From May 27th to June 1st, Dr. Rosenthal, the Head of the Section of Spine Surgery in Regional Hospital Bad Homburg and former President of German Spine Society (DWG), visited the Wuhan Orthopedics Hospital of Integrated Traditional Chinese and Western Medicine (The Affiliated Hospital of Wuhan Sports University) as an international visiting professor, and carried out a series of academic exchange activities in the hospital, including outpatient consultations, ward rounds, surgical guidance, surgical practice, internal lectures, discussions on department management and complex cases, and public lecture, etc.

Highlights

From May 27th to June 1st, Dr. Daniel Rosenthal, an internationally renowned spine master, visited the Wuhan Orthopedics Hospital of Integrated Traditional Chinese and Western Medicine (The Affiliated Hospital of Wuhan Sports University) for a week as a visiting professor. Dr. Rosenthal was born in Argentina and finished his medical studies there, and then moved to Germany to start his legendary medical career. He is the world-class master in thoracoscopic spine surgery, he holds several patents for endoscopic instruments, he has performed surgeries for many heads of state and government officials, he has simple but insightful understanding about spine surgery, he is rigorous in medical field but humorous in life, he speaks four languages, and he has traveled around the world to give lectures... This visit to the Wuhan Orthopedics Hospital of Integrated Traditional Chinese and Western Medicine (The Affiliated Hospital of Wuhan Sports University) is a great opportunity to rekindle friendship with Chinese colleagues and to exchange ideas and insights. During the one-week visit, Dr. Rosenthal had participated in a series of academic exchange activities with the company of President LI Xugui, Secretary of the Party Committee WANG Jing, Deputy Secretary of the Party Committee, Secretary of the Discipline Inspection Commission ZHU Yaoqing, Member of the Party Committee, Vice President XIE Wei, as well as the directors of four spine surgery departments and their colleagues, including expert outpatient consultation, ward rounds, complex case discussion, surgical guidance, the Training Course of Minimally Invasive Spine Surgery Techniques of the Sino-German Training Center for Minimally Invasive Spine Surgery, the Sino-German Global Webcast on Minimally Invasive Spine Surgery, master’s public lecture, seminar about spine specialist training and scientific research experience sharing. During the visit, Dr. Rosenthal showed great interest in the hospital's concept of “integration of medical treatment, medical care and rehabilitation” and understood deeply the hospital's rich clinical experience in combining orthopaedic treatment and rehabilitation during the week's work; He also observed the hospital's distinctive therapies, “Sacral Injection Therapy”, and the “Precision Small Needle Therapy” which was selected as the representative program of Intangible Cultural Heritage of Hongshan District. If the therapeutic effect can be long-lasting, Dr. Rosenthal said that he would be interested in learning this technique and bringing it back to Europe when he visits Wuhan again in the future. At the same time, the arrival of Dr. Rosenthal also injected new vitality into the hospital. He shared his experience on the diagnosis and treatment of thoracic disc herniation, the tricks and surgical steps of anterior surgery/OLIF, the introduction of the VITOM imaging system, the German experience on training spine specialists, and his personal understanding about the future trend of spine surgery and scientific research experience, and so on. The result of this all-round academic exchange was very successful, not only deepening the friendship between the colleagues from China and Germany, but also deepening their understanding of spine surgery, promoting the construction and development of spine surgery, and enriching the atmosphere of academic exchange in the hospital, which ultimately brings benefits to the patients.

Welcome Ceremony

On the morning of May 27th, Secretary of the Party Committee WANG Jing, Deputy Secretary of the Party Committee, Secretary of the Discipline Inspection Commission ZHU Yaoqing, Member of the Party Committee, Vice President XIE Wei, as well as the directors of four spine surgery departments and their colleagues held a welcome ceremony for Dr. Rosenthal, and both sides made a brief introduction of their hospitals.

Secretary of the Party Committee WANG Jing and CHEN Ming, Director of Spine Surgery Ward I, introduced the history of the hospital, the spine department, and its facilities and equipment, personnel structure, etc. Dr. Rosenthal introduced the orthopaedic department of the Regional Hospital Bad Homburg, Germany and thanked the hospital in particular for its invitation. He hoped that he would be able to share his experience with the Chinese colleagues in the coming week and at the same time, he would have a deeper understanding of the hospital's experience of integrating medical treatment and rehabilitation.

