March 11-14th, 2009 is the Silver Anniversary (25th) of the AANS/CNS Joint Section Meeting on Disorders of the Spine and Peripheral Nerves. The “spine section” is the largest surgical spine society in the world and plays an important role in the development of, interpretation of, and utilization of scientific information regarding the surgical management of spinal disorders. The theme of this year’s meeting is Evidence, Appraisal and Advocacy. The meeting will be held at the JW Marriott Desert Ridge Resort & Spa in Phoenix, Arizona.

As we head into this meeting, we note that spine surgery as a subspecialty faces special challenges. Spine surgeons strive to provide excellent patient care by using scientific and clinical knowledge. However, we find ourselves defending the benefit of spine surgery under increasingly strenuous examination by the media, government regulators and economists. Data derived from high profile studies such as the SPORT trials have been appropriated by the lay press and have been inappropriately used to denigrate the efficacy of surgical techniques.9 The Centers for Medicare and Medicaid Services (CMS) is shifting its focus from efficacy to cost effectiveness in medical care and in spine surgery in particular. The public’s concern about the relationships between industry and healthcare has also put spine surgery back into the newspaper. 1 Recent congressional inquiries have focused the public’s concern onto these relationships (Sunshine Act, Grassley et al, 2008).

Despite these challenges, spinal surgery continues to move forward at a breathtaking pace. We are moving beyond arthrodesis into arthroplasty. Recent developments for biologic disc replacement and dynamic stabilization reveal exciting new non-fusion possibilities for our patients. These new technologies and the focused application of current technologies have the potential to provide substantial improvements in the quality of our patient’s lives.