From November 13th to 17th, Prof. Markus Kroeber, the Director of Orthopedics, Trauma and Spine Surgery of Helios Clinic Rottweil of Germany, visited Dongguan Hospital of TCM as an international visiting professor, and carried out a series of academic exchange activities, including outpatient consultations, ward rounds, surgical guidance, surgical practice, internal lectures, discussions on department management and complex cases, and public lecture, etc.

Highlights

On Friday night, I was waiting at a Michelin-starred restaurant in Guangzhou for a dinner with a famous German specialist. He used to work with the world-class minimally invasive spine surgery master, Prof. Michael Mayer at Sch?n Klinik München Harlaching. His 5-day visit at Dongguan Hospital of TCM as an international visiting professor has come to a perfect end. And he will fly back to Frankfurt from Guangzhou tonight. He is Prof. Markus Kroeber, the Director of Orthopedics, Trauma and Spine Surgery of Helios Clinic Rottweil. Helios is the largest private hospital group in Germany. Founded in 1994, it has over 76,000 employees, receives up to 5.5 million patients per year, and has 7 billion euro sales volume in 2022. Helios has built a strong medical network during the last 30 years to share information rapidly among every hospital and transfer each kind of patients to different specialized hospitals for efficient treatment. The Orthopedics Department of Helios Clinic Rottweil, where Prof. Kroeber serves as the director, develops spine surgery as its main specialty. The department has only 50 beds but performs 3,500 surgeries per year with high efficiency. This week, his work at Dongguan Hospital of TCM includes outpatient consultations, ward rounds, case discussions, surgical guidance, lectures on department management as well as public classes. A brand new orthopedics building of Dongguan Hospital of TCM will be put into use in 2026, which will provide better medical services for millions of people in Dongguan. During the last two years, Prof. Kroeber has been cultivating two M.D. students from two Grade III-A hospitals of Nanchang and Wuhan in Germany. Now famous specialists all over the world are willing to help us because our country is getting stronger. 

Welcome Ceremony

In the morning of November 13th, YE Guohua, Secretary of Party Committee of Dongguan Hospital of TCM, together with the directors of various orthopedic specialties, held a welcome ceremony for Prof. Kroeber, and expressed a warm welcome to him.

YE Guohua, Secretary of Party Committee of Dongguan Hospital of TCM, issued a letter-of-appointment of visiting professor to Prof. Kroeber.

On the welcome ceremony, Prof. Kroeber introduced that there are three types of hospitals in Germany -- public hospitals, church hospitals and private hospitals. Helios Hospital Group, where Prof. Kroeber works, is the largest private hospital group in Germany with 76,000 employees. Its expertise is in prevention, acute medicine, outpatient clinics, rehabilitation and retirement homes for patients. Helios has built a medical network covering all over Germany with 86 hospitals, 240 outpatient clinics, 6 prevention centers. It receives 5.5 million patients per year. In 2022, the sales volume reached 7 billion euros. Every hospital of Helios Group has an orthopedics department with different focuses. With the strong medical network, information can be shared rapidly among every hospital and patients can be transferred by helicopters or ambulances to corresponding orthopedics specialties of different hospitals for treatment.

The Orthopedics Department of Helios Clinic Rottweil, where Prof. Kroeber serves as the director, has its expertise in spine surgery and complex pelvic trauma. Through the medical network of Helios, the department provides high-quality medical services for patients with spinal diseases and pelvic trauma all over Germany. Helios Clinic Rottweil is located in the southwestern part of Germany, adjacent to France, Swiss and Austria. It is a comprehensive hospital with 10 departments, 300 beds, 500 employees and receives 40,000 patients per year. The Department of Orthopedics, Trauma and Spine Surgery has Specialties of Knee and Joint Surgery, Hand and Foot Surgery, Sports Medicine, Trauma Surgery, and Complex Pelvic Surgery. And the Spine Center treats all kinds of spinal diseases, including spine deformities, degenerative spinal diseases, spine tumors and trauma.

Then, the executives of Dongguan Hospital of TCM showed Prof. Kroeber around the hospital and the Department of Spine Surgery. Prof. Kroeber was surprised by what he saw in China in just one day, especially by the philosophy of Traditional Chinese Medicine. And he would be looking forward to further exchanges with Chinese colleagues in the following days.

Outpatient Consultation

On November 14th, Prof. Kroeber arrived at the outpatient clinic of Dongguan Hospital of TCM and provided consultation for 23 patients together with Deputy Director FENG Yonghong and Chief Physician LI Zhen of the Department of Orthopedics Ward III (Spinal Disease).

There was a case that Prof. Kroeber considered valuable for discussion. The patient had undergone a surgery on thoracic spine, but recently had thoracic kyphosis and lumbar lordosis which led to the pain in her chest and lower back. Prof. Kroeber suggested to treat thoracic kyphosis first in order to relieve the pain in thoracic spine as well as to improve lumbar lordosis.

During the consultation, Prof. Kroeber noticed that Director Feng and Doctor Li would see patients' tongues to know their conditions and make prescriptions for them. And he was very curious and interested in the four ways of diagnosis of TCM -- "look, listen, question and feel the pulse".

An Experience in TCM-Featured Treatments

After the outpatient consultation, with the company of ZHOU Li, the Head Nurse of the Department of Orthopedics Ward III, Prof. Kroeber visited the TCM Center of Dongguan Hospital of TCM, and had an experience in TCM-featured Treatments -- Lei Huo (thunder and fire) moxibustion and Huo Long (fire and dragon) cupping. After that, Prof. Kroeber felt that cupping is an effective way to relax muscles, and let him develop a deeper understanding of TCM culture and he hoped that TCM can be developed worldwide.

