The 2005 Shriners Hospitals for Children (SHC) Symposium on The
Immature Spine has taken a different approach than in the past.
Previously, there was a relationship between the American Academy of
Orthopaedic Surgeons (AAOS) and the SHC to develop a triennial symposium that
led to a bound publication that was offered for sale to Academy members.
Because of declining sales following the 2002 symposium on Caring for the
Child with Spina Bifida, the AAOS decided not to pursue this cooperative
venture further. This marked the end of a relationship that had existed since
1989 and had produced four publications from the previous symposia.
In 1989, when Newton C. McCollough III, MD, was the president of the AAOS,
the relationship between the SHC and the AAOS was initiated. This relationship
began with Dr. McCollough presenting a plaque to Mr. Gene Bracewell, then
chairman of the board of trustees of SHC, expressing appreciation from the
AAOS to the SHC for its many contributions to orthopaedics, including resident
training, fellowship training, research, and pediatric orthopaedic care. Dr.
McCollough had previously arranged, during that same year, for the SHC Board
of Trustees to donate $50,000 to the AAOS every three years to fund a
symposium on an important topic in pediatric orthopaedics. Mr. Bracewell made
the presentation of this grant immediately following the AAOS award to the
SHC. The proceedings of these symposia were published as the Shriners
Symposium Series, which was a collaborative effort between the AAOS, the SHC,
and the Pediatric Orthopaedic Society of North America (POSNA). S. Terry
Canale, MD, who was president of POSNA at that time, was also on stage as a
corecipient of this initial presentation. The concept was that the AAOS would
provide logistical support for staff at the meeting and would publish and
market the volumes.
The original concept was that the symposium would be more like a workshop,
constituted by twenty-five to thirty experts in a specific field. After a
plenary session in which the issues involved were to be laid out, the experts
would meet in a workshop forum to make recommendations regarding the
prevention and treatment of disorders of the immature spine as well as to
identify directions for future research, keeping in mind the goal of
publishing to a broad audience. The experts were then to prepare specific
"keynote" articles in advance and present them at the opening
plenary session. These articles, which would define the current state of care
and identify problem issues, would serve as discussion material for the
workshop group participants, who would be asked to define the current status,
identify problems or shortcomings, and make recommendations for the future.
Each workshop topic (e.g., natural history, prevention, current treatment,
current resources available and required, and research) would have a
designated chairman who would conduct the workshop and make recommendations to
a plenary session for review and modification by the entire group on the final
half-day of the workshop. Workshop reports were to be typed by the AAOS staff
the evening before the final plenary session and made available to the entire
group of participants in the morning. These reports would then be organized
and, ultimately, published in textbook form.
Dr. McCollough had also arranged, through Dr. Canale, for POSNA to
collaborate in the production of this event. A steering committee would be
formed, constituted by the president of POSNA and/or his or her representative
together with the chairman of the AAOS Committee on Pediatric Orthopaedics (no
longer in existence) and/or his or her representative. This committee would be
empowered to choose the topic, select the symposium chairman and participants,
serve as the on-site steering committee for the symposium, and serve as the
editorial board for the publication. The publication was to contain all of the
keynote articles as well as the work product of each workshop. The reason for
the workshop format was to facilitate the development of useful guidelines and
recommendations on problematic entities and to promote this information to a
wide audience. The workshop format had been selected by Dr. McCollough on the
basis of his early experience with the National Academy of Sciences, where he
shared a few endeavors, and because he wanted to publish the consensus of
experts on conditions for which care was controversial or not well
defined.
While the initial symposia were successful and resulted in an adequate sale
of textbooks to cover the costs incurred by the AAOS, sales unfortunately
declined over time. (The names of the symposia, their year of publication, and
the number of textbook sales and giveaways are presented in
Table I.) In 2002, the AAOS
informed the SHC and POSNA that it no longer wished to be involved with the
symposia due to the increased costs and limited sales. At that time, George H.
Thompson, MD, president of POSNA and chairman of the POSNA/SHC symposia
selection committee, selected The Immature Spine to be the next
symposium topic. The committee selected Lawrence G. Lenke, MD, and Stephen J.
Tredwell, MD, FRCS(C), as co-chairmen, and these gentlemen shared the
responsibility for developing the symposium. As the immature spine represents
a subject of considerable controversy and importance, especially considering
the increased use of "growing rods" for surgical treatment, the
AAOS was contacted again, this time with a proposal to change the symposium
format to a one-day course prior to the POSNA annual meeting. The plan was
that all attendees would receive a copy of the textbook as part of their
course fee and that other textbooks would be made available for sale by the
AAOS. It was anticipated that this strategy would increase the number of books
distributed and would entice the AAOS to continue to participate in future
symposia. However, even with the potential for increased sales and
distribution of textbooks, the AAOS did not believe that the venture was a
financially viable one and declined to participate. Dr. Thompson, who at that
time was deputy editor for pediatric orthopaedics for the American volume of
The Journal of Bone and Joint Surgery, approached the editor of that
publication, James D. Heckman, MD, and asked him to consider publishing the
symposium as a supplement to The Journal. The SHC grant would be used
to cover most, if not all, of the cost of publishing the supplement. Dr.
Heckman recognized the importance of these symposia and agreed. Because the
topic for the next POSNA one-day course—the immature spine—had
already been selected and because of the unique subject matter involved,
Randal R. Betz, MD, president-elect of the Scoliosis Research Society (SRS),
was contacted to see if that society would be interested in presenting this
symposium as a one-day course prior to one of their annual meetings. There was
appreciable interest, and the SRS agreed to use The Immature Spine as
the one-day course for their October 2005 annual meeting in Miami, Florida.
With approximately 300 attendees present, the symposium was a
success—despite the fact that Hurricane Wilma had passed through the
area just two days earlier. The symposium was therefore a win-win-win venture
for the SHC, for POSNA, and for the SRS: the SHC was able to continue to
sponsor and fund a symposium; POSNA received the credit for the organization
and development of it; and the SRS received the financial remuneration for
hosting the course. All of us owe a debt of gratitude to Dr. Heckman for his
wisdom and vision in publishing this symposium. His decision has allowed
continuation of the Shriners symposia and gives greater academic recognition
to the participants, who spent more than two years preparing their material
for presentation at the symposium and for publication. Hopefully, the greater
academic recognition achieved with the publication of this symposium will
encourage other societies to join in a cooperative venture with the SHC and
POSNA for the purpose of continuing the Shriners Symposium Series in the
future. ?