Although the Division of Spine Surgery at the Department of Orthopaedics and Traumatology, University of Hong Kong was formed relatively recently in 2000, it has served as a specialist center for Hong Kong Island for many years. The Division is also 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 (QMH), the Duchess of Kent Children’s Hospital (DKCH) 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, and is further composed by clinical members Professor Kenneth MC Cheung, Dr. Yat-Wa Wong, Dr. Wai-Yuen Cheung and others, research staff, such as Dr. Dino Samartzis, and various allied health professionals. Although relatively young as an official spine surgery division, the Department 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 DKCH 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 1993 the Center for Spinal Disorders was established and continued collaboration with the Division of Rehabilitation ensures comprehensive, complimentary services for chronic back pain are on offer. 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.
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.
The Queen Mary Hospital carries the dual designations of level one trauma center and university teaching hospital, which means that QMH 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.
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 is 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.
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. Formal collaborative spine center agreements with two hospitals in China (Peking Union Medical Hospital in Beijing and Sun Yat Sen University in Guangzhou) demonstrate the Division’s commitment to furthering education and research within the Asia-Pacific region.
Well known for modern, novel research and innovation related to spine surgery, the Division has published numerous articles in esteemed international journals that highlight their dedication to advancing the field.
A comprehensive research team supports intensive basic and clinical research into spine-related issues. Current research topics include: genetic epidemiology and molecular mechanisms of intervertebral disc degeneration, intervertebral disc regeneration and tissue engineering, intervertebral disc transplantation, bioactive bone cement, superelastic spinal implants, and surface modification of implants (see Box 1).
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 Human Genetics, Arthritis and Rheumatism, and the Journal of Bone and Joint Surgery, and has received numerous accolades and international awards.
- The “Hong Kong Operation” for spinal tuberculosis (anterior debridement and spinal fusion)
- Transoral approach to the cervical spine
- 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
- The fulcrum bending radiograph for scoliosis assessment
- Routine use of intraoperative multimodal spinal cord monitoring
- Initiation of scoliosis schools screening programme in Hong Kong
- Development of a smart memory shape alloy rod for gradual scoliosis correction
- Gene mutation discovery of 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
- Biological therapy for disc degeneration
- Novel imaging of the intervertebral disc and endplate
- Serum biomarkers of disc degeneration
- Genetic epidemiology of disc degeneration and pain
- Cheung KMC, Luk KDK. Prediction of scoliosis correction by the fulcrum bending radiograph. J Bone Joint Surg Am 1997, 79: 1144-1150
- Luk KDK, Ruan DK, Lu DS, Fei ZQ. Fresh frozen intervertebral disc allografting in a bipedal animal model. Spine, May 2003, 28(9): 864-869.
- Luk KDK, Chow DHK, Holmes A. Vertical instability in spondylolisthesis – a traction radiographic assessment technique and the principle of management. Spine, April 2003, 28(8):819-827.
- Cheung KMC, Lu WW, Luk KDK, Wong CT, Chan D, Shen JX, Qiu GX, Zheng ZM, Li CH, Liu SL, Chan WK, Leong JCY. Vertebroplasty by use of a strontium containing bioactive bone cement. Spine. Sept 1, 2005. Vol.30, No.17S. S84-S91.
- Luk KDK, Ng MC, Wong KK, Li G, Lai S, Yang ES, Hu Y. Proton density-weighted spinal fMRI with sensorimotor stimulation at 0.2T. Neuro Image, February 2006, 29(3):995-999.
- Yeung KWK, Lu WW, Luk KDK, Cheung KMC. Mechanical testing of a smart spinal implant locking mechanism
based on nickel-titanium alloy. Spine, 15th Sept 2006. Vol 31, no. 20. 2296-2302.
- Leung VYL, Chan D, Cheung KMC. Regeneration of intervertebral disc by mesenchymal stem cells: Potentials, limitations, and future direction. European Spine Journal. 2006 Aug; 15 Suppl 3:S406-13.
- Cheung KMC, Senkoylu A, Alanay A, Genc Y, Lau SSN, Luk KDK. Reliability and Concurrent Validity of the Adapted Chinese Version of Scoliosis Research Society-22 (SRS-22) Questionnaire. Spine. 2007 May. Volume 32(10), 1141–1145.
- Ruan DK, He Q, Ding Y, Hou LS, Li JY, Luk KDK. Intervertebral disc transplantation in the treatment of degenerative spine disease: a preliminary study. Lancet, Mar 2007, 369:993-999.
- Song YQ, Cheung KMC, Ho DWH, Poon SCS, Chiba K, Kawaguchi Y, Hirose Y, Alini M, Grad S, Yee AFY, Leong JCY, Luk KDK, Yip SP, Karppinen J, Cheah KSE, Sham P, Ikegawa S, Chan D. Association of the Asporin D14 allele with lumbar disc degeneration in Asians. American Journal of Human Genetics, 2008 Mar;82(3):744-7.
Link to spine fellowship programme
‘My learning experience in Hong Kong’ – by one of our spine fellow – Dr Lu Sheng (Written in Chinese)
香港学习生活感想 成都军区昆明总医院全军骨科中心 – 陆声