American Society of Spine Radiology Annual Meeting: A Transformation into an Impactful Subspecialty

The recent ASSR meeting in mid-February featured some common topics such as structured radiology reporting and how to demonstrate the value of imaging. But it also began to touch on issues that made the meeting more impactful such as how to incorporate minimally invasive treatments into your practice and how to expand your focus to patient management.

Typically, radiology meetings focus on the diagnostic portion of the organ system, which is important of course, but the lack of visibility leads to the need to demonstrate value. If the value is obvious then one wouldn’t need to demonstrate it.

The value proposition of this meeting has morphed into something that includes talks on regenerative medicine, minimally invasive spine treatments, and training certification. An example of how this will change the practice of medicine for the positive can be seen with how we treat back pain. Back pain is at the top of the list of conditions that cause the most disability for people. Stable discogenic back pain is usually treated with non-surgical methods because surgical intervention is often unsuccessful. Data presented at the meeting include treatments for discogenic back pain, such as mesenchymal stem cells (MSC’s) for slightly to moderately degenerative lumbar discs and basivertebral nerve (BVN) ablation for moderate to severely degenerated discs. There is very good data that supports these treatments as more effective than surgery and something that can treat the majority of patients with a needle stick rather than surgery. This has the potential to change and dramatically improve the way that back pain is treated.

Mortality data was also presented from a large Medicare claims-based analysis of over two million patients. It demonstrated that patients diagnosed with vertebral compression fractures (VCF’s) treated with vertebroplasty or kyphoplasty suffered morbidities or died significantly less often than patients treated with non-surgical management. This supports other studies with similar conclusions and firmly categorizes vertebral augmentation as one of the things we do in medicine that is demonstrably life-saving and life-prolonging.

There was also discussion of certification for Radiologists for interventional pain management. This becomes an issue when applying for hospital privileges and the committee asks for a certificate to prove training in pain management. Although most of the fellowship programs in Interventional Radiology, Musculoskeletal Radiology, and Interventional Neuroradiology include training for interventional pain procedures, the fellowship certificate that is rendered upon graduation is one based in Radiology, not pain. The Radiologists are then often left with the odd scenario where they are able to put a catheter in someone’s brain and save their life from a stroke or haemorrhage but they can’t get privileges to do a lumbar epidural injection. The American Board of Radiology has a certificate of Pain Medicine that can be given to Radiologists who complete a fellowship in pain management. But this is not particularly helpful for those who have completed another type of fellowship. There was discussion around a recent development from the World Institute of Pain that will now examine Radiologists’ actual training, including number of procedures and experience, for possible admission to take the board exam. This addition was viewed as an egalitarian way to support and assist the practice of high quality interventional pain management.

Overall the meeting was replete with new developments that are not only interesting but have a chance to make a substantial impact on all of medicine. Closing the loop between diagnosis and treatment was one of the underlying themes and one that will be a welcome addition moving forward.

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