The largest challenge I faced in my career involved the pedicle screw litigation that peeked in the 1990s. As a young surgeon 7 years into practice, I was utilizing this internal fixation in spinal surgery (obviously common now) and lecturing and instructing on pedicle screw technique and its applications. Internal fixation of the spine quickly became a “standard of care” as an adjunct to fusion in the surgical community. However, for unclear reasons, the regulatory process lagged in its evaluation of the technique and pedicle screw systems to augment spinal fusions remained unapproved by the FDA. Thus, there was no regulatory approval for a technique that was considered a standard of care by many. This dichotomy made its utilization questionable in many minds. The regulatory situation opened the door for multiple medical malpractice suits against surgeons, manufacturers and even some medical societies. An environment of tremendous distrust between patients and surgeons as well as surgeons and manufacturers resulted. As a personal example, in just one day, I received 25 lawsuits from patients I did not operate on and who were implanted with a system I did not use - based on the fact that I had given a lecture at a national meeting on the technique. In the end, the interaction among surgical innovation, regulatory oversight, and legal liability was fundamentally reshaped in this period. NASS, under the direction of then President Hansen Yuan, played a major role in standing up to and defeating the Plaintiff’s Bar to the benefit of all spinal surgeons.

My membership in NASS has provided a context to my professional growth and career. The educational offerings have provided continued learning opportunities for intellectual growth beyond my formal training. Involvement in multiple committee and administrative offerings has not only continued that intellectual growth but has provided opportunities to improve my teaching and leadership skills. Finally, NASS has provided the unexpected opportunity to develop deep and lasting friendships among multiple individuals in the field of spinal care.

The advice would be the same that I followed: Trust your education, instincts, and skills and, as they say here in Texas, “Just keep on keep’n on.”