- Email: [email protected]
The North American Spine Society Focuses on Multidisciplinary Spine Care
The Spine Journal 1 (2001) 1–4
Editorial
The North American Spine Society Focuses on Multidisciplinary Spine Care Tom G. Mayer, MD* In this first issue of The Spine Journal, the North American Spine Society (NASS) membership will receive an important new benefit. NASS has always tried to enhance knowledge about the spine field and the factors influencing it. In order to promote timely dissemination of high-quality, peer-reviewed scientific articles and provide a better understanding of the issues that affect us collectively, NASS has joined with Elsevier Science, a prestigious publisher of scientific journals. This is our maiden voyage, and we hope that you enjoy it. NASS’ mission is clearly stated by its leadership as follows: “NASS is a multidisciplinary organization that advances quality spine care through education, research, and advocacy.” There are at least five primary goals attached to that mission statement. The goals point NASS toward being recognized as the leading advocate for quality spine care; the members’ primary resource for education, knowledge exchange, and better practice; a leading force in promoting and supporting spine research; a leader in dissemination of credible spine care information to government, the general public, media, other health-care professionals, and industry; and a responsive infrastructure striving for balanced growth. The Spine Journal will be a partner with NASS in accomplishing these goals. The first four goals are very strongly connected to the “official journal” status conveyed upon our new venture. The authors of the best research presented at NASS meetings will be invited to prepare manuscripts for expedited review in The Spine Journal, which will be provided as a member benefit to all professionals belonging to our Society. The premiere research reports from our annual meeting will reach a large international audience in a timely fashion. In presenting original scientific work along with literature reviews, focused technical reports, and special features, our goals of advocacy for quality spine care and dissemination of information will be facilitated. To accommodate the balanced growth of various specialties joining NASS, The Spine Journal will be considering the needs of surgeons and nonoperative professionals, research scien-
* Corresponding author. North American Spine Society, 22 Calendar Ct., 2nd Floor, LaGrange, IL, 60525
tists, and clinical practitioners. It will balance the needs of the professionals engaged exclusively in spine care versus those who are less consistently connected. The NASS leadership has mandated that the balanced growth objectives of the North American Spine Society will be reflected in this peer-reviewed journal insofar as possible. Why is there a need for a new spine journal, and why did NASS decide to pursue it at this time? The intent to produce an official NASS journal is nothing new. It has been a stated goal of the board of directors of NASS for the past decade and has been given a high-priority rating at each of the last two tri-annual board retreats on program development. A number of reasons have been cited by NASS members, board, and staff for development of The Spine Journal at this time. First, and perhaps most important, is the issue of member benefit with regard to publication. Over NASS’ first decade, publications had been one of the least developed areas. As such, publications of all kinds have been a focus of increasing attention over the past several years. Some important milestones in our increasing concern about the benefit of publications include the development and dissemination of practice guidelines, the conversion of NASS News to a far more interesting format as SpineLine, the updating of previous Contemporary Concepts and development of new ones, and the publication of a variety of simplified explanations of complex spine issues for public health purposes. A second issue of importance is accountability of The Spine Journal to the NASS board of directors. The publisher and editorin-chief serve by contract to the board and are committed to responsiveness to perceived needs of NASS members. Although The Spine Journal will maintain an independent editorial policy, NASS members can be assured that the overall interests of our Society are uppermost in the minds of the editors. The vast majority of reviewers of manuscripts are NASS members. Because the journal is received free by our membership, the majority of readers (at least of the first few issues) will be NASS members. Individuals whose scientific work is judged superior by committees reviewing papers for NASS annual and affiliated meetings will be invited to publish their manuscripts with expedited review. The difficulty experienced in publishing manuscripts, as expressed by a
1529-9430/01/$ – see front matter © 2001 Elsevier Science Inc. All rights reserved. PII: S1529-9430(01)00 0 1 9 - 5
2
Editorial / The Spine Journal 1 (2001) 1–4
large number of our members in our needs survey, should be addressed by flexible growth of The Spine Journal. Nor is there any reason to expect the field of spinal care to diminish its production of quality research anytime in the near future. With an aging population discovering growing awareness of treatment options and technologies, our field is expanding. The relevance of NASS in this expansion is shown by its exponential growth, nearly tripling in size to nearly 3000 members over the past 6 years. Changes in society lead also to a change in NASS members’ techniques for information retrieval. Scientific studies on diagnosis and treatment will be accompanied by companion pieces on outcomes, reimbursement-driven changes in health-care delivery, government-induced limitations on care and legal and administrative factors, which strongly influence the way medicine is practiced in the new millennium. NASS’ charitable foundation is raising funds for research that is not otherwise supported by government or industry sources. The results of this research are of direct interest to our membership, so that recipients of NASS grants are likely to be encouraged to publish the results of their work in The Spine Journal. To date, more than $1 million has been provided to grant recipients. Finally, our public relations and advocacy efforts through the 501(c) organization, the National Association of Spine Specialists, are likely to be enhanced by the visibility of The Spine Journal. Based on a recent vote of the NASS board of directors, the NASS Outstanding Paper awards will become The Spine
