News

Friday kicks off with the Resident/Fellow Education Track: A Primer on the Fellowship Match, from 11:00 AM–12:00 PM. This interactive session will provide practical guidance for residents navigating the fellowship application process, including developing a strategic program list, using signaling effectively, preparing for interviews and understanding how fellowship directors evaluate applicants. Faculty will also discuss cross-specialty fellowship training, building professional networks and how to leverage fellowship training toward long-term career goals.

From 12:00–1:30 PM, the Early Career Advisory Council Luncheon & Roundtable Discussions: Navigating the Transition to Early Spine Practice: Careers, Choices, and Sustainability will offer an informal, interactive opportunity to discuss the realities of launching and sustaining a spine career. Participants will join small-group discussions led by early career members and experienced spine care providers and researchers. Topics include early-career clinical decision-making; adopting new technology and innovation; growing a clinical practice; coding and billing; building a research career; working with industry and intellectual property; interdisciplinary spine care; and leadership, mentorship and professional growth.

Friday afternoon continues with the Resident/Fellow Education Track: Transitioning to Practice, from 3:30–4:30 PM. Designed for residents, fellows and early career spine surgeons, this session focuses on the professional, financial and leadership considerations that accompany the move to independent practice. Topics include negotiating your first employment contract, managing your first 50 cases, building your professional reputation, adopting new technologies and working with industry, and navigating transitions between academic and private practice settings.

After Friday's educational sessions, early career attendees can continue the conversation at the Early Career Reception, a chance to connect with peers, faculty and colleagues in a more informal setting.

Then, on Saturday, be sure to attend the Early Career Abstract Presentations, showcasing the research and work of the next generation of spine professionals.

Evaluation of Intraoperative Evoked Potentials Monitoring During Spine Surgeries Compared to the Clinical Result Postoperatively

1. What inspired your team to investigate whether improvements in motor evoked potentials (MEPs) during surgery could predict patient outcomes?
   Most studies on intraoperative neuromonitoring focus on what happens when MEPs deteriorate, because signal loss is understandably associated with neurological injury. In daily practice, however, we often observed the opposite phenomenon: immediately after an effective decompression, some patients showed a clear improvement in their MEPs. This study originated from our experience within Professor Pneumaticos' spine surgery unit, where all procedures were performed under his surgical leadership. Repeated intraoperative observations during his routine clinical practice prompted us to investigate whether improvements in MEPs following decompression could serve not only as reassuring neurophysiological findings but also as predictors of postoperative functional recovery.
2. For readers who may be less familiar with intraoperative neuromonitoring, can you explain what MEPs measure and why they're important during spine surgery?
   MEPs evaluate the functional integrity of the motor pathways by stimulating the motor cortex and recording the electrical response from the muscles. During spine surgery, they allow us to assess the status of the spinal cord and nerve roots continuously and in real time. Traditionally, surgeons use MEPs to identify neurological compromise before it becomes permanent. Our study suggests that they may also provide positive feedback by indicating that decompression has successfully restored neural conduction.

Comparing the Operative Costs and Direct Hospital Costs of Endoscopic Discectomy versus Microdiscectomy: A Systematic Review and Meta-Analysis of Comparative Studies

1. Although overall costs were similar, endoscopic discectomy was associated with a shorter hospital stay. How clinically meaningful do you think that finding is?
   A shorter hospital stay is potentially meaningful because it may reflect earlier mobilization, less postoperative pain, and a faster return to normal activity. It can also improve patient experience, reduce exposure to inpatient complications, and preserve hospital bed capacity. In our pooled data, the average difference between groups was approximately two days.
   
