Dear Member

Warmest greetings.  I would like to update you on some of the forthcoming events of interest to you as well as the Society’s activities since the last newsletter.

1.      SA SPINE CONGRESS:  28 - 31 MAY 2009

It is now a year to our next congress and Dr Frank Snyckers is on track with a great scientific guest list and proposed program.  Please take note of dates that were forced on us by availability of congress venues and booking schedules.  The congress will run from Thursday to Sunday, 28 ^- 31 May 2009 rather that the usual Wednesday to Saturday format we had in the past.  As noted this was not our choice but due to the only times available at a suitable venue. 

The proposed theme for the congress is “Current Challenges in Spinal Surgery with Reference to Complication Avoidance and Management”.  

The intended guest speakers will be

-     Lawrence (Larry) Lenke, St Louis, Missouri USA

-     Eugene Carragee, Stanford, California USA

-     Dietrich Schlenzka, Helsinki, Finland

They are all very eminent in current spinal science.  

I urge all members to consider making scientific contributions and presentations and sharing with us their practice experience and knowledge at this event.

2.      MEDICAL AID INTERACTIONS

2.1. Cervical disc prosthesis

We presented the case for cervical disc prosthesis and as from 2008 this has been routinely funded, based on guidelines as devised from best international studies available. As this is a rapidly evolving field, I predict that the treatment selection criteria will change and thus revision of the current guidelines is likely to occur from time to time.   

2.2. Interspinous process devices 

These devices had been funded and then this was stopped. The funders claimed that they had done so in error, and it was never their intention to fund such devices because of the lack of sound scientific evidence.  When the devices showed up in significant numbers per month they became aware of the issue and the funding was stopped.  In some centres up to 40 devices were being implanted in some months.

We took up this mater for the members that used the devices. This was a very contentious issue, because of the varied nature of the devices, and their proposed use, and thus cross over of information from one device to the other could not be utilised. Furthermore there are very limited quality studies to show device efficacy, only one device having some acceptable evidence basis for use.  However so as not to get involved in specific device accreditation, it was agreed that funding should be made available for the generic procedure, on the basis of guidelines as published by the SA Spine Society, and thus the interspinous process device is being funded at this stage based on published guidelines on our web page.     

2.3. Intra Operative Navigation 

Routine usage of Intra Operative Navigation for spinal cases came under the spot light quite suddenly and funding was ceased.   

The whole process of literature review was undertaken with the funders, and clearly the evidence is there for the utilisation of Intra Operative Navigation.  However the evidence for routine use is not present. Further more the funders statistics show that only a small percentage of spinal surgeons used Intra Operative Navigation, and of these a further small percentage use it almost routinely. 

A rational compromise was reached, and Intra Operative Navigation is now being funded, based on published guidelines as noted on our web page.

2.4. Prosthetic monetary limit

Based on information from the previous years average billing practices, a prosthetic limit of R17 000.00 per lumbar spinal level was imposed. We have started investigations in this regard, and if there is reasonable evidence to support change in this amount, then revision is likely to occur in the future. I foresee that this will be the case, especially due to the recent rand currency weakness. We will keep you informed of proceeding in this matter.

2.5.   Orthopaedic & Neurosurgical Assistants Fees

The Orthopaedic Association has motivated that an assistant fee should be allowed to each surgeon (0009) when operating together on a case.  THIS WILL ONLY APPLY AS FROM 2009. We will keep you informed relating to developments in this regard.

3.      NEUROSURGICAL CONGRESS –  DURBAN  - Sunday 24 - Wednesday 27 August 2008:  FIRST DAY SPINAL TOPIC

As noted in the previous newsletter, the Neurosurgical Society and the Neurosurgical Congress Committee has so organised its program so as to devote the first day (Monday) to spinal topics, and the ethics lecture early on the Tuesday morning.  

This should give members an opportunity to make contact, and share views and current opinions and also get CPD allocations. The registration details can be found on http://www.precisionconferences.co.za/event1.asp. 

4.      AO SPINE MEMBERSHIP

South African spine surgeons have for many years benefited from the training offered by the AO Foundation largely via the AO Foundation’s connection with Synthes in South Africa. Since the restructuring of the organisation to form AOSpine International the link with Synthes has been severed and AOSpine is now an autonomous organisation. It has no political or trade specific allegiances.

AOSPINE E-PROFESSIONAL MEMBERSHIP

As from January 2008 membership of AOSpine will require registration and payment of affiliation fees. In return for these fees members will enjoy a range of online benefits including

INSPINE

EVIDENCE BASED SPINE SURGERY

SPINE

            JOURNAL OF SPINAL DISORDERS

            JBJS

            JOURNAL OF ORTHOPEDIC TRAUMA

            and now

            EUROPEAN SPINE JOURNAL.

Dr Norman Fisher-Jeffes has negotiated that South African based spine specialists be granted a special concession for 2008.

We have been allocated 70 E-PROFESSIONAL Membership’s at a 70% reduction on the normal subscription rate of CHF 150 / US$ 120/ Euro 90.  In rand terms this means you will pay only CHF 40/US$ 36 / Euro 27.

To benefit from this offer you need to contact Norman by e-mail on ndfisherjeffes@mweb.co.za 

5.      CADAVER SPINE APPROACH COURSE – CAPE TOWN – 20-21 NOVEMBER 2008

The 6^th Cadaver based spinal approaches course will be held on the 20-21 November 2008 at the University of Cape Town. 

This course instructs on anatomical approaches as well as a variety of instrumentation techniques.  It allows surgeons of all skill levels to familiarise themselves with the relevant anatomy and learn new techniques in a risk free environment. 

If interested contact Dr Robert Dunn on info@spinesurgery.co.za  or your local Synthes / Medtronic representative.

6.      FURTHER GUIDELINES PUBLISHED ON WEBSITE

Guidelines for the use of intra operative navigation have been posted, together with revision of those previously published .

I would urge members to review these as they relate to their practices, and give us feed back with respect to any anomaly based on current valid scientific studies, that should be consider, so as to review current guides.

With kind regards.

GIAN MARUS

PRESIDENT:  THE SA SPINE SOCIETY