Tom G. Mayer, MD
Journal Outstanding Paper awards beginning in 2001. A distinguished panel of deputy and associate editors will form a multidisciplinary peer review committee to oversee the most balanced review process we can establish. The board of directors has also decided to enhance the attractiveness of the competition by increasing the value of each award to $5,000.00 The Announcement of The Spine Journal Outstanding Paper awards will have been made by the time you receive your first issue of The Spine Journal, and we hope many of our readers will be submitting manuscripts. The Spine Journal will provide peer review of the highest quality. The NASS membership represents some of the best and brightest multidisciplinary clinicians in the field of spinal disorders. Many of them have extensive prior experience in peer review with other journals associated with their board specialties, as well as with the spine care subspecialty. Our associate editorial board begins with approximately 80 experienced member reviewers and is expected to grow as our journal matures. The advisory editorial board is an opportunity for younger members interested in gaining experience in peer review to make a contribution to our burgeoning field and ultimately move up to membership in the associate editorial board. Appointments will be made on an annual basis. We are also inviting a group of correspondent reviewers to provide occasional service and join a board of reviewers. This group will include senior professionals outside NASS who have extraordinary expertise to offer. The board of reviewers category is also appropriate for NASS members whose other time commitments are such that they are unable to take on the responsibility of joining one of the regular editorial boards and be available for reviews within the 21-day window routinely. I wish to encourage any of our membership, as well as those in affiliated societies that cosponsor meetings with NASS, to consider applying as a board of reviewers or advisory editorial board member by requesting an application from our NASS editorial office. Elsevier Science, our publishing partner in this new NASS effort, has a superb reputation as an experienced publisher of scientific journals. The NASS board was particularly impressed by the record of over 1200 journals published in virtually all areas of medicine and other scientific endeavors. Elsevier Science is especially strong in its relationship to a number of specialty medical societies as the publisher of their official journals for information dissemination. Their recently announced intent to merge with the Harcourt companies adds major publishers of orthopedic texts, such as W.B. Saunders and Mosby, to their group. As with other published medical journals, The Spine Journal, and its future electronic components, will be NASS’ principal means of communicating about multidisciplinary spine care, to comprise its basic and clinical research, clinical practice, legislative and regulatory affairs, history, and education. The Spine Journal will be distributed free of additional costs as a member benefit to the entire NASS membership and will also be distributed to subscribers, institutions, and libraries throughout North America and around the world. In our recent call for papers, we solicited original scientific
Editorial / The Spine Journal 1 (2001) 1–4
articles, literature reviews, and technical reports. However, we are also interested in submitted case reports, editorials, letters to the editor, innovations, and teaching points for residents. Because NASS sponsors regular meetings with a number of Asian and South American spine societies, we anticipate a great opportunity to publish scientific information of relevance to North Americans from a multitude of international sources. Within the United States and Canada, a large number of board-certified specialists have chosen to join NASS to underscore their commitment to spine care in their clinical and academic practices. Orthopedic and neurological surgeons still represent the majority of NASS members. However, a growing minority of nonoperative specialists, in fields as diverse as anesthesia, physical medicine and rehabilitation, occupational medicine, psychology/psychiatry, sports medicine, and pain management, have chosen to join us. There is also a representation by basic scientists, including epidemiologists, outcomes researchers, biochemists, and ergonomists. Our membership also includes academic chiropractors and physical therapists. All of these groups benefit from the timely dissemination of scientific information in the spine field and contribute greatly to its development. As the field expands, keeping surgeons informed about nonoperative issues and vice versa requires an ongoing commitment by our society and its board. The Spine Journal will be strongly supportive of this goal of our organization. At this time, a publishing plan to meet the needs of our NASS membership and to provide outreach to nonmembers around the world is still in development. SpineLine, edited by Stuart Weinstein, M.D., hopes to serve NASS as the primary spine practice information resource. It will do so by combining clinically based scientific articles with a series of columns focusing on current, practical, and thought-provoking socioeconomic and policy issues. In contrast, The Spine Journal will meet all anticipated needs for a peer-reviewed publication. Electronic opportunities currently exist to facilitate communication of scientific information and are likely to improve in the near future. In a timely fashion, The Spine
Editor-in-chief with deputy editors at North American Spine Society annual meeting in New Orleans, Louisiana.
