The 25th Annual Meeting of Japan Society for the Study of
Surgical Techniques for Spine and Spinal Nerves (JPSTSS)
Greeting from President

Akiyoshi Yamazaki, MD

It is a great pleasure and honor for me to host the 2018 25th annual meeting of the JPSTSS (Japan Society for the Study of Surgical Technique for Spine and Spinal Nerves) in Tokyo. A quarter century has passed since the foundation of this society, and some of the founding members are slowly beginning to step down. However, the three original guidelines of this society, established by one of the founders, Dr. Kiyoshi KUMANO, namely, “to contribute to simultaneous worldwide progress”, “to encourage collaboration between orthopedics and neurosurgery”, and “to participate as an individual, not as a functionary of an institution” still provide this society with its grounding principles. Many lesser-known scientific conferences in Japan are now beginning to lose attendees at an accelerating rate, partly because corporate sponsors have withdrawn their financial support due to harder economic times. Nonetheless, we are convinced that this conference will continue thanks to its strong sense of mission. In the hopes, therefore, of the continuing success of this society, I wish to announce ‘fusion’ as the theme of this meeting. Thanks to the recent dramatic improvement of information networks, the exchange of knowledge has become easier than ever before. However, it is still important to get together in one place and communicate with each other face-to-face in order to sustain the sense of community. Such social intercourse is vital as a stimulus to innovation and as a source of inspiration for those who are engaged in a common enterprise and aiming for the same goals. One of the topics of this meeting is the ‘artificial cervical disc,’ which will become available in Japan soon. We hope to provide information about this new device to our attendees. Another topic is the ‘procedure for introducing new devices from bench to bedside’. One of the main concerns of the JPSTSS is to contribute to the technical improvement of instrumentation surgery, which relies on innovations in the relevant technologies. Many steps are involved in making any new technology available and beneficial to patients. In internal medicine, a new drug will bring about the same results regardless of who receives it, as long as the dose is correct. On the other hand the results of surgery strongly depend on the surgeon who performs it. In addition, there exists the so-called learning curve in surgery. No matter how perfectly the surgeon prepares for the task, the results of his early work will always be surpassed by his or her later efforts as he or she gains more experience and learns to take advantage of new technologies. Formerly, it was left up to each surgeon to improve his or her own expertise as much as possible. However, nowadays, the surgeon’s expertise is coming more and more under government control. Yet in contrast to the government’s regulation of drugs, there is no well-established protocol for introducing novel procedures dependent on new technologies into the clinical field. As with other aspects of the medical profession, in principle the government bears the final responsibility. Naturally bureaucrats are not conversant with all the issues in the medical profession and must consequently collaborate with academics. Thus professional autonomy is crucial. In this framework, the academic is asked to prepare guidelines for each issue, and relevant industries are required to follow them by the government. Yet it is still unclear how high the bar should be for the approval of a new procedure or technology. If we set the bar too high, many patients who might benefit from this new technology will be unable to do so. However, if it is set too low, it will pose a risk to the patient’s well-being. Indeed, in the field of spinal instrumentation, we experienced an instance of this dilemma quite recently. I think it is time to reconsider the criteria for approving new devices for clinical use and what needs to be changed in order to facilitate the process. I have also asked a legal expert to comment on the responsibility of the doctors in the event of an accident during the testing of a new technology or procedure. As mentioned above, the chief aim of this meeting is refining the surgeon’s skills in spinal instrumental surgery. In combat, both superior strategy and tactics are necessary to win. Likewise, we can’t discuss the best surgical treatment solely from a technical standpoint. We also need to consider the details of treatment strategy including what the best treatment is for different kinds of patient, what kinds of problem in the patient’s daily life are at issue, and what treatment options are available, including surgical, medical, and conservative treatments. Therefore, I have added ‘challenging difficult cases’ as one of the major topics of this meeting. In our discussion of this topic, we will review representative past cases presented on the homepage and ask you to suggest solutions for discussion. The cases will be common problems we have all experienced in the field of spinal instrumentation, e.g., adult spine deformity due to severe osteoporosis and spinal deformity due to Parkinson disease, where the central posture control system itself is malfunctioning. These are typical cases where the consideration of total treatment strategy is necessary. I do not expect that there will be a consensus, but I am sure that participating in this type of discussion itself will help all participants to clarify their own ideas about treatment. Again, this is one type of ‘fusion’ that exemplifies the theme of our meeting. Also welcome are all papers concerning the surgical treatment of the spine and neuro-spinal disease. The congress will be held at ‘Schönbach SABO’ located just inside the outer moat of Edo castle. Behind this moat used to be exclusive residence of the Samurai under the direct supervision of the Shogun, who were not the hereditary vassals of the Shogun’s family but were gathered from all over Japan. In this sense, this area used to be a ‘melting pot’ of many different regional cultures. In the post-WW II era, the Federal Democratic Party had its offices in the SABOH building, where many representatives elected from all over Japan gathered. In these both senses, the congress venue is well-suited to the main theme of ‘fusion’. I am looking forward to meeting you at this place on September 14-15 in 2018.

October 2017
The 25th Annual meeting of JPSTSS
President Makoto TANIGUCHI, MD PhD