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Pushing the boundaries of research and education
The Division of Spine Surgery at the Department of Orthopaedics and Traumatology, The University of Hong Kong
Well known for its novel research and innovative approach to spine care the Division of Spine Surgery at the Department of Orthopaedics and Traumatology, The University of Hong Kong is a busy department offering a comprehensive range of treatment options. A recognized AOSpine Reference Center since 2002, the division also offers international fellowships for further education.
The Department of Orthopaedics and Traumatology enjoys a long history of spine surgery marked by the advent of the anterior approach for the treatment of spinal tuberculosis in the 1950s, which has since been referred to the world over as “The Hong Kong Operation.” The Division of Spine Surgery has since been a tertiary/quaternary referral centre for the entire region and receives referrals from China and Southeast Asia. The department dedicates its time between, Queen Mary Hospital, the Duchess of Kent Children's Hospital and the MacLehose Medical Rehabilitation Centre, which is a dedicated centre for spinal cord injury rehabilitation. The Division of Spine Surgery is led by Professor Keith DK Luk (former department head 2003–2012), and is further composed by clinical members Professor Kenneth MC Cheung (Head of Department), Dr. Yat-Wa Wong (Deputy Division Chief), Dr. Wai-Yuen Cheung and others, research staff, such as Dr. Dino Samartzis and Dr. Victor Leung, and various allied health professionals.
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Research of the highest caliber
The Division follows a comprehensive research program addressing intensive basic and clinical research into spine-related issues. Current research topics include: genetic epidemiology and molecular mechanisms of intervertebral disc degeneration and pain, novel imaging technologies and biomarkers of the spine and pain, intervertebral disc regeneration and tissue engineering, intervertebral disc transplantation, bioactive bone cement, superelastic spinal implants, and surface modification of implants (see Box below).
Of particular note is the center’s demonstration of the world’s first human disc transplant, which introduced a new research platform investigating allogeneic intervertebral disc transplantation for the treatment of degenerative disc disease. In addition, the spine team has established the largest population-based cohort in the world aimed to identify genetic, environmental, lifestyle, and molecular factors related to disc degeneration and pain. This cohort project entails international collaboration and has received over 15 million USD in funding support, currently supported by a competitive theme-based research grant of Hong Kong. Overall, throughout the years, the clinical and basic science work of the spine team has led to major publications in esteemed journals, such as the Lancet, PNAS, Journal of Clinical Investigation, Journal of Human Genetics, Arthritis and Rheumatism, and the Journal of Bone and Joint Surgery, and has received numerous accolades and international awards.
First to introduce scoliosis school screening
Working with the Department of Health, the Division was the first to introduce a scoliosis school screening programme in Hong Kong in 1995. Since that time, the program has screened approximately 1 million students, resulting in over 300 yearly detections and referrals to early treatment and prevention of surgery. This is one of the most successful and sustainable programs in the world to date. To further support this program, the division has further implemented measures to improve brace compliance.
Over 50 years of innovation and research
1950s and 1960s
- The “Hong Kong Operation” for spinal tuberculosis (anterior debridement and spinal fusion)
- Transoral approach to the cervical spine
1970s and 1980s
- The halo-pelvic apparatus
- Use of a titanium mesh block (one of the earliest forms of cages) for anterior spinal fusion
- Transpedicular decancellation osteotomy for ankylosing spondylitis
1990s
- The fulcrum bending radiograph for scoliosis assessment
- Routine use of intraoperative multimodal spinal cord monitoring
- Initiation of scoliosis schools screening programme in Hong Kong
- Intervertebral disc transplantation in animals
2000s-present / Basic science
- Development of a smart-shape memory alloy rod for gradual scoliosis correction in animal models
- Gene mutation discovery of scoliosis
- Biological therapy for disc degeneration
- Genetics of disc degeneration
2000s-present / Clinical
- Clinical trials of smart-shape memory alloy rod for scoliosis
- Application of magnetic growing rod technology for early-onset scoliosis
- New distal radius ulna (DRU) classification for assessing skeletal maturity
- Prone traction radiograph for assessing vertical instability in spondylolisthesis
- Intervertebral disc transplantation in humans
- Novel imaging of the intervertebral disc and endplate
- Serum biomarkers of disc degeneration and pain
- Epidemiology and phenotyping of disc degeneration and pain
Education is paramount
Education, knowledge exchange, and training to improve patient care have always propelled the Division. It offers research and clinical spine fellowships as well as AOSpine sponsored fellowships, which to date has trained over 100 spine surgeons, representing all 7 continents of the globe, that have received training and gone on to operate, teach and pursue research endeavors throughout the world. The hallmarks of the Division are in its rational and principled treatment of spinal conditions, based on evidence-based medicine. Fellows visiting the Division are witnessed to the meticulous discussion of each case and the careful consideration of treatment options. Furthermore, the Division has received various Visiting Professors throughout the years to further broaden and exchange knowledge of spinal disorders as well as establish research collaborations. In addition, as an International Spine Reference Center, the Division organizes and hosts international and local training courses and workshops each year, as well as contributing to the research and development of AOSpine programs.
Collaborative approach to spine care
The Duchess of Kent Children's Hospital is internationally renowned for its care of both pediatric and adult patients. Having once been a major hub in Asia for the treatment of spinal tuberculosis and post-polio deformities, the team currently focuses on patients with scoliosis and other spinal deformities as well as degenerative conditions of the cervical and lumbar spine. In addition to surgery, the centre provides a full spectrum of spine care. This includes assessment, treatment, and rehabilitation which is reliant on a multidisciplinary care team comprised of: the orthopedic surgeon, bioengineer, clinical psychologist, nurse, occupational therapist, pain specialist, physiotherapist, prosthetist, interventional radiologist, and social worker.
Queen Mary Hospital carries the dual designations of level one trauma center and university teaching hospital, which means that the hospital handles acute conditions, such as spinal fractures, infections and tumors. In addition, an acute spinal cord injuries unit and Center for Paraplegic Walking at the MacLehose Medical Rehabilitation Center round out the division and work to assist patients to maintain mobility. With three outpatient clinics and three full day operating lists each week, the Division of Spine Surgery maintains a busy profile.
http://www.ortho.hku.hk/spine.html
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