3
Journal will develop, or participate in Elsevier Science Direct, a web-based source of our articles, as well as those of the other journals of Elsevier’s publishing family; an online version of The Spine Journal; www.spine.org, the NASS website, which is currently targeted to a broad array of enhancements for members, other professionals, patients, and their families, and which will expand The Spine Journal’s scientific communications. David Fardon, M.D., deputy editor for special features, is busy formulating a number of ways in which the written journal can interact with electronic media. Dr. Fardon, who trained in Missouri, Kansas, and New York, practices orthopedic surgery in Knoxville, Tennessee. He is academically affiliated with the University of Tennessee Memorial Research Center and a founding member of NASS. He is an active member of the American Academy of Orthopedic Surgeons (AAOS) and the American Orthopedic Association. He has previously served on a number of editorial boards and is currently editor of the AAOS, Orthopedic Knowledge Update (OKU-2) on spine. NASS’ other deputy editors bring great scientific and professional credibility, along with extensive service to NASS, to The Spine Journal. They include Howard An, M.D., covering basic sciences, Charles Branch, M.D., supervising neurosurgical issues, Scott Haldeman, M.D., overseeing nonoperative care, and Neil Kahanovitz, M.D., handling orthopedic surgery. Dr. An is currently professor of orthopedic surgery and holder of the Morton International Endowed Chair for Spine Research at Rush Medical College in Chicago. He has received research awards from three spinal societies (NASS, Scoliosis Research Society, and Cervical Spine Research Society). He is director of the Rush Spine Fellowship, is extensively published, and has considerable prior editorial experience. He has also performed peer reviews for Spine, Journal of the American Academy of Orthopedic Surgeons, and the American Journal of Orthopedic Surgery. Charles Branch, M.D., is associate professor of neurosurgery at the Wake Forest University School of Medicine in Winston-Salem, North Carolina. He trained in Oklahoma, Texas, North Carolina, and California. He is currently acting chairman of the Division of Surgical Sciences at Wake Forest. He has previously done editorial review work for Clinical Orthopedics and Related Research, Journal of Radiosurgery, Neurosurgical Focus, and Journal of Spinal Disorders. He is co-author of numerous peer-reviewed neurosurgery articles and is active in national neurosurgical societies. Scott Haldeman, M.D., practices in Santa Ana, California, and has an extraordinary international scientific background. He received a chiropractic degree in the United States (where he was valedictorian of his class), then returned home to receive his M.Sc. in Pretoria, South Africa. He received a Ph.D. in neurophysiology in Vancouver, Canada, where he also received his M.D. degree. His neurology residency took place in California. He is currently clinical professor of neurology at the University of California in Irvine. Dr. Haldeman’s honors and presentations are too numerous to recount. He has actively engaged in the practice of chiropractic as well as medicine and therefore presents a unique perspective on nonoperative care. In addition
4
Editorial / The Spine Journal 1 (2001) 1–4
to reviewing nonoperative manuscripts, he will personally author, and encourage, literature reviews on numerous controversial subjects in this often ambiguous area of spine care. Neil Kahanovitz, M.D., NASS’ immediate past president, is also published in this first issue of The Spine Journal through his presidential address. For the past decade he has been director of spinal surgery and rehabilitation at the Anderson Orthopedic Institute in Arlington, Virginia. This followed nearly a decade in full-time academics at New York University culminating as assistant chairman of orthopedics at the Hospital for Joint Diseases Orthopedic Institute in New York. Like the other deputy editors, he has a lengthy bibliography with extensive prior editorial and review experience. As a sign of things to come, the premiere issue of The Spine Journal features the presidential address from the recently concluded and highly successful 2000 annual meeting in New Orleans. In future years, it is our sincere goal to continue the tradition of expedited publishing as demonstrated by the ability to disseminate the presidential address and important scientific work, such as The Spine Journal Outstanding Papers, a few months after the annual meeting. In the past, we have usually waited 12 to 18 months for the opportunity to provide this material. Another problem we hope to resolve is that only a few of the manuscripts generated from annual meeting presentations were included in our specialty publications. A