   However, the practical implication is highly dependent on the healthcare setting. Many centers in the United States now perform both procedures in ambulatory settings on an outpatient basis or with an overnight stay, whereas several international studies in our analysis reported substantially longer admissions for both groups. That limits the direct transferability of the pooled absolute difference. Importantly, the shorter stay may not be directly translated into a statistically significant reduction in direct hospital costs. It may therefore be most valuable in systems with longer baseline admissions, constrained inpatient capacity, or where earlier discharge reliably leads to lower episode-of-care costs.
2. Although overall costs were similar, endoscopic discectomy was associated with a shorter hospital stay. How clinically meaningful do you think that finding is? A shorter hospital stay is potentially meaningful because it may reflect earlier mobilization, less postoperative pain, and a faster return to normal activity. It can also improve patient experience, reduce exposure to inpatient complications, and preserve hospital bed capacity. In our pooled data, the average difference between groups was approximately two days.
   
   However, the practical implication is highly dependent on the healthcare setting. Many centers in the United States now perform both procedures in ambulatory settings on an outpatient basis or with an overnight stay, whereas several international studies in our analysis reported substantially longer admissions for both groups. That limits the direct transferability of the pooled absolute difference. Importantly, the shorter stay may not be directly translated into a statistically significant reduction in direct hospital costs. It may therefore be most valuable in systems with longer baseline admissions, constrained inpatient capacity, or where earlier discharge reliably leads to lower episode-of-care costs.

Postoperative restoration of balance and fall-risk reduction following cervical decompression in degenerative cervical myelopathy: cone of economy and posturography analysis

1. What inspired your team to look beyond clinical outcome measures and study balance and postural control following cervical decompression?
   Balance dysfunction is one of the most clinically important manifestations of degenerative cervical myelopathy because it contributes directly to falls, loss of independence, and reduced quality of life. Yet routine follow-up still relies heavily on basic neurological examination and patient-reported outcomes, which may not detect subtle instability or compensatory postural strategies which have significant impact on quality of life and future fall risk. We wanted to determine whether cervical decompression produces measurable recovery in the neuromechanical systems responsible for upright balance, providing an objective perspective on recovery beyond basic current measurements.
2. Your team has published extensively on the cone of economy and its relationship to spinal alignment. How does this study build on that body of work?
   Our prior work established the Cone of Economy as a method for quantifying the amount of movement and neuromuscular effort required to maintain upright posture. This study extends that framework into degenerative cervical myelopathy by combining Cone of Economy metrics with computerized dynamic posturography and the Sensory Organization Test. Rather than assessing sway magnitude alone, we evaluated multiple complementary dimensions of postural control, including balance efficiency, directional control, fatigue, corrective responses, and sensory integration before and after cervical decompression. Together, these measures provide a more comprehensive picture of postoperative neurological recovery and identify potential areas for patient centered physical therapy for further optimization.

Comparative clinical and radiographic outcomes of mini-ALIF with percutaneous fixation versus MI-TLIF in intermediate-to-high-grade isthmic spondylolisthesis

1. Your study found lower pseudarthrosis rates and longer time to revision with mini-ALIF and percutaneous fixation. What do you think accounts for those differences?
   We think it largely comes down to biomechanics.
   
   The anterior approach allows placement of a larger interbody implant with a broader footprint and excellent endplate preparation while restoring disc height and anterior column support. When that is combined with supplemental percutaneous fixation, the construct is well positioned to resist the significant shear forces that characterize isthmic spondylolisthesis. Interestingly, both procedures improved pain, disability, and overall alignment to a similar degree. Where we saw the difference was in fusion durability. That suggests that although patients may initially feel similarly well after either operation, the mechanical environment created by the anterior approach may provide advantages that become more apparent over longer-term follow-up.
2. For surgeons deciding between these approaches, what patient or disease characteristics most strongly influence your procedural selection?
   There really isn't a one-size-fits-all answer, and that's one of the important messages from the study.
   
   When we're considering an anterior approach, we look carefully at factors such as vascular anatomy, prior abdominal surgery, body habitus, and the overall safety of retroperitoneal exposure. If those factors are favorable, mini-ALIF offers excellent anterior column reconstruction and, based on our findings, may provide improved construct durability.
   
   On the other hand, MI-TLIF remains an outstanding option when anterior exposure carries greater risk or is otherwise less desirable. It avoids the anterior corridor entirely while still providing reliable decompression and meaningful clinical improvement.
   
