey Mullin, MD; Michael P. Kelly, MD; Bassel G. Diebo, MD; Thomas J. Buell, MD; Justin K. Scheer, MD; Virginie Lafage, PhD; Eric O. Klineberg, MD; Han Jo Kim, MD; Peter G. Passias, MD; Khaled M. Kebaish, MD; Robert K. Eastlack, MD; Alan H. Daniels, MD; Alex Soroceanu, MD, FRCS(C), MPH; Gregory M. Mundis Jr., MD; Themistocles S. Protopsaltis, MD; Kojo D. Hamilton, MD, FAANS; Munish C. Gupta, MD; Frank J. Schwab, MD; Christopher I. Shaffrey, MD; Christopher P. Ames, MD; Douglas C. Burton, MD; International Spine Study Group - And more
Learn the details of this research topic below: Accurate Scoring System Predicts Cord-Level Intraoperative Neuromonitoring (Ionm) Loss During Spinal Deformity Surgery: A Machine Learning Algorithm
Nathan J. Lee, MD; Lawrence G. Lenke, MD; Varun Arvind, MD, PhD; Ted Shi, BS; Alexandra Dionne, BS; Chidebelum Nnake, BS; Mitchell Yeary, BS; Michael Fields, MD, BS; Matthew Simhon, MD; Anastasia Ferraro, BS; Matthew Cooney, BS; Erik Lewerenz, BS; Justin Reyes, MS; Steven G. Roth, MD; Chun Wai Hung, MD; Justin K. Scheer, MD; Thomas M. Zervos, MD; Earl D. Thuet, BS; Joseph M. Lombardi, MD; Zeeshan M. Sardar, MD; Ronald A. Lehman, MD; Benjamin D. Roye, MD, MPH; Michael G. Vitale, MD, MPH; Fthimnir Hassan, MPH
- Hypothesis | Machine learning(ML) can create an accurate scoring system to preoperatively predict cord-level IONM data loss.
- Design | Retrospective review of single surgeon prospective, consecutively collected patient data
- Introduction | An accurate knowledge of a patient’s risk for IONM cord-level loss prior to deformity correction is important for the informed decision-making process, but no prediction tool currently exists.
- Methods | 1,106 patients (adult=735, pediatric=371) who had spinal deformity surgery from 2015-2023 were reviewed. 205 periop variables were included (demographics, diagnosis, medical history, physical exam, operative factors, labs, preop/intraop x-rays, preop MRI/CT). IONM cord-level data was reviewed with the senior member of the IONM team. A stepwise ML approach using random forest analysis and multivariate logistic regression was performed. Pts. were randomly allocated into training(50%) and testing(50%) cohorts. Threshold values for features were calculated from the trained random forest model, and feature scores were derived by rounding up feature weights from the logistic regression model. Variables in the final scoring calculator were selected to optimize predictive performance (accuracy, sensitivity, specificity and area under the receiver operating characteristic curve (AUROC)). Analysis was performed using scikitlearn( v.0.24.2) in Python(v.3.9.18).
- Results | Through the ML process, a total of 7 features were designated to be included in the scoring system: Spinal Cord Shape Type 3(score=2), Conus level below L2(- score=2), Preop Upright Largest Cobb ≥75⁰(score=2), Upper Instrumented Vertebra in the Cervical spine(- score=2), Preop to Intraop Decrease in Hematocrit ≥12(score=1), Total Deformity Angular Ratio(TDAR)≥25(- score=1), and Three Column Osteotomy(3CO)(score=1). Patients with increasing cumulative scores had dramatically increased rates of IONM cord-level loss, with a cumulative score ≤ 2 having an IONM cord-level loss rate of 0.8% vs. score ≥7 rate of 95%. When evaluated on the test cohort, the scoring system achieved an accuracy of 90.3%, sensitivity of 80%, specificity of 91%, and an AUROC of 0.85.
- Conclusion | This is the first study to provide an ML derived scoring system using perioperative variables which accurately predicted IONM cord-level loss during pediatric and adult spinal deformity surgery with over 90% reliability.