close relationship between the editorial boards of The Spine Journal and NASS committees responsible for the annual meeting program allows for this timely publication. In his presidential address, Neil Kahanovitz, the 1999– 2000 president of the millennium, presents his thoughts on NASS’ future. At the outset, he spoke of the marvels of revolutionary technology and the impact it has had on diagnosis and treatment of spinal disorders. He speaks of the effect Washington, D.C. and managed care organizations have had on clinical practice. He leaves us with an uplifting message of redemption through increased contact with our patients and advocacy. Physicians, standing forthrightly for the needs of the patient, must balance their views with understanding of the bottom-line interests of insurance carriers, business, government, and some attorneys. Our single Outstanding Paper by Michael Fredericson and colleagues from Stanford University is previewed by the Outstanding Paper award cover sheet. We anticipate that this page will highlight several Outstanding Papers annually. In this imaging study, normal subjects underwent magnetic resonance imaging before and after a full day of simulated work and moderate to heavy spinal loading. Posterior disk bulging and foraminal size were noted to be altered by the combination of activity and posture. Two distinct behavior characteristics of the normal spine with flexion-extension movement were found. This is the first study that we are aware of to take a “dynamic” view of magnetic resonance imaging for examining changes, often considered pathologic, that may actually occur simply with regular activity. In a subsequent article, Marc Malberg, M.D., makes the
case for a new system of classification for spinal injuries. Stan Gertzbein, M.D., provides the first commentary accompanying an article in this inaugural issue of The Spine Journal. Dr. Malberg has sought to identify a method of analyzing spine trauma that is applicable to all levels of the spine, based on the morphology of the injury. The system was then retrospectively applied to a defined patient population thought to be representative of most spine trauma. All cases were found to be classifiable using the new system. In his commentary, Dr. Gertzbein acknowledges the problems associated with identifying a universal system that is applicable throughout the spine and pays attention to the mechanism of injury and bony changes, while simultaneously taking neurologic alteration into account. The point-counterpoint approach is likely to raise substantial controversy. Scott Haldeman, M.D., Ph.D., one of The Spine Journal’s deputy editors, has written a critical review of cervicogenic headache for the inaugural issue with his colleague, Simon Dagenais, D.C. This extremely common symptom is usually associated with a confusing and controversial number of diagnoses and treatments, many of which often appear to conflict with each other. In this thorough literature review, the authors carefully assess what we do and do not know about this condition. Literature reviews on important topics will be a major feature of The Spine Journal. In future issues, they will also be accompanied by NASS Contemporary Concepts, edited by Alexander Vacarro, M.D., and his committee. These original, or updated, reviews will provide state-of-the-art information about major clinical topics in spine care. Despite the turmoil of the past decade, medicine in general, and spine care in particular, is still at a crossroads. Medical care still represents close to 13% of the gross domestic product and has once again begun to grow more rapidly than the rest of the economy. The acknowledged failures of many managed care initiatives is serving only to increase the red flags going up in corporate boardrooms, in Washington, D.C., and on Wall Street. Pressed by international competitive pressures from companies operating in partially socialized medical systems in other industrialized countries, US employers are still seeking more ways to reduce medical costs. Meanwhile, costs of drugs, devices, and precertification services expand far more rapidly than the cost of physician services. In the years to come, we will be most relevant in a changing economy if we can organize to demonstrate our ability to deliver high-quality, efficient health care with the least possible external supervision. Our ability to follow evidence-based medicine, as promoted by The Spine Journal, is a critical aspect of improving clinical practice. Research studies will lead the way in guiding both practitioners and regulators. As your first editor-in-chief, I ask that you help me by staying involved, contributing your manuscripts and features, and informing your colleagues. As we face this newest frontier together, I fervently wish to engage your support and participation.
