Spine

Clinical Service and Achievement

Our hospital has been caring for patients of spinal trauma and diseases since the development of the Department of Orthopaedics and Traumatology in 1983. Spinal surgery has become sub-specialized in the 90s. Evolving from the Spinal Injury and Rehabilitation (SIR) team, the Spine Team was established since 1998. Over the years, Spine team provided wide scopes of clinical service for adult spinal conditions, including injuries, degeneration, tumor, infection and deformities, for the New Territory East Cluster population and served as a tertiary referral center of spinal surgery for other regions of Hong Kong. Spine team also worked together with Paediatric team in the treatment of congenital spinal conditions, adolescent disc and scoliosis. In collaboration with Spine and Rehabilitation team in Alice Ho Miu Ling Nethersole (AHNH) and Tai Po Hospitals, we provided a comprehensive service to improve functional outcome of spinal patients through a multidisciplinary team approach.

Epidemiology of spinal disease has been ever-changing and our innovations of surgical technique have kept pace with the change. Surgical techniques of various approaches to spinal column including the transoral approach to atlantodental region, split manubrium approach to upper thoracic spine, transthoracic extrapleural approach to thoracic spine and retroperitoneal approach to lumbosacral junction have been well mastered since the 80s for spinal tumors and infections especially tuberculosis. Microscopic assisted procedures have been firstly applied in lumbar microdiscectomy and decompression since the early 90s for prolapsed intervertebral disc and lumbar spinal stenosis; followed by the introduction of Micro-endoscopic Discectomy (MED) and decompressive laminotomy technique in the late 90s. Later on, microscopic procedures extended to anterior cervical discectomy, corpectomy and laminoplasty for other common degenerative conditions like cervical spondylotic radiculo-myelopathy (CSRM) and ossification of posterior longitudinal ligament (OPLL). Transforaminal lumbar interbody fusion (TLIF), which was developed rapidly in our unit among other hospitals in Hong Kong since the early 2000s, has become a standard and reliable instrumented lumbar spinal fusion technique for degenerative spondylolisthesis and scoliosis. With the rich experience of computer assisted orthopaedics surgery (CAOS) acuminated in our department, we have pioneered the clinical application of computer-aided navigation (CAN) spine surgery in the mid 2000s. By using either the preoperative computer tomographic (CT) based system or intraoperative 3D-fluoroscopic based system, CAN was shown to promote the accuracy of pedicle screws insertion in cervical spine, severe scoliosis, and revision surgery with previous fusion or poorly identifiable anatomy. Minimal invasive spinal surgery (MISS) techniques such as laparoscopic lumbar fusion, video-assisted thoracoscopic spinal surgery (VATS) and percutaneous endoscopic lumbar discectomy (PELD) and foraminoplasty have also been employed since the 2000s.

Being a level one trauma center and teaching hospital, Prince of Wales Hospital manages the majority of patients with acute spinal cord injuries as the results of fractures and tumors. Tai Po Hospital has been designated as one the three Spinal Cord Injury (SCI) Rehabilitation Centers in Hong Kong by Hospital Authority since 2001. Spine team is taking a leading role to provide comprehensive rehabilitation service to SCI patients of the whole New Territories through a multidisciplinary approach, with clinical psychologist, nurse of special training, physiotherapist, occupational therapist, prosthetist and social worker. Standardized protocols for nursing care and rehabilitation after spinal surgeries such as laminoplasty, discectomies, anterior and posterior spinal fusions have been developed and undergone hospital accreditation review by the Australian Council on Healthcare Standards (ACHS) in 2013. Our rehabilitation center also operates the Paraplegic clinic helping the chronic SCI patients to maintain mobility and the Combined Back Pain clinic treating patients with chronic back pain and failed back surgery in collaboration with pain specialist, and neurosurgeon (see section on Rehabilitation). Spinal injections such as selective nerve root block are performed by spine teams of both PWH and AHNH in local anaesthesia sessions every 2 weeks for spine patients to serve as a diagnostic and therapeutic procedure.

Computer Aided Navigation Spine Surgery Development

Spine clinics in Prince of Wales Hospital are among the busiest orthopaedics outpatient clinics in Hong Kong. More than 11000 patients were seen in the year of 2000, the number has been exponentially increased to 17000 patients in the year of 2010. We have four outpatient clinics (one post-op follow-up and 3 general spine clinics). Last year, spine team served to see more than 2100 new cases of spinal complaint, which doubles the number five years ago. Outpatient Spine Triage Program has been introduced since 2008 for injury on duty new referrals. The program is coordinated by a spine surgeon and physiotherapists. By providing early clinical assessment of the spinal new cases, this shortens the waiting time of patients with red flag signs for new case clinic and provides early physiotherapy to patients before their first clinic attendance. By the joint effort of physiotherapists, occupational therapists, social worker and spine team, the Work Rehabilitation Program has began in 2011 aiming to promote the safe return of patients to work.

Teaching and Education Responsibility

Education has always been an important part of our mission. Spine team takes up the role in the undergraduate teaching of adult spinal disorders through bedside and outpatient tutorials. Tutorials in spinal disorders, designated by the Hong Kong College of Orthopedic Surgeons, have been delivered to higher orthopaedic trainees for preparation of exit examination. Our team has also actively involved in organizing professional examinations for MBChB, MRCS and FHKCOS, and giving lectures in spinal injury and spinal degeneration topics for post-graduate Master courses of CUHK. Spine fellowships have been provided in our unit for overseas and mainland spine surgeons. They were offered opportunity to work side-by-side with our spine faculty; and a broad experience in primary and revision cases, including minimal invasive and complex reconstructive techniques. Many of them have been subsequently taken important service positions in their own spine units all over the world. Our team has been regularly organizing spinal surgery workshops in the Orthopaedic Learning Center and CUHK. Some of the marked and important workshops delivered by the distinguish speakers are listed below:

Spine Workshops over the years

Research Competency and Future Development

Despite being a relatively small team, we believe that active research pursuit is important to advance our understanding of adult spinal problems and maintain our high standards of clinical practice. Spine team has been active in conducting clinical research. Through regular research meetings with clinicians and research assistants of PWH and AHNH, we share innovative research ideas and consolidate practical research direction. Clinical research includes both long term prospective studies and retrospective analyses. Area of recent and on-going research projects include:

Epidemiological studies

Radiological studies

Surgical outcome studies

Practice in cadaveric spine workshops and local spine surgeons