Did you catch these highlights from Safety in Spine Surgery Month, Week 3? Our April 15 webinar was packed full of practical advice on implementing checklists and guidelines, and the faculty included leaders from the SRS, the AANS, POSNA, and more. We jammed a lot of education into those 2 hours! You can catch the replay on our website here.

Since we are talking about checklists, do you know about all the free safety in spine surgery resources on the S3P website? We have risk severity scores, checklists, pathways, and more.

We also continue to post daily videos about safety from a variety of leaders across all our social media channels. I think these videos are getting better and better! This week’s videos included:

  • Carlton Weatherby from Medtronic talking about their steadfast commitment to unmatched quality.
  • Dr. John Smith sharing about the success he’s seen in dedicated surgical teams and checklists—they make surgery “much more efficient, safer, and fun.”
  • We posted a clip from Dr. Roger Härtl’s 2020 talk about the market approval process for new technology.
  • Dr. Kevin Shea told us about the POSNA Safe Surgery Program. Learn more here.
  • Dr. Rick Sasso explained the No Strikeout Protocol he developed at the CSRS. This resource is free to download, too.
  • Dr. Chris Hardesty shared about peri-op care protocols, which “help remove variation in practice, which can help decrease variation in outcomes.”
  • Finally, we capped off the week with General Stan McChrystal, our Keynote Lecturer at the 2018 Safety in Spine Surgery Summit, sharing his thoughts on how teams impact safety.

As always, you can review all these videos, plus our library of past talks, for free on the website.

We want to thank this week’s contributors, as well as this week’s partner organizations: Medtronic, Pediatric Spine Study Group & the Pediatric Spine Foundation, POSNA, and the CSRS.

We still want to hear from you! Post safety tips or questions on your own social media—tag us, and you might win a $100 gift card! Winners are drawn each week from all social media channels.

View all this week’s videos here.

We had some amazing videos sharing the message about safety in spine surgery, with both top-level commentary as well as practical tips. This week our daily safety tip videos were seen by over 11,000 people, and our overall audience grew by 40%. Highlights included:

  • Dr. Lehman asked us, “Why is it safer to fly in an airplane than to have surgery?,” in his video on Safety By the Numbers.
  • Prof Carl-Eric Aubin shared about the biomechanical considerations in assessing spinal instrumentation for safety.
  • Vafa Jamali from Zimmer Biomet shared about their support of the Safety month.
  • Dr. Hey shared about the importance of spine surgery checklists, including a link to the downloadable checklists he’s created.
  • And finally, Dr. Elowitz explained the connections between communication, patient safety, and medical malpractice.

Several of these daily tip videos are taken from longer talks presented at past Safety in Spine Surgery Summits. Did you know we have a library of these talks that you can browse & watch for free? Visit the videos tab on our website, or start here with the 2020 Safety Summit videos.

We also had over 500 people register for the April 15 webinar Checklists & Guidelines Which Make Spine Surgery Safer, which featured 4 of our Award Winners for the Best New Methodologies and Techniques to Enhance Safety in Spine Surgery, as well as a “who’s who” of surgeon leaders representing spine safety efforts from leading societies including the SRS, AANS, and POSNA.

We want to thank this week’s contributors, as well as this week’s partner organizations: NewYork-Presbyterian, Medtronic, Zimmer Biomet, NeuroPoint Alliance, Hey Clinic, and CareGuard.

We want to hear from you, too! Post safety tips or questions on your own social media—tag us, and you might win a $100 gift card! Winners are drawn each week from all social media channels.

View all this week’s videos here.

The Safety in Spine Surgery Project (S3P) is pleased to announce the 10 winners of the Safety in Spine Surgery Month Call for Abstracts / Call for Projects. The winning submissions for Best New Methodologies and Techniques to Enhance Safety in Spine Surgery will present their work during two live webinars for Safety in Spine Surgery Month. The free webinars will be held on April 15 and April 29. Registration and further details are available at the link below.

April 15 Webinar

Checklists and Guidelines which Make Spine Surgery Safer
  • Spine Surgery Checklist: A Step towards Perfection through Protocols
    Jwalant Patel, MS, FASSI; Arvind Kulkarni, MS
  • Establishing a Standardized Protocol for Identifying Patients at High Risk for DVT/PE Following Spine Surgery
    Zeeshan Sardar, MD, MSc; Kristen Mitchell, PA; Rick Leung, PA; Derek Mazique, MD
  • Surgical Site Infection Following Neuromuscular Posterior Spinal Fusion Fell 72% After Adopting the 2013 Best Practice Guidelines
    Stephen R. Stephan, MD; Kenneth D. Illingworth, MD; Kavish Gupta, MD; Lindsay M. Andras, MD; David L. Skaggs, MD MMM
    Cedars-Sinai Medical Center & Children’s Hospital Los Angeles
  • Learning from Air Travel: Utilizing a Checklist Prior to Closing (Landing) in Pediatric Spine Surgery
    Jessica H. Heyer, MD; Patrick J. Cahill, MD; John M. Flynn, MD; Jason B. Anari, MD
    Children’s Hospital of Philadelphia