Editorial
The North American Spine Society Focuses on Multidisciplinary Spine Care Tom G. Mayer, MD* In this first issue of The Spine Journal, the North American Spine Society (NASS) membership will receive an important new benefit. NASS has always tried to enhance knowledge about the spine field and the factors influencing it. In order to promote timely dissemination of high-quality, peer-reviewed scientific articles and provide a better understanding of the issues that affect us collectively, NASS has joined with Elsevier Science, a prestigious publisher of scientific journals. This is our maiden voyage, and we hope that you enjoy it. NASS’ mission is clearly stated by its leadership as follows: “NASS is a multidisciplinary organization that advances quality spine care through education, research, and advocacy.” There are at least five primary goals attached to that mission statement. The goals point NASS toward being recognized as the leading advocate for quality spine care; the members’ primary resource for education, knowledge exchange, and better practice; a leading force in promoting and supporting spine research; a leader in dissemination of credible spine care information to government, the general public, media, other health-care professionals, and industry; and a responsive infrastructure striving for balanced growth. The Spine Journal will be a partner with NASS in accomplishing these goals. The first four goals are very strongly connected to the “official journal” status conveyed upon our new venture. The authors of the best research presented at NASS meetings will be invited to prepare manuscripts for expedited review in The Spine Journal, which will be provided as a member benefit to all professionals belonging to our Society. The premiere research reports from our annual meeting will reach a large international audience in a timely fashion. In presenting original scientific work along with literature reviews, focused technical reports, and special features, our goals of advocacy for quality spine care and dissemination of information will be facilitated. To accommodate the balanced growth of various specialties joining NASS, The Spine Journal will be considering the needs of surgeons and nonoperative professionals, research scien-
* Corresponding author. North American Spine Society, 22 Calendar Ct., 2nd Floor, LaGrange, IL, 60525
tists, and clinical practitioners. It will balance the needs of the professionals engaged exclusively in spine care versus those who are less consistently connected. The NASS leadership has mandated that the balanced growth objectives of the North American Spine Society will be reflected in this peer-reviewed journal insofar as possible. Why is there a need for a new spine journal, and why did NASS decide to pursue it at this time? The intent to produce an official NASS journal is nothing new. It has been a stated goal of the board of directors of NASS for the past decade and has been given a high-priority rating at each of the last two tri-annual board retreats on program development. A number of reasons have been cited by NASS members, board, and staff for development of The Spine Journal at this time. First, and perhaps most important, is the issue of member benefit with regard to publication. Over NASS’ first decade, publications had been one of the least developed areas. As such, publications of all kinds have been a focus of increasing attention over the past several years. Some important milestones in our increasing concern about the benefit of publications include the development and dissemination of practice guidelines, the conversion of NASS News to a far more interesting format as SpineLine, the updating of previous Contemporary Concepts and development of new ones, and the publication of a variety of simplified explanations of complex spine issues for public health purposes. A second issue of importance is accountability of The Spine Journal to the NASS board of directors. The publisher and editorin-chief serve by contract to the board and are committed to responsiveness to perceived needs of NASS members. Although The Spine Journal will maintain an independent editorial policy, NASS members can be assured that the overall interests of our Society are uppermost in the minds of the editors. The vast majority of reviewers of manuscripts are NASS members. Because the journal is received free by our membership, the majority of readers (at least of the first few issues) will be NASS members. Individuals whose scientific work is judged superior by committees reviewing papers for NASS annual and affiliated meetings will be invited to publish their manuscripts with expedited review. The difficulty experienced in publishing manuscripts, as expressed by a
1529-9430/01/$ – see front matter © 2001 Elsevier Science Inc. All rights reserved. PII: S1529-9430(01)00 0 1 9 - 5
2
Editorial / The Spine Journal 1 (2001) 1–4
large number of our members in our needs survey, should be addressed by flexible growth of The Spine Journal. Nor is there any reason to expect the field of spinal care to diminish its production of quality research anytime in the near future. With an aging population discovering growing awareness of treatment options and technologies, our field is expanding. The relevance of NASS in this expansion is shown by its exponential growth, nearly tripling in size to nearly 3000 members over the past 6 years. Changes in society lead also to a change in NASS members’ techniques for information retrieval. Scientific studies on diagnosis and treatment will be accompanied by companion pieces on outcomes, reimbursement-driven changes in health-care delivery, government-induced limitations on care and legal and administrative factors, which strongly influence the way medicine is practiced in the new millennium. NASS’ charitable foundation is raising funds for research that is not otherwise supported by government or industry sources. The results of this research are of direct interest to our membership, so that recipients of NASS grants are likely to be encouraged to publish the results of their work in The Spine Journal. To date, more than $1 million has been provided to grant recipients. Finally, our public relations and advocacy efforts through the 501(c) organization, the National Association of Spine Specialists, are likely to be enhanced by the visibility of The Spine Journal. Based on a recent vote of the NASS board of directors, the NASS Outstanding Paper awards will become The Spine
