Q: What were your initial thoughts regarding this recognition?

Dr. Traynelis: Two things came to mind. First, that it is a great honor. Second, am I really that old?

Q: What do you see as the significant near term challenges to spine surgery?

Dr. Traynelis: It is clear that many gains have been made in recent years in understanding spinal alignment and balance. The challenge we now have is to understand what we do with this understanding. Does everyone need a T4 to Pelvis operation? In which patients is it safer to proceed with a more limited operation? There is much to sort out in this space. We do not want to do too much or too little. In this regard, questions of cost effectiveness must be answered as if payers elect to not pay for these procedures, then what will we do? This is not only an economic, but also a moral dilemma.

I am also a little concerned about the rise of outpatient surgery. Specifically, I am worried that advancements that are good for some patients are then being generalized to all patients. For example, the fact that perhaps a 30 year old may safely undergo an outpatient surgery does not translate to a 90 year old being treated as an outpatient.

One other thing comes to mind; we must begin to influence payers on the costs of non-operative therapies. We are constantly being challenged on operative interventions. We must challenge payers and our peers in other specialties for data on the cost effectiveness of non-operative interventions.