   Ultimately, the procedure should fit the patient's anatomy and goals rather than the other way around.

Wednesday, October 14

10:00-11:00 a.m.

Use of Innovative Technologies in Spinal Cord Injury Treatment
Presented by the Section on Spinal Cord Injury, this symposium highlights emerging technologies that are reshaping care for patients with spinal cord injury. Faculty will review applications of artificial intelligence for prognostication and rehabilitation, as well as neuromodulation approaches such as spinal epidural and vagus nerve stimulation that are demonstrating functional gains in clinical studies. The session will also examine the evolving role of stem cell therapies and biomaterial platforms as they move toward clinical translation. Together, these topics provide an overview of how innovation is advancing recovery and treatment possibilities in spinal cord injury care.

11:00 a.m.-12:00 p.m.

The No Surprises Act: Turning Regulation into Revenue and Business Implications for Spine Surgery Practices
The No Surprises Act has introduced significant changes to reimbursement and administrative workflows that directly affect spine surgery practices. This session will review the structure of the law, the federal Independent Dispute Resolution (IDR) process, and how these mechanisms influence payment outcomes and practice operations. Faculty will share real-world examples illustrating how practices can navigate compliance requirements while identifying opportunities within the evolving regulatory environment. The discussion will also highlight advocacy efforts and emerging support resources designed to help spine surgeons respond strategically to these changes.

1:00-2:00 p.m.

Avoiding the Top Financial Mistakes Spine Surgeons Make: A Practical Blueprint for Financial Wellness
Spine surgeons devote years to mastering clinical decision-making, yet many face avoidable financial pitfalls that can affect long-term security and career flexibility. This session highlights common financial planning mistakes—from tax inefficiencies and risk protection gaps to advisor misalignment and lack of exit strategy—and explains how they develop over the course of a career. Using the What, Why, How (WWH) Method, the presentation offers a structured approach to connecting financial decisions with personal goals, career planning, and long-term security. Participants will leave with a clearer framework for strengthening financial strategy before problems become difficult to reverse.

3:00-4:00 p.m.

Endoscopic Lumbar Interbody Fusion: The Time Has Come: Part I
Endoscopic lumbar interbody fusion (Endo-LIF) is rapidly expanding from a niche technique to a potential alternative to traditional microscopic fusion approaches. This symposium will review current evidence on outcomes and fusion rates, compare endoscopic and microscopic TLIF techniques, and examine the role of Endo-LIF in ambulatory surgery center settings. Faculty will also demonstrate key uniportal and biportal techniques and discuss strategies for managing intraoperative challenges and complications. The session offers a practical, evidence-based perspective for surgeons considering incorporating endoscopic fusion into their practice.

4:00-5:00 p.m.

Endoscopic Lumbar Interbody Fusion: The Time Has Come: Part II
Endoscopic lumbar interbody fusion (Endo-LIF) is rapidly expanding from a niche technique to a potential alternative to traditional microscopic fusion approaches. This symposium will review current evidence on outcomes and fusion rates, compare endoscopic and microscopic TLIF techniques, and examine the role of Endo-LIF in ambulatory surgery center settings. Faculty will also demonstrate key uniportal and biportal techniques and discuss strategies for managing intraoperative challenges and complications. The session offers a practical, evidence-based perspective for surgeons considering incorporating endoscopic fusion into their practice.

Thursday, October 15

1:00-2:00 p.m.

To Disc or Not to Disc...That Question is No Longer Simple
Total disc replacement continues to evolve as evidence; implant design, and patient selection criteria become more nuanced. This symposium will review lessons learned from multiple IDE trials, biomechanical principles of disc design, and key anatomical considerations that influence implant selection. Faculty will also examine retrieval analyses and biological responses associated with implant failure to better understand long-term performance. Together, these perspectives provide a deeper framework for evaluating when disc replacement is—and is not—the right choice for patients.

3:00-4:00 p.m.