Tom G. Mayer, MD
Journal Outstanding Paper awards beginning in 2001. A distinguished panel of deputy and associate editors will form a multidisciplinary peer review committee to oversee the most balanced review process we can establish. The board of directors has also decided to enhance the attractiveness of the competition by increasing the value of each award to $5,000.00 The Announcement of The Spine Journal Outstanding Paper awards will have been made by the time you receive your first issue of The Spine Journal, and we hope many of our readers will be submitting manuscripts. The Spine Journal will provide peer review of the highest quality. The NASS membership represents some of the best and brightest multidisciplinary clinicians in the field of spinal disorders. Many of them have extensive prior experience in peer review with other journals associated with their board specialties, as well as with the spine care subspecialty. Our associate editorial board begins with approximately 80 experienced member reviewers and is expected to grow as our journal matures. The advisory editorial board is an opportunity for younger members interested in gaining experience in peer review to make a contribution to our burgeoning field and ultimately move up to membership in the associate editorial board. Appointments will be made on an annual basis. We are also inviting a group of correspondent reviewers to provide occasional service and join a board of reviewers. This group will include senior professionals outside NASS who have extraordinary expertise to offer. The board of reviewers category is also appropriate for NASS members whose other time commitments are such that they are unable to take on the responsibility of joining one of the regular editorial boards and be available for reviews within the 21-day window routinely. I wish to encourage any of our membership, as well as those in affiliated societies that cosponsor meetings with NASS, to consider applying as a board of reviewers or advisory editorial board member by requesting an application from our NASS editorial office. Elsevier Science, our publishing partner in this new NASS effort, has a superb reputation as an experienced publisher of scientific journals. The NASS board was particularly impressed by the record of over 1200 journals published in virtually all areas of medicine and other scientific endeavors. Elsevier Science is especially strong in its relationship to a number of specialty medical societies as the publisher of their official journals for information dissemination. Their recently announced intent to merge with the Harcourt companies adds major publishers of orthopedic texts, such as W.B. Saunders and Mosby, to their group. As with other published medical journals, The Spine Journal, and its future electronic components, will be NASS’ principal means of communicating about multidisciplinary spine care, to comprise its basic and clinical research, clinical practice, legislative and regulatory affairs, history, and education. The Spine Journal will be distributed free of additional costs as a member benefit to the entire NASS membership and will also be distributed to subscribers, institutions, and libraries throughout North America and around the world. In our recent call for papers, we solicited original scientific
Editorial / The Spine Journal 1 (2001) 1–4
articles, literature reviews, and technical reports. However, we are also interested in submitted case reports, editorials, letters to the editor, innovations, and teaching points for residents. Because NASS sponsors regular meetings with a number of Asian and South American spine societies, we anticipate a great opportunity to publish scientific information of relevance to North Americans from a multitude of international sources. Within the United States and Canada, a large number of board-certified specialists have chosen to join NASS to underscore their commitment to spine care in their clinical and academic practices. Orthopedic and neurological surgeons still represent the majority of NASS members. However, a growing minority of nonoperative specialists, in fields as diverse as anesthesia, physical medicine and rehabilitation, occupational medicine, psychology/psychiatry, sports medicine, and pain management, have chosen to join us. There is also a representation by basic scientists, including epidemiologists, outcomes researchers, biochemists, and ergonomists. Our membership also includes academic chiropractors and physical therapists. All of these groups benefit from the timely dissemination of scientific information in the spine field and contribute greatly to its development. As the field expands, keeping surgeons informed about nonoperative issues and vice versa requires an ongoing commitment by our society and its board. The Spine Journal will be strongly supportive of this goal of our organization. At this time, a publishing plan to meet the needs of our NASS membership and to provide outreach to nonmembers around the world is still in development. SpineLine, edited by Stuart Weinstein, M.D., hopes to serve NASS as the primary spine practice information resource. It will do so by combining clinically based scientific articles with a series of columns focusing on current, practical, and thought-provoking socioeconomic and policy issues. In contrast, The Spine Journal will meet all anticipated needs for a peer-reviewed publication. Electronic opportunities currently exist to facilitate communication of scientific information and are likely to improve in the near future. In a timely fashion, The Spine
Editor-in-chief with deputy editors at North American Spine Society annual meeting in New Orleans, Louisiana.