Afterwards, Secretary of the Party Committee WANG Jing awarded a letter-of-appointment of visiting professor to Dr. Rosenthal.

After the welcome ceremony, Dr. Rosenthal went to visit the four spine surgery departments, the Minimally Invasive Spine Surgery, Spine Surgery Ward I, Spine Surgery Ward II, and Dept of Neck, Shoulder, Low Back and Leg Pain, learning more about the teams of each spine department and their diagnostic and treatment techniques.

In the afternoon, led by Dr. TANG Jin, head nurse of the operating room and the director of Dept of Anesthesiology, Dr. Rosenthal visited the operating room and had a detailed understanding of the surgical equipment and instruments of the hospital. During the visit, both sides had a pleasant afternoon exchanging ideas on the number of operating rooms and the arrangement of doctors and nurses in the OR in German and Chinese hospitals, and the avoidance of complications of patients with a prone position, etc.

Bilingual Case Discussion to Share Surgical Plans

On the morning of May 28th, Dr. Rosenthal went to the Dept of Minimally Invasive Spine Surgery and the Dept of Neck, Shoulder, Low Back and Leg Pain to have ward rounds and discuss difficult cases. Doctors of the two departments prepared the presentations in Chinese and English in advance, and after the arrival of Dr. Rosenthal, they started introducing the patient's situation, showing the images, discussed the surgical cases, and completed the discussion of 6 cases in only one and a half hours.

The Dept of Neck, Shoulder, Low Back and Leg Pain especially discussed a degenerative lumbar scoliosis case with Dr. Rosenthal, exchanged ideas on the issues such as angle of correction, range of decompression and selection of fusion level, showing different surgical plans from Chinese and German doctors.

Afterwards, accompanied by Dr. TANG Jin from the Dept of Minimally Invasive Spine Surgery, Dr. Rosenthal came to the outpatient clinic of the hospital to see the patients and also watched the hospital's distinctive therapy “Sacral Injection Therapy” in the outpatient building.

After the outpatient consultation, ZHU Ling, Director of Neck, Shoulder, Low Back and Leg Pain Department, learned that Dr. Rosenthal has decades of experience in microscopic surgery and invited Dr. Rosenthal to the operating room, where the two of them successfully completed a lumbar decompression surgery under microscopy in around one hour.

Then, Dr. Rosenthal observed an endoscopic lumbar decompression surgery performed by ZHAO Zhou, Director of the Dept of Minimally Invasive Spine Surgery, and discussed the similarities and differences between Chinese and German surgeons in terms of endoscopic instruments, requirements for anesthesia, and the necessity of removing the calcified part of the lumbar disc after decompression was completed. Through this full day's work, Dr. Rosenthal had a deeper understanding of the Dept of Minimally Invasive Spine Surgery and the Dept of Neck, Shoulder, Low Back and Leg Pain.

Academic Exchange and Sharing of Diagnosis and Treatment Experience

On May 29th, Dr. Rosenthal went to Dept of Spine Surgery Ward I and Dept of Spine Surgery Ward II for case discussion, ward round, outpatient consultation and surgical guidance. During the visit, Dr. Rosenthal discussed a case of patient with low back pain and leg pain with LU Qilin, Director of Dept of Spine Surgery Ward II, and he introduced the concepts of "mechanical pain" (caused by spinal instability) and "radicular pain" (caused by nerve compression).

Dr. Rosenthal introduced that in Germany, they can decide the surgical plan by the degree of back pain and leg pain of the patient, if the patient's leg pain is more severe than the low back pain, and the low back pain does not have much impact on the patient's quality of life, then most of them will choose to do simple decompression surgery rather than fusion surgery.

Then, CHEN Ming, Director of Spine Surgery Ward I, also prepared two thoracic spinal stenosis cases, discussed surgical techniques for thoracic spine with Dr. Rosenthal by showing the literature, and later also demonstrated an endoscopic surgery to treat thoracic spinal stenosis from the lateral approach in the surgical session.

Feel the Charm of Combined Chinese and Western Medicine Therapies

During the two-day outpatient consultation, Director LU Qilin and Director ZHU Ling showed Dr. Rosenthal the hospital's distinctive therapies, “Sacral Injection Therapy”, and the “Precision Small Needle Therapy” which was selected as the representative program of Intangible Cultural Heritage of Hongshan District, which allowed Dr. Rosenthal to feel the charm of combined Chinese and Western medicine therapies.