Public Class

In the morning of November 15th, Prof. Kroeber visited the operating rooms of Dongguan Hospital of TCM, and observed a L5-S1 decompression and fusion surgery operated by Director LU Guoliang.

In the afternoon, Prof. Kroeber delivered two public lectures, Indication for Thoracic-Lumbar Stabilization and Concept of Diagnosis and Treatment of Spinal Tumors, at the TCM Center of Dongguan Hospital of TCM. In the first lecture, Prof. Kroeber introduced AO Spine classification of thoracolumbar spine fractures and different choices in conservative or surgical treatments for each classification, and had discussions on surgical plans with Director LU Guoliang and other colleagues. In the discussion, Prof. Kroeber also explained the advantages of first performing decompression and internal fixation from posterior approach, then implanting cage in thoracic spine for fusion from anterior approach.

In addition, Prof. Kroeber had a heated discussion with a doctor from the Department of Orthopedics Ward IV on topics such as the necessity of en bloc resection for spinal metastases, and the necessity of cage implantation after radiofrequency ablation with bone cement. After the public classes, both parties agreed that it was an inspiring academic discussion with rich knowledge and experience.

Case Discussion

In the afternoon of November 16th, Prof. Kroeber arrived at the office of the Department of Orthopedics Ward III and had case discussions with spine surgeons. Since Prof. Kroeber wanted young residents to join the discussion, he selected relatively simple cases with a wide variety including spine fractures, metastases and deformities. 

By raising questions, Prof. Kroeber encouraged young doctors to make the optimal treatment plan for patients step by step according to the patients' overall condition and images.

Prof. Kroeber also explained different treatments for different indications in detail. For example, for two patients with similar condition but with a breast cancer metastasis and a kidney cancer metastasis respectively, Prof. Kroeber would choose the same surgery, but he reminded the doctors that they should first perform embolization before surgery because bleeding is a risky factor in surgeries for kidney cancer metastases.

Among all the cases, Prof. Kroeber also shared a patient with Kümmell's disease and had a further discussion with Chinese colleagues. He patiently explained common difficulties and problems in surgeries for Kümmell's disease. After the discussion, Chinese colleagues all appreciated that the cases sharing from Prof. Kroeber were worth learning.

Experience Sharing on Specialty Construction and Scientific Research

In the morning of November 17th, Prof. Kroeber arrived at the office of the Department of Orthopedics Ward III and had case discussions with Chinese colleagues.

Doctors shared a case of severe lumbar kyphosis and asked for Prof. Kroeber's surgical advice. Prof. Kroeber suggested to perform a pedicle subtraction osteotomy and a Smith-Peterson osteotomy to correct the kyphosis. He also showed his former patients as examples and answered the questions of the doctors.

In the afternoon, Prof. Kroeber arrived at the teaching room of the department with orthopedic surgeons, and delivered a lecture on scientific research. By sharing his own research experience in a laboratory 20 years ago, Prof. Kroeber told the doctors that although sometimes basic researches are hard to be translated into clinical practice, doctors should still pay efforts in scientific researches for the development of medicine.

After the lecture, Director LU Guoliang and other doctors also had a discussion with Prof. Kroeber on department construction and management. In the end, both parties learned a lot from each other.

Founded in 1965, Dongguan Hospital of Guangzhou University of Chinese Medicine (Dongguan Hospital of TCM) is the only modern Grade III-A TCM hospital in Dongguan region. It enjoys a good reputation and wide popularity in Guangdong Province and even the Southern China. It is the top 100 competitive TCM hospitals among all Chinese hospitals, the third batch of Postdoctoral Innovative Practice Base in Guangdong Province, the leading hospital of Dongguan Orthopedics Specialty Alliance, as well as the chairman hospital of Spine Surgery Committee of Dongguan Medical Association. In recent years, the Department of Orthopedics of Dongguan Hospital of TCM has built up sub-specialties of trauma, traditional bone-setting, knee and joint, spine surgery, micro-orthopedics surgery, bone disease, bone tumor, pediatric orthopedics, foot and ankle surgery, traditional orthopedic trauma, etc. It has eight inpatient wards and 10 sub-specialties. All these make the department the only national key specialty and high-level clinical key specialty of Guangdong in the field of orthopedics in Dongguan City. And it is listed in the 'Recommended Departments in Guangdong-Hong Kong-Macao Greater Bay Area - Best Departments of Guangdong Hospitals'.

Founded in 2002, the Department of Spine Surgery of Dongguan Hospital of Guangzhou University of Chinese Medicine (Dongguan Hospital of TCM) is the first department in Dongguan region that specializes in clinical diagnosis, treatment and scientific research of spinal diseases. In 2012, it was separated into two departments -- Orthopedics Ward III and Orthopedics Ward IV. Under the leadership of Director LU Guoliang and Director HUANG Xiongfei, the two departments have constantly reached new achievements. In the past three years, they averagely received 40,000 outpatients and more than 4,000 inpatients every year, and had an annual surgery volume of more than 2,500, among which more than 1,100 were complex spine surgeries, and nearly 400 were endoscopic surgeries. The Orthopedics Department has made great contributions to the effective prevention, control and reduction of spinal diseases and protect the health of people's spine in Dongguan region, earning them wide recognition and praise from colleagues in and out of Dongguan City and the public.