While still training in areas such as skull base and cerebrovascular neurosurgery, I soon realized that functional outcomes should be the utmost priority of any surgical procedure. Such an insight has guided my surgical career ever since. As a spine surgeon, I am fully convinced that radiographic targets should always be pursued with the understanding that the ultimate goal of any treatment is not only correction of spinal deformity (or other anatomical abnormalities) but above all improvement of quality of life, reduction of pain and improvement in functionality. In such a paradigm, minimizing complications and avoiding excessive risks become a paramount strategy for long-term success. Our treatments can’t be more dangerous than the natural history of the disease and, at the end I strongly believe that a patient with a perfectly realigned spine but a new permanent motor deficit is by definition a poor outcome.

I became involved with NASS more than a decade ago, when I was still finishing my spinal deformity fellowship. At that time I was eager to join a premiere scientific community of experts in spine surgery, and was very excited by the invitation to become a reviewer of The Spine Journal. My journey at NASS has been exceedingly rewarding. Throughout I have established long-lasting connections with world leaders in the field of spinal care and, more recently, have had the privilege of participating of the launching of the North American Society Journal (NASSJ), where I currently serve as Deputy Editor.

If I could provide one advice to my younger self it would be that it inevitably takes time for anyone to develop the surgical skills necessary for steady optimal outcomes, especially when considering complex spine surgeries. Ultimately, most spine surgery trainees are exceedingly bright and likely very eager to start employing every technique they have learned in their fellowship. However, it takes years (if not decades) of experience to adequately learn not only how to successfully perform a surgical procedure, but also the many ways it can go wrong and especially what can be done in terms of damage control when such problems happen. I have personally experienced that trainees with a broad exposure to a variety of advanced surgical techniques are at a uniquely vulnerable position, especially in the beginning of their careers, as they probably “know enough to be dangerous”. Developing a well-thought surgical plan, foreseeing possible intra and peri-operative pitfalls, and pursuing a flexible mindset that enables one to change the initial plan in order to minimize complications is something that takes experience as well as a special degree of humility and wisdom. I am sure each one of you will be successful! Just don’t try to make it happen overnight…