For me to say that NASS has been special to me would be a massive understatement. It is truly a gift to be in the company of fellow travelers and likeminded individuals. The COVID pandemic reinforced how important is the crucial role of collegiality and interaction between peers. During the COVID pandemic, most experienced a profound social disconnection which affected societies worldwide. With the severity of the pandemic lessening and daily routines returning to normal, one would perhaps anticipate a bit of a social reconnection. Unfortunately this has not been the case. The surgeon general, Dr. Vivek Murthy, recently issued an advisory on the epidemic of loneliness in this country.1,2 Loneliness appears to affect about 20% of American adults and has significant implications in terms of health care and cost. The solution to this is not solely in health care, but requires involvement of integrated programs and services. While the pandemic fostered a sense of social disconnection, many other factors are involved. Basically, the nature of modern life, with rise of the internet, texting, and the proliferation of social media fostered a social fabric into which isolation fitted seamlessly. All ages and genders are affected. Americans are spending less time in direct interpersonal interactions than two decades ago. In people aged 15 to 24, 70% report less social interactions with their friends; in those age 65 or more 43% report feelings of loneliness.3 This trend has a profound impact on the cost of health care with increased utilization of medical, behavioral and support services. The Centers for Disease Control and Prevention recently estimated that the cost of loneliness is approximately $406 billion per year. This is in addition to an increase in Medicaid cost of $6.7 billion per year.5 From a purely medical perspective, loneliness is associated with increased risk of diabetes, hypertension, and dementia, with an increased risk of heart attack (29%) and earlier mortality (32%).4 Improved social connectedness is increased with better health and longevity.7 In terms of neurological health, social interaction stimulates the central nervous system and is associated with improved memory, and recall. There is also a suggestion that it may be somewhat protective from neurodegenerative diseases.6 Clearly, health care practitioners have an important role to play in the treatment of this crisis. Routine screening tools during patient visits can help identify depression and loneliness. Relying solely on the results of a questionnaire is suboptimal both diagnostically and therapeutically. Direct interaction with the patient has been shown to produce better outcomes. What does this have to do with the spine specialist? In an internal project, I am seeking Institutional Review Board review of a proposed study to examine the incidence and type of behavioral and psychological disorders in patients referred to a tertiary spine practice. Anecdotally, in this rural setting the incidence of these serious issues seems to be much higher than I recall in my previous level 1 urban academic positions. Currently, our group is in discussions with our colleagues in behavioral health about the impacts of various behavioral disorders on response to treatment, particularly interventional. More to follow. In this issue, Dr. Scott Kreiner discusses an important issue, AI impacting spine care, in From The First Vice President. The Invited Review by Eley et al, provides great insight to the role of APCs and spine practice. This is particularly a topic in which I am interested as in my current position, as we do not have an orthopedic residency but rely heavily on APCs. Having been involved in academic programs for over 30 years I had worried that a transition from residents to APCs would be difficult. It has not been so at all. In the Literature Review, Winter and Grauer discuss CRP curves and pyogenic spondylitis, and in the Section Spotlight Kurtzman proposes an interesting concept about the deleterious effect of silos in health care. He looks at this as a disease due to its impact with synergistic benefits of more widespread care. This month’s Coding piece by Saiz, Laminectomy 101, is particularly informative and really needs to be read closely by all surgical practitioners and staff. Finally, the May/June Ethics Poll results and a new poll question follows. We end with news from a variety of NASS departments. It is difficult for me to convey how much I am looking forward to our annual meeting in Chicago. Aside from a superb message on AI, the fact that it was written by the first vice president, Scott Kreiner, is a sign that the annual meeting is just around the proverbial corner. Do your part to combat loneliness. Come to Chicago.