Dr. Rosenthal was very curious and full of praise for the two techniques. He also hoped to further observe the follow-up treatment of the two patients. If he has the opportunity to visit the Affiliated Hospital of Wuhan Sports University again, he would like to learn these techniques and introduce them to Europe, so that the Chinese and Western Medicine can spark new ideas together.

Keep Developing Spine Surgery via Sino-German Cooperation

On the morning of May 30th, the "Keep Developing Spine Surgery via Sino-German Cooperation, the First Training Course on MISS Techniques of Sino-German Minimally Invasive Spine Surgery Training Center at the Affiliated Hospital of Wuhan Sports University” successfully kicked off.

Prof. ZENG Xiaojun from Shiyan People's Hospital, Prof. XIE Tian from Wuhan Hospital of Traditional Chinese Medicine, Prof. CHEN Hua from Hubei Provincial Hospital of Traditional Chinese Medicine, ZHU Ling, Director of Dept of Neck, Shoulder, Low Back and Leg Pain, WU Congjun and CHEN Ming, Directors of Spine Surgery Ward II, LU Qilin, Director of Spine Surgery Ward II, Director ZHAO zhou and Dr. TANG Jin from Dept of MISS shared their clinical experiences.

Based on the problems met during the surgeries or on past experience, they discussed with Dr. Rosenthal and the attendees about the cutting-edge spine surgery techniques at home and abroad, and shared some complex cases, so as to open up the new ideas for the treatment and development of spine surgery, to improve the surgical techniques, and to further provide high-quality and safe healthcare services for the patients. Participants all benefited a lot from today’s training course.

In the morning lecture session, Dr. Rosenthal gave a lecture on "Thoracic disc herniation

And Diagnostic and therapeutic Algorhythm". Dr. Rosenthal introduced the epidemiology of thoracic disc herniation, shared the common clinical symptoms of this pathology, and clearly explained the diagnosis and treatment flowchart of this pathology in their department; at the same time, by showing the intro-op video, he vividly demonstrated their surgical treatment for thoracic disc herniation.

Dr. Rosenthal said that although thoracic disc herniation is not common among spinal diseases, it is not as seldom as published, and spine surgeons still need to consider this possibility when making a diagnosis. He recommended that Chinese doctors could read a paper published by one of his doctoral students to better understand the clinical symptoms of thoracic disc herniation, which is "Symptom distribution and development in thoracic disc surgery - A retrospective case series of 664 patients".

In the afternoon lecture session, Dr. Rosenthal shared a lecture titled "VITOM - An option for less invassive approaches". Vitom is an optimized image system that allows the surgeon to perform microsurgical gestures in complex spinal procedures thus minimizing the approach related trauma. He introduced many advantages of VITOM by comparing the optics and operation methods of endoscope, conventional microscopes, and VITOM, 1) it can be adapted to multiple

techniques or approaches; 2) it has less light absorption on the surface; 3) it can be used combined with normal instruments; and 4) it has the advantages of a microscope without the “bulky equipment”, but with a wider working area. At the end, he showed how the VITOM system used in clinical practice by showing a resection of thoracic neurinoma under the VITOM system.

During the one-day meeting, Chinese colleagues and Dr. Rosenthal had an intense and rich academic discussion on minimally invasive spine surgery techniques, and the atmosphere was warm and everyone gained a lot from it.

Sino-German Global Webcast on Minimally Invasive Spine Surgery

On the morning of May 31st, the Sino-German Global Webcast on Minimally Invasive Spine Surgery was successfully held in the Affiliated Hospital of Wuhan Sports University, where Dr. Rosenthal, Director ZHU Ling and Director LU Qilin, performed an OLIF surgery together, during which the percutaneous pedicle screw fixation from the posterior approach at L3 to L5 was performed by Director ZHU Ling.

The live broadcast of the surgery attracted doctors from home and abroad to watch online with more than 80,000 real-time viewers, and received many comments. The live broadcast of the surgery was of great significance, as Dr. Rosenthal skillfully demonstrated every step of the OLIF surgery, which provided a good teaching demonstration for the spine