Early in my medical education, I heard anthropologists opine that the evolutionary enlargement of the human frontal lobes decreased the angle between the horizonal axis of vision and the vertical axis of the cervical spine. In response, homo sapiens stood upright to better visualize the potential dangers ahead and, over time, the straight spine of the great apes evolved into the curvilinear spine and “habitual bipedalism” of humans.

With the aging process, our upright posture can place significant vertical load on the degenerating spinal segments and produce considerable pain, disability and neurological dysfunction. Unlike other skeletal segments where total joint replacement and other treatment modalities produce predictable improvement, the available treatment options for many patients with spinal disorders are often less efficacious and the potential risk of neurological injury is greater. For me, the greater need for better treatments of spinal disorders was the draw to pursue a career in spine surgery.

Over the past two decades, I’ve had the privilege of participating in many memorable NASS gatherings. My involvement with the Advocacy Committee, Spine PAC, and the annual Washington, DC legislative visits with congressional representatives provided meaningful and informative opportunities to engage with issues critical to the optimal care of our patient population. Among the many NASS events that I’ve attended, the annual winter Evidence & Technology Spine Summit in Park City stands out as a particularly collegial and enjoyable event. Within that gathering, the annual dinner at the Mountain Top restaurant remains a meeting highlight and one of my favorite NASS memories.

Identifying the correct underlying cause of the patient’s complaint is the most important diagnostic skill.

Because of an increase in US life expectancy and obesity rate, there has been an increase in the number of patients presenting with pain, immobility and/or neurological dysfunction. Concurrently, there has been a proliferation of free-standing MRI imaging centers willing to provide imaging of any requested body part for a fee. Since imaging of the elderly is likely to reveal a range of degenerative findings that may be unrelated to the patient’s complaint, it is critical that the spine surgeon correctly localize the source of the complaint prior to recommending surgery to correct a potentially unrelated imaging finding.