On July 10, 2020, the "Sino-US Spine Surgery Video Conference" concluded successfully in the conference room on the sixth floor of the outpatient clinic of Zhengzhou Orthopaedics Hospital. The invited guest Prof. Jeffrey C. Wang, President of North American Spine Association and Co-Director of USC Spine Surgery Center, brought a wonderful lecture to the meeting. Four young doctors from the Spine Clinical Department of Zhengzhou Orthopaedics Hospital actively participated in the meeting and shared their typical cases.
On behalf of Zhengzhou Orthopaedics Hospital, Executive Vice President Aiguo Wang expressed his warmest welcome and sincere greetings to Prof. Wang for his participation in the meeting. He described the current development and achievements of the Spine Surgery Department of Zhengzhou Orthopaedics Hospital and introduced Prof. Wei Mei, the leader of the Spine Surgery Department of Zhengzhou Orthopaedics Hospital.
At the same time, Prof. Wang expressed his gratitude to Zhengzhou Orthopedic Hospital for the kind invitation and introduced the overall situation and development direction of the Department of Orthopaedic Surgery, University of Southern California. He hoped that we would increase mutual understanding through continuous exchanges and make progress together.
Prof. Wang started a wonderful lecture on "Surgical Considerations for Cervical Deformity". He gave detailed explanations on the incidences, preoperative planning, surgical treatment strategies, and postoperative complications prevention of cervical vertebra deformity, which was confirmed by several typical cases.
How Prof. Wang Assess the Deformity
Prof. Wang described how to assess the cervical sagittal balance. The most important of these are the two vertical axes C2 SVA and C7 SVA. The distance between the C2 and C7 vertical axes is normally maintained within 1.5 cm, however, as the local cervical sequence deteriorates, the distance will be >4 cm. Proper consideration of the distance between two axes is required to maintain the normal state of the cervical sagittal sequence.
Another point is the issue of lordosis. For the lumbar spine, two-thirds of the lordosis is located at L4-S1. Most of the lordosis of the cervical spine is at C1-2, and although most of the surgical site is at C4-7, lordosis is not often seen at C4-7, so you can take full advantage of this to create a reasonable amount of more lordosis.
Most of the lumbar spine will be measured based on pelvic parameters, while the cervical spine has similar parameters, with the T1 Slope being the one to keep a close eye on. If the T1 Slope is relatively large, the muscles need more tension to keep the head balanced and more forward projection to keep the head in the normal cervical sequence. However, if the T1 Slope is too large, it is important to consider whether the problem is elsewhere than the cervical spine, such as whether it is a problem related to thoracic vertebrae.
Pre-Operative - Reducing Complications
In this section, Prof. Wang introduces the ERAS (Early Recovery After Surgery), which refers to a series of measures to optimize perioperative management with Evidence-based medicine evidence to reduce physiological and psychological traumatic stress in patients and to achieve rapid recovery.
By implementing the concept of ERAS, the number of patients taking painkillers after the operation has decreased.
Intraoperative infections can occur at any time, and to better minimize infections and complications, Prof. Wang emphasized the importance of keeping implants free of contact. Although all instruments and implants are sterilized before surgery, sterilization does not guarantee 100% sterility, so the suggested changes are as follows:
1. Handling implants with only fresh gloves
2. Keeping implants covered until the immediate time of use
3. Reducing operating room traffic
4. Avoiding touching the implants
There are a variety of osteotomies, but before choosing one of these techniques, you must figure out the main parts of the deformity. The professor cited a few cases of an incorrect judgment of the deformity and pointed out that when judging the deformity, the conclusion cannot be made solely based on the situation shown by the image. The main parameters must be combined to analyze whether the patient has undergone other operations in the previous period and then make the final judgment.
The professor shared his surgical skills through classic cases and surgical videos
Afterward, four young doctors in the spine clinical department of Zhengzhou Orthopedics Hospital also shared difficult cases. They presented a series of complete cases based on patient performance, diagnosis and treatment in English, and consulted Prof. Wang for discussion on difficult issues such as clinical diagnosis of the disease, selection of treatment options, and treatment of complications. Prof. Wang gave detailed answers one by one, and highly praised the diagnosis and treatment level of difficult and complicated spine cases in Zhengzhou Orthopedics Hospital.
Dr. Zhe Shao and Dr. Zhenhui Zhang, doctors from the Department of Orthopaedic Spine I
The professor thanked the two doctors for sharing and said that the postoperative results were excellent. The two sides had a heated discussion on how to choose the osteotomy site and osteotomy angle, and how to avoid vascular nerve injury in surgery. The professor agreed with the osteotomy site chosen by the team and was very satisfied with the results of the surgery. As for the reduction of vascular nerve damage during surgery, it was suggested to reduce the damage to the spinal cord, slow down the speed of surgery, and do the surgery carefully enough to avoid damaging the important parts.
Dr. Yunlong Jiao and Dr. Baotian Li of Orthopedic Spine II gave a case report on spinal infection. This was followed by a discussion of the indications for debridement and antibiotic withdrawal.
Dr. Yunlong Jiao and Dr. Baotian Li of Orthopedic Spine II
For preventing surgical site infections, Prof. Wang also shared their hospital's experience. Daily preoperative bathing and spinal wiping with chlorhexidine for a week before surgery can also reduce the risk of infection.
A case report on scoliosis was given by Dr. Depeng Kou of Spine III.
Dr. Xiaoguang Zhou and Dr. Yaojun Dai of the Minimally Invasive Spine Department gave a case report on ankylosing spondylitis deformity.
Dr. Xiaoguang Zhou and Dr. Yaojun Dai of the Minimally Invasive Spine Department
Prof. Wang stated that this was a very fascinating case and thought they did the right thing and he agreed that it was safer to do it on the lumbar spine than on the thoracic spine. The post-operative pictures show that the surgery was successful and the patient is recovering well.
Vice President of Operations Wei Mei concluded the video conference with his remarks. He once again thanked Prof. Wang for taking the time to share the advanced treatment concept and experience of cervical deformity with us and looked forward to Prof. Wang coming to the hospital for on-site communication and guidance, as well as expecting our young spine surgeons to be sent to the United States for study and communication in the future.
To achieve the rapid development of the hospital, Zhengzhou Orthopaedics Hospital attaches great importance to the international exchange and cooperation, continuously expanding external exchanges, actively organizing high-level academic conferences, inviting foreign experts to give lectures and guidance. Prof. Wang, as the President of the North American Spine Association and Co-Director of the Spine Surgery Center of the University of Southern California, has a great theoretical and technical level and international influence. This video conference exchange demonstrated the good academic atmosphere of the spine in Zhengzhou Orthopaedics Hospital, and also provided a platform for young doctors to express themselves, which pointed out the direction for future development.