Designing a Comprehensive Multidisciplinary Spine Center
This multidisciplinary symposium will outline key considerations for developing and implementing a Comprehensive Multidisciplinary Spine Center (CMSC) within academic or hybrid practice environments. Faculty will discuss strategies for integrating surgical, nonoperative, rehabilitation, and administrative services to improve coordination, efficiency, and patient outcomes. The session will also explore models for centralized triage, patient access, and collaboration across spine care specialties. Together, these perspectives provide a practical roadmap for building and sustaining an effective multidisciplinary spine program.

4:00-5:00 p.m.

AI in Spine Practice: Practical Applications from Clinic to OR
Artificial intelligence is gaining adoption in clinical workflows, imaging interpretation, patient engagement, electronic health records (EHR), and surgical planning. This non-CME special session will provide a practical overview of current and emerging AI applications relevant to spine clinicians, while also addressing limitations, ethical considerations, and potential risks. Through focused presentations and moderated panel discussion/Q&A session, faculty will explore AI tools being integrated into spine practices and how clinicians can critically evaluate these technologies.

Friday, October 16

10:00-11:00 a.m.

Joint NASS/KOMISS Endoscopic Spine Surgery
This collaborative session brings together leading experts from NASS and the Korean Minimally Invasive Spine Surgery Society (KOMISS) to showcase the latest clinical advancements in minimally invasive and endoscopic spine surgery. Attendees will gain insights into emerging techniques, innovative technologies, and evolving best practices that are improving patient outcomes and expanding the role of endoscopic approaches in spine care.

11:00 a.m.-12:00 p.m.

Personal Implants: Fad or Future
This non-CME special session explores the growing role of patient-specific implants and personalized technologies in spine care, including digital twins, custom rods, lumbar cages, disc replacement, corpectomy implants, biomaterials, and 3D printing innovations. Through a series of industry-led presentations and expert discussion, faculty will examine the rationale, engineering considerations, clinical applications, and limitations of these emerging technologies. The session will conclude with a live debate examining whether personalized implants represent a transformative advancement in spine surgery or a trend whose promise may outpace its long-term clinical value.

1:00-2:00 p.m.

Ancillary Income: Physician Profit vs Patient Benefit
This non-CME special session aims to review options for physicians with innovative new technology and help clarify goals and objections for patient benefit vs financial gain.

2:30-3:30 p.m.

From Coding to Hospital Purchasing: What is the Future Surgeon’s Role?
This non-CME special session will examine the evolving role of spine surgeons beyond the operating room. Discussion topics may include reimbursement, hospital purchasing, industry partnerships, practice models, and other business considerations influencing the future of spine care.

3:30-4:30 p.m.

Debate on the Role of Arthroplasty in Spine Surgery
This non-CME special session will examine the evolving role of motion-preserving technologies in spine care. Through expert discussion and debate, faculty will explore the current evidence, indications, limitations, and long-term outcomes associated with cervical and lumbar arthroplasty while comparing these approaches with traditional fusion procedures. Attendees will gain insight into the future direction of motion preservation and its potential impact on patient outcomes, surgical decision-making, and spine practice.

Kicking off Texas Style

Join your fellow attendees at our Opening Night Reception on Wednesday, October 14, from 5:30–6:30 p.m. for an evening packed with Lone Star fun. From Texas-inspired food, drinks, and entertainment, you'll experience the best of San Antonio while kicking off the start of your NASS Annual Meeting!

AI in Spine Practice: Practical Applications from Clinic to OR

Artificial intelligence is gaining adoption in clinical workflows, imaging interpretation, patient engagement, electronic health records (EHR), and surgical planning. This non-CME special session will provide a practical overview of current and emerging AI applications relevant to spine clinicians, while also addressing limitations, ethical considerations, and potential risks. Through focused presentations and moderated panel discussion/Q&A session, faculty will explore AI tools being integrated into spine practices and how clinicians can critically evaluate these technologies.