April 29 Webinar

Leveraging the Team to Make Spine Surgery Safer
  • Reduction of Facial Pressure Injuries after Prone Positioning in Spine Surgery: A Multi-Disciplinary Approach
    Mindy Stites, MSN, APRN; Brandon B. Carlson, MD MPH; Linda Brookman, RN; Jake Kessen, CRNA; David Pennington, CRNA; Jacob Birlingmair, MD; Kabir A. Torres, BA; Douglas C. Burton, MD
    University of Kansas Health System
  • Design and Implementation of an Enhanced Recovery After Surgery (ERAS) Protocol in Elective Lumbar Spine Fusion by Posterior Approach: A Retrospective, Comparative Study
    Bhavuk Garg, MS, MRCS; Nishank Mehta, MS; Tungish Bansal; Shubhankar Shekhar; Puneet Khanna; Dalim Vaidya
    All India Institute of Medical Sciences
  • Comparison of Procedural Utilization Rates and Timeline to Care in Multidisciplinary versus Unidisciplinary Spine Clinic Models
    Joshua Benton, BA; Vijay Yanamadala, MD, MBA, MS; Brandon T. Weiss BS; Wenzhu B. Mowrey, PhD; Michael Longo, BA; Rafael De La Garza Ramos, MD; Yaroslav Gelfand, MD; Phillip Cezayirli, MD; Erida Castro-Rivas, MS; Mark Headlam, BS; Adaobi Udemba, NP; Lavinia Williams, RN; Merritt D. Kinon, MD; Andrew I. Gitkind, MD, MHA; Reza Yassari, MD, MS
  • Multidisciplinary Conference for Complex Surgery Leads to Improved Quality and Safety
    Zoe Norris, BFA; Michelle Zabat, BA; Hershil Patel, BS; Nicole Mottole, BS; Kimberly Ashayeri, MD; Eaman Balouch, MD PhD; Constance Maglaras, PhD; Themistocles Protopsaltis, MD; Aaron Buckland, MBBS FRACS; Charla Fischer, MD
    NYU Langone Health & NYU Langone Orthopedic Hospital
  • Innovative Technology System to Prevent Wrong Site Surgery and Capture Near Misses: A Multi-center Review of 487 Cases
    David Gloystein, MD; John Devine, MD; Bradley Heiges, MD; David Schwartz, MD; Deborah Spratt, MPA BSN RN CNOR
  • The Effect of a Transdisciplinary Spine Conference on Quality and Safety for Adult Spinal Deformity Surgery
    Gregory Mundis Jr., MD; Fernando Rios, MD; Hani Malone, MD; Bahar Shahidi, PhD; Tina Iannacone, BSN; Shae Galli, BS; Robert Eastlack, MD

The Safety in Spine Surgery Project is pleased to announce the First Annual Safety in Spine Surgery month, taking place in April of 2021. The goal of this project is to improve safety in spine surgery by sharing guidelines, techniques, and protocols that make care better, and to share lessons learned from participants who have developed specific, successful safety protocols. This event will feature 2 live webinars and an industry-wide social media campaign throughout April.

Under the leadership of Michael G. Vitale, MD, MPH and co-chairmen John Flynn, MD; Roger Härtl, MD; Larry Lenke, MD; Rajiv Sethi, MD, S3P is partnering with surgeons, allied health care providers, organizations, hospitals, and medical device companies in this effort. It is the belief of the program directors that all major healthcare stakeholders are obligated to invest their expertise and funds to enhance patient safety.

Submission of abstracts and projects summaries is underway for Best New Methodologies and Techniques to Enhance Safety in Spine Surgery. The 10 best submissions will each be awarded $1000 and be featured during one of the live webinars. We encourage our colleagues to submit not only scientific papers, but also any project that has made a difference in spine surgery quality, safety, or value. Submissions are due to Kate Laney by February 19, 2021.

Registration is open for two live webinars, taking place April 15 and April 29. The first will focus on predictive analytics, enabling technology, and innovative techniques to make the OR safer. The second will highlight checklists, guidelines, and tricks to avoid complications and improve neurological safety. Registration is free and can be accessed at this link.