3
Journal will develop, or participate in Elsevier Science Direct, a web-based source of our articles, as well as those of the other journals of Elsevier’s publishing family; an online version of The Spine Journal; www.spine.org, the NASS website, which is currently targeted to a broad array of enhancements for members, other professionals, patients, and their families, and which will expand The Spine Journal’s scientific communications. David Fardon, M.D., deputy editor for special features, is busy formulating a number of ways in which the written journal can interact with electronic media. Dr. Fardon, who trained in Missouri, Kansas, and New York, practices orthopedic surgery in Knoxville, Tennessee. He is academically affiliated with the University of Tennessee Memorial Research Center and a founding member of NASS. He is an active member of the American Academy of Orthopedic Surgeons (AAOS) and the American Orthopedic Association. He has previously served on a number of editorial boards and is currently editor of the AAOS, Orthopedic Knowledge Update (OKU-2) on spine. NASS’ other deputy editors bring great scientific and professional credibility, along with extensive service to NASS, to The Spine Journal. They include Howard An, M.D., covering basic sciences, Charles Branch, M.D., supervising neurosurgical issues, Scott Haldeman, M.D., overseeing nonoperative care, and Neil Kahanovitz, M.D., handling orthopedic surgery. Dr. An is currently professor of orthopedic surgery and holder of the Morton International Endowed Chair for Spine Research at Rush Medical College in Chicago. He has received research awards from three spinal societies (NASS, Scoliosis Research Society, and Cervical Spine Research Society). He is director of the Rush Spine Fellowship, is extensively published, and has considerable prior editorial experience. He has also performed peer reviews for Spine, Journal of the American Academy of Orthopedic Surgeons, and the American Journal of Orthopedic Surgery. Charles Branch, M.D., is associate professor of neurosurgery at the Wake Forest University School of Medicine in Winston-Salem, North Carolina. He trained in Oklahoma, Texas, North Carolina, and California. He is currently acting chairman of the Division of Surgical Sciences at Wake Forest. He has previously done editorial review work for Clinical Orthopedics and Related Research, Journal of Radiosurgery, Neurosurgical Focus, and Journal of Spinal Disorders. He is co-author of numerous peer-reviewed neurosurgery articles and is active in national neurosurgical societies. Scott Haldeman, M.D., practices in Santa Ana, California, and has an extraordinary international scientific background. He received a chiropractic degree in the United States (where he was valedictorian of his class), then returned home to receive his M.Sc. in Pretoria, South Africa. He received a Ph.D. in neurophysiology in Vancouver, Canada, where he also received his M.D. degree. His neurology residency took place in California. He is currently clinical professor of neurology at the University of California in Irvine. Dr. Haldeman’s honors and presentations are too numerous to recount. He has actively engaged in the practice of chiropractic as well as medicine and therefore presents a unique perspective on nonoperative care. In addition
4
Editorial / The Spine Journal 1 (2001) 1–4
to reviewing nonoperative manuscripts, he will personally author, and encourage, literature reviews on numerous controversial subjects in this often ambiguous area of spine care. Neil Kahanovitz, M.D., NASS’ immediate past president, is also published in this first issue of The Spine Journal through his presidential address. For the past decade he has been director of spinal surgery and rehabilitation at the Anderson Orthopedic Institute in Arlington, Virginia. This followed nearly a decade in full-time academics at New York University culminating as assistant chairman of orthopedics at the Hospital for Joint Diseases Orthopedic Institute in New York. Like the other deputy editors, he has a lengthy bibliography with extensive prior editorial and review experience. As a sign of things to come, the premiere issue of The Spine Journal features the presidential address from the recently concluded and highly successful 2000 annual meeting in New Orleans. In future years, it is our sincere goal to continue the tradition of expedited publishing as demonstrated by the ability to disseminate the presidential address and important scientific work, such as The Spine Journal Outstanding Papers, a few months after the annual meeting. In the past, we have usually waited 12 to 18 months for the opportunity to provide this material. Another problem we hope to resolve is that only a few of the manuscripts generated from annual meeting presentations were included in our specialty publications. A