Use of Innovative Technologies in Spinal Cord Injury Treatment

Presented by the Section on Spinal Cord Injury, this symposium highlights emerging technologies that are reshaping care for patients with spinal cord injury. Faculty will review applications of artificial intelligence for prognostication and rehabilitation, as well as neuromodulation approaches such as spinal epidural and vagus nerve stimulation that are demonstrating functional gains in clinical studies. The session will also examine the evolving role of stem cell therapies and biomaterial platforms as they move toward clinical translation. Together, these topics provide an overview of how innovation is advancing recovery and treatment possibilities in spinal cord injury care.

Innovations in Spinal Cord Injury Treatment

This session presents recent advances in spinal cord injury (SCI), addressing artificial intelligence, biomaterials, translational research, and acute clinical management while integrating basic science with clinical application. Participants will gain insights into emerging evidence, international best practices, and innovative strategies to improve patient outcomes, followed by an interactive panel discussion.

Abstract Presentations: Diagnostics, Imaging and AI

• Evaluating ChatGPT's diagnostic and treatment accuracy in lumbar spine pathology
• Temporal trends in SI joint fusion utilization and patient demographics: A nine-year analysis using epic cosmos (2016-2024)
• Research on the comparison of recurrence rates between open and endoscopic nucleotomy for lumbar disc herniation based on AI large model prediction

On Thursday, October 15, from 12 p.m. to 1 p.m., Voices of Experience Luncheon: Conversations about Retirement with NASS Emeritus Members will be chaired by Past NASS President Edward Dohring, MD. The interactive luncheon allows opportunities for attendees to connect with NASS’ Emeritus members seeking advice and personal insight into various topics surrounding the road to retirement. Each table will be led by members of the Emeritus Engagement Committee and faculty will facilitate open dialogue and be available to answer questions.

On Friday, October 16, two luncheons from 12 p.m. to 1 p.m. will be held. Early Career Advisory Council Luncheon & Roundtable Discussions: Navigating the Transition to Early Spine Practice: Careers, Choices, and Sustainability will be chaired by Uri Hadelsberg, MD, MBA, and Daniel Kim, MD, MS. The interactive session is designed for early-career spine professionals seeking practical guidance on the clinical, academic, and business aspects of launching and sustaining a successful career. Participants will join informal, small-group roundtable discussions focused on real-world challenges and opportunities not typically addressed during residency or fellowship.

Also from 12 p.m. to 1 p.m. on Friday, the Women in Spine Networking Luncheon will be chaired by Kathryn Jurenovich, DO, and Hania Shahzad, MD. This session will highlight advances in digital platforms, robotics, artificial intelligence, global innovation, and leadership, followed by an interactive panel discussion on the future of spine surgery. Explore how women leaders are driving innovation and shaping the future of spine surgery through emerging technologies and new models of care.

Non-CME Special Session: Endoscopic Lumbar Interbody Fusion: The Time Has Come: Part I

Non-CME Special Session: Endoscopic Lumbar Interbody Fusion: The Time Has Come: Part II

Endoscopic lumbar interbody fusion (Endo-LIF) is rapidly expanding from a niche technique to a potential alternative to traditional microscopic fusion approaches. This symposium will review current evidence on outcomes and fusion rates, compare endoscopic and microscopic TLIF techniques, and examine the role of Endo-LIF in ambulatory surgery center settings. Faculty will also demonstrate key uniportal and biportal techniques and discuss strategies for managing intraoperative challenges and complications. The session offers a practical, evidence-based perspective for surgeons considering incorporating endoscopic fusion into their practice.

Symposium: Small Incisions - From Minimally Invasive to Endoscopic Spine Surgery

Minimally invasive and endoscopic techniques continue to expand the options available for treating spinal pathology with less tissue disruption and faster recovery. This symposium will review core principles of decompression and fusion through tubular and retractor-based approaches, along with evolving strategies for endoscopic surgery. Faculty will also explore how emerging technologies—including navigation, artificial intelligence, and virtual and augmented reality—are shaping the future of minimally invasive spine care. Attendees will gain practical insight into selecting and applying these techniques in contemporary surgical practice.