We encourage you to get involved in this effort by submitting abstracts, attending the webinars, and getting active on social media during the month of April. Post your successes and difficulties with the hashtags #safetyinspinesurgery and #s3p. Follow us on Twitter, Facebook, Linkedin, and Instagram for further information.

If your practice, organization, or medical device company would like to partner with us, please contact Kate Laney.

We are looking forward to an exciting month of collaboration!

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By Rajiv K. Sethi, Aditya V. Karhade, Michael G. Glenn and Gary S. Kaplan—

Until the Covid-19 pandemic struck, surgical patients in the U.S. had been increasingly traveling to designated Centers of Excellence, health systems that met stringent criteria for providing exceptional, high-value care for specific procedures such as knee replacement and spinal surgery. In some cases, large employers such as Walmart entered into contracts with the COE providers to care for their employees, whose travel to the specified provider for evaluation and, if needed, surgery, would be fully covered. In other cases, patients would travel from afar using other coverage to receive this specialized care.

Our institution, Virginia Mason, along with others including Geisinger, the Mayo Clinic, and Johns Hopkins are designated Centers of Excellence. Among the services patients have traveled to us for are complex spine surgeries, one of the most challenging procedures.

By shutting down most travel, the pandemic might have put an end to such programs, at least for the duration. But at Virginia Mason, prior investments in telemedicine technology for virtual patient encounters and virtual multidisciplinary perioperative clinical-team conferences have allowed us to continue providing surgery and other spine care to both local and remote patients traveling from hundreds or thousands of miles away, as well as to enhance virtual patient care broadly.

The Spine Team Approach

Based in Seattle, we were among the first organizations to confront the Covid-19 pandemic and, as such, had no blueprint to guide our response. Regulatory guidelines were constantly evolving and there were widespread shortages of personal protective equipment (PPE). Travel restrictions were keeping patients from many states away from Seattle and, fearing infection with the novel virus, local patients were deferring needed care. A ban on elective procedures resulted in precipitous and profound decreases in clinical care revenue and financial pressures were intensifying.

The pandemic forced us to quickly respond to novel clinical challenges, but we also needed to develop new ways to coordinate our sophisticated care teams and to safely engage with patients, including those traveling to Virginia Mason for complex spine surgery.

Like many leading organizations, Virginia Mason emphasizes a multidisciplinary approach to value-based care, which focuses on improving outcomes while reducing costs. The “Seattle Spine Team Approach” is a fully developed example of such comprehensive and condition-specific care. This model involves pre-surgical team conferences (now held virtually) that include orthopedic surgeons, neurosurgeons, physiatrists, pain medicine specialists, specialty-trained nurses and physician assistants, hospitalists, psychologists, and anesthesiologists. These conferences, along with the requirement that two attending surgeons are present during complex spine surgeries and the institution of a tailored intraoperative anesthesia protocol, have resulted in a three-fold reduction in major complications in the most complex spinal procedures. Many team members see these conference as the cornerstone of the entire spine care program.

When a patient is referred for spine surgery, the team holds a virtual “patient clearance” conference to evaluate whether he or she will decisively benefit from the procedure or may be as effectively treated without it. (In our prior studies of in-person visits where referred patients were presumed to need lumbar surgery, we found that 58% in fact didn’t need it.) For those patients found to be good candidates for surgery, the team conducts a risk stratification to determine which require immediate surgery and begins pre-surgical “optimization,” evaluating patients for surgical risk factors such as obesity, diabetes or smoking. In non-urgent cases, the team postpones surgery to allow time to address these.

Our clinicians have embraced the virtual conference format. We have seen increased attendance and continued engaged discussion by our clinical staff. Further, providers who rotate between clinical sites can attend these more easily than the previous physical meetings. As a result, the spine team has now committed to all-virtual patient-clearance conferences as its “new normal” and expects to continue with these virtual conferences even after restrictions on in-person meetings are lifted.

Combining Virtual and Hands-on Care

A recent case illustrates how we are integrating traditional destination care and new virtual care models. A 57-year-old man from Alaska had been experiencing progressive weakness in his arms and legs and for several weeks was unable to get timely outpatient evaluation because of the pandemic. As his symptoms became severe, his local doctor referred him to one of our physicians. The team held a virtual care conference and the same day a consultation with his local doctor, determining that the patient would require complex cervical spine reconstructive surgery. Within a day of those meetings, the patient was on a plane from Alaska to Seattle where he was scheduled to undergo immediate surgery at Virginia Mason. Two weeks later, the patient returned to Alaska and all further communication with the patient and his local doctor has been conducted virtually. Within three months after surgery, the patient had regained full use of his arms and legs and returned to work. We are continuing to follow him through serial virtual visits that include his surgeon, specialized spine physician assistants, rehab physicians and pharmacy.

