NASS International Annual Meeting: Session Spotlights
At the 2025 NASS International Annual Meeting in Taipei, Taiwan, spine specialists from all around the world gathered to exchange ideas, share new research, and advance the conversation on patient care. Among the many educational offerings, symposia provided in-depth perspectives on emerging issues in the field. In this issue, SpineLine spotlights three sessions through summaries prepared by their moderators.
Controversies in Thoracolumbar Fractures
By Charles Reitman, MD
Moderators: Charles Reitman, MD; Jeng-Beom Park, MD
It was my privilege to moderate the session with Jeng-Beom Park on controversies in thoracolumbar fractures at the NASS International meeting in Taipei. We had a collection of international presenters that delivered concise, well organized and informative talks that provided the foundation for a very interactive discussion amongst the participants.
John Liu from the USA started the session with a talk on percutaneous fracture stabilization. I followed with a brief discussion of biomechanical principles of fracture fixation. We then had two debates. The first topic was benefits of anterior versus posterior surgery for treatment of unstable burst fractures. Khanathip Jitpakdee from Thailand and Hani Mhaidli from the Canary Islands provided outstanding, evidence-based cases for anterior and posterior approaches respectively.
This was followed by a healthy 15-minute discussion with the audience further defining the roles for both anterior and posterior surgery. The session concluded with a second debate on the value of direct vs indirect decompression for management of neurological deficits following thoracolumbar fractures. Masayoshi Iwamae from Japan presented the argument for direct decompression, and Alan Hilibrand from the USA finished the session advocating for indirect decompression.
These were again followed by a superb 15-minute discussion with the audience. We concluded the meeting with a summary of these discussions that provided the audience with a foundational strategy for decision making in the surgical management of thoracolumbar fractures. I am deeply appreciative of the preparation and insight provided by all the speakers and my co-moderator to make this such a terrific and pragmatic educational forum.
AI, Next Generation Technology, and the Future of Spine Surgery and Interventional Spine
By Koji Tamai, MD, PhD
Moderators: Jean-Jacques Abitbol, MD; Koji Tamai, MD, PhD
As technological innovation accelerates, spine surgery is entering an era where artificial intelligence (AI), robotics, augmented reality (AR), and other next-generation tools are poised to reshape clinical practice. Yet, their adoption brings not only opportunities but also challenges—ranging from cost-effectiveness and learning curves to ethical considerations and equitable access. This NASSi 2025 symposium in Taipei brought together distinguished faculty to explore how these technologies are influencing spine surgery today and how they might define its future. The session blended visionary perspectives with grounded clinical experience, offering both inspiration and practical insight for surgeons navigating this rapidly evolving landscape.
Dr. Norman B. Chutkan opened with an exploration of augmented reality in the education and training of healthcare professionals. He demonstrated how immersive visualization can accelerate skill acquisition and extend high-quality training to regions with limited specialist access, potentially narrowing global disparities in surgical education.
Dr. Jean-Jacques Abitbol addressed the ethical dimensions and learning curves inherent in adopting novel technologies. He stressed the importance of ensuring patient safety during the integration phase, the need for rigorous training, and maintaining transparency in algorithmic decision-making when AI is introduced into clinical workflows.
Delivering potentially one of the session’s most resonant messages, Dr. Jeffrey C. Wang urged that even the most advanced innovations must be evaluated for their value relative to their cost. He urged the audience to consider not only clinical outcomes but also long-term sustainability and accessibility, warning against adopting innovations solely for their novelty.
Dr. John C. Liu examined a spectrum of advancements — from minimally invasive and endoscopic techniques to navigation, robotics, and smart implants — challenging participants to discern whether each is a genuine breakthrough or a passing trend.
A lively discussion brought the themes together, underscoring that the future of spine surgery will be shaped by surgeons who can thoughtfully integrate these tools—balancing innovation with evidence, cost-effectiveness, and a steadfast commitment to improving patient outcomes worldwide.
Spine Surgery for Super-Elderly Population
By Koji Tamai, MD, PhD
Moderators: Koji Tamai, MD, PhD; Patrick C. Hsieh, MD, MBA, MS
With populations aging worldwide, spine surgeons are increasingly encountering super-elderly patients whose surgical needs are complicated by frailty, comorbidities, and unique biomechanical considerations. The joint NASSi–JSSR symposium in Taipei brought together experts from Japan and the United States to share evidence, clinical experience, and strategies for optimizing outcomes in this high-risk group. The session emphasized a patient-centered approach that balances functional gains with surgical risks, grounded in multidisciplinary decision-making.
Dr. Masayoshi Iwamae opened by discussing the indications and limitations of adult spinal deformity (ASD) surgery in the super-elderly. While surgery can significantly improve alignment and quality of life, complication rates are high — particularly in patients over 75 with comorbidities or over 80. He stressed assessing physiological age, frailty, nutrition, and bone quality over chronological age, and avoiding overcorrection to reduce mechanical complications.
Dr. Charles A. Reitman followed with a review of preoperative optimization and rehabilitation for elderly ASD patients. Despite theoretical benefits, he concluded that there is currently no standardized, effective preoperative rehabilitation protocol for this population — highlighting a critical gap in surgical preparation.
Dr. Hiroshi Taniwaki presented on Hounsfield unit (HU) measurement from CT as a rapid, cost-effective method to assess bone mineral density. HU values below 100 indicate high fracture risk and poorer surgical outcomes. He also shared emerging evidence that HU changes may predict survival in patients with spinal metastases.
Dr. Norman B. Chutkan addressed the impacts of frailty and sarcopenia, emphasizing that muscle mass and quality directly influence recovery and complication rates. Early identification and targeted intervention are essential for optimizing outcomes.
Concluding the session, Dr. Koji Tamai presented nationwide Japanese data on cervical spinal cord injury in patients over 65, showing that most injuries result from low-energy falls, with 40% occurring without major bone injury. Malnutrition, dementia, and OPLL were significant predictors of poor recovery and survival, underscoring the need for tailored acute and long-term management.
The panel discussion reinforced that treating the super-elderly requires precise patient selection, optimization of nutrition and bone health, and realistic surgical goals — integrating global insights to guide safe, effective, and compassionate care.