close relationship between the editorial boards of The Spine Journal and NASS committees responsible for the annual meeting program allows for this timely publication. In his presidential address, Neil Kahanovitz, the 1999– 2000 president of the millennium, presents his thoughts on NASS’ future. At the outset, he spoke of the marvels of revolutionary technology and the impact it has had on diagnosis and treatment of spinal disorders. He speaks of the effect Washington, D.C. and managed care organizations have had on clinical practice. He leaves us with an uplifting message of redemption through increased contact with our patients and advocacy. Physicians, standing forthrightly for the needs of the patient, must balance their views with understanding of the bottom-line interests of insurance carriers, business, government, and some attorneys. Our single Outstanding Paper by Michael Fredericson and colleagues from Stanford University is previewed by the Outstanding Paper award cover sheet. We anticipate that this page will highlight several Outstanding Papers annually. In this imaging study, normal subjects underwent magnetic resonance imaging before and after a full day of simulated work and moderate to heavy spinal loading. Posterior disk bulging and foraminal size were noted to be altered by the combination of activity and posture. Two distinct behavior characteristics of the normal spine with flexion-extension movement were found. This is the first study that we are aware of to take a “dynamic” view of magnetic resonance imaging for examining changes, often considered pathologic, that may actually occur simply with regular activity. In a subsequent article, Marc Malberg, M.D., makes the
case for a new system of classification for spinal injuries. Stan Gertzbein, M.D., provides the first commentary accompanying an article in this inaugural issue of The Spine Journal. Dr. Malberg has sought to identify a method of analyzing spine trauma that is applicable to all levels of the spine, based on the morphology of the injury. The system was then retrospectively applied to a defined patient population thought to be representative of most spine trauma. All cases were found to be classifiable using the new system. In his commentary, Dr. Gertzbein acknowledges the problems associated with identifying a universal system that is applicable throughout the spine and pays attention to the mechanism of injury and bony changes, while simultaneously taking neurologic alteration into account. The point-counterpoint approach is likely to raise substantial controversy. Scott Haldeman, M.D., Ph.D., one of The Spine Journal’s deputy editors, has written a critical review of cervicogenic headache for the inaugural issue with his colleague, Simon Dagenais, D.C. This extremely common symptom is usually associated with a confusing and controversial number of diagnoses and treatments, many of which often appear to conflict with each other. In this thorough literature review, the authors carefully assess what we do and do not know about this condition. Literature reviews on important topics will be a major feature of The Spine Journal. In future issues, they will also be accompanied by NASS Contemporary Concepts, edited by Alexander Vacarro, M.D., and his committee. These original, or updated, reviews will provide state-of-the-art information about major clinical topics in spine care. Despite the turmoil of the past decade, medicine in general, and spine care in particular, is still at a crossroads. Medical care still represents close to 13% of the gross domestic product and has once again begun to grow more rapidly than the rest of the economy. The acknowledged failures of many managed care initiatives is serving only to increase the red flags going up in corporate boardrooms, in Washington, D.C., and on Wall Street. Pressed by international competitive pressures from companies operating in partially socialized medical systems in other industrialized countries, US employers are still seeking more ways to reduce medical costs. Meanwhile, costs of drugs, devices, and precertification services expand far more rapidly than the cost of physician services. In the years to come, we will be most relevant in a changing economy if we can organize to demonstrate our ability to deliver high-quality, efficient health care with the least possible external supervision. Our ability to follow evidence-based medicine, as promoted by The Spine Journal, is a critical aspect of improving clinical practice. Research studies will lead the way in guiding both practitioners and regulators. As your first editor-in-chief, I ask that you help me by staying involved, contributing your manuscripts and features, and informing your colleagues. As we face this newest frontier together, I fervently wish to engage your support and participation.