While the pandemic hasn’t substantially interrupted our destination care program for patients needing urgent specialized spinal surgery, it has underscored the less dramatic, but equally important element of the program—it’s focus on identifying candidates for surgery who in fact can be effectively managed without it. It’s now clear that, going forward, many nonsurgical patients could receive a comprehensive evaluation and treatment without physically traveling to Seattle. These patients can be managed virtually by our non-operative spine specialists and continue their treatment plan without travel-related interruption. With virtual multidisciplinary care we have actually increased access to quality care while, with the decrease in required travel, dramatically reducing the costs of evaluation and treatment.

Acknowledging the terrible human suffering and financial toll of Covid-19, we anticipate some positive lasting changes. Virtual multidisciplinary conferences and telemedicine allow us to provide our model of care to all patients, not just those in COE programs. For patients back home after surgery, telemedicine allows for close and timely follow-up without the burden of travel. Virtual multidisciplinary conferences can improve care by allowing same-day, real-time assessments of the urgency of patients’ needs and facilitating immediate triage. In addition, they can serve as a consult resource for patients’ local providers. The potential silver lining of the current Covid crisis may be its role as a catalyst to enable a better paradigm of value-based care.

Read Full article here >


Less than 2 weeks before the 5th Annual Safety in Spine Surgery Summit on March 13, NewYork-Presbyterian Hospital received its first COVID patient. These were the early days of an unprecedented strain on the city’s healthcare system. NYC is still fighting a hard battle every day and continues to rise to the challenge.

Despite taking the necessary step to cancel the live Safety Summit in March, we were still committed to providing top-tier educational resources to the spine surgery community. Our local faculty gathered for discussion and our long-distance faculty recorded their own presentations. In the words of Dr. Flynn & Dr. Vitale, it’s more a mission than a course. Thanks to our faculty and supporters, we’re now pleased to present these to you as a free Safety Summit Online CME video series.

Surgeons, PAs, and Nurses can earn 4.2 hours of CME/CE credit by viewing this series of lectures and panel discussions. Learn from experts in spine surgery, neuromonitoring, medical device approval, malpractice, and more. Plus, gain invaluable insight from Stephen Harden of LifeWings, a leader in transforming patient safety programs around the country. We’ve also provided the full text of the outstanding abstracts submitted for this meeting. In addition, you can review the E-Poster presentations, representing some of the best new research in our field. This CME-accredited course is available through February 2021.

We hope you’ll take advantage of this year’s on-demand learning experience. We look forward to joining together in person again for the 6th Annual Safety Summit in Spring 2021. Until then—stay healthy. Stay safe.

Click here for more information.

Save the date for the 5th Annual Safety in Spine Surgery Summit: April 13, 2020 in New York City.

Friday, March 13, 2020
Location: The Heart Conference Center / New York-Presbyterian Hospital, 173 Fort Washington Avenue, New York, NY 10032


  • Michael G. Vitale, MD, MPH


  • John M. Flynn, MD
  • Roger Härtl, MD
  • Rajiv K. Sethi, MD

An ESSENTIAL program for:

  • Spine surgeons
  • Surgical spine team members
  • Hospital execs responsible for patient safety

Registration details will be posted on the Event’s Page.

View the videos from presenters at the 4th Annual Safety in Spine Surgery Summit. Learn insights and practical techniques for improvement of safety in spine surgery from experts in the medical field as well as other fields.

Click here to view videos

Hear what leaders in the spine industry have to say about the Safety in Spine Surgery Summit.

Michael Vitale, MD, MPH, Chief of Pediatric Orthopedics and Pediatric Spine Surgery at the Columbia University Medical Center, shares the motivation behind the S3P meeting. In addition, Drs. Sethi and Lenke explain what makes the Summit so unique. Learn why it is an essential meeting for spine surgeons, surgical spine team members, hospital execs responsible for patient safety, and more. Watch the video below.

"This meeting is the most valuable for any practicing surgeon." —Rajiv Sethi, MD

"You'll provide better service to your patients." —Lawrence Lenke, MD

We are excited to be convening the 4th Annual Safety in Spine Surgery Summit on April 26, 2019 in New York City, NY! In addition to the fantastic roster of speakers, we look forward to sharing the following:

  • Latest in Best Practices for Safety in Spine Surgery
  • Using tools to reduce variability and improve predictability of achieving positive outcomes
  • Discussing the importance of safety on the macroeconomic level
  • Designing Talent, culture and team to achieve best outcomes
  • Protecting surgeons and providers
  • Discussing value-based care in spine with all stakeholders

We look forward to seeing you at the Safety in Spine Surgery Summit!

Register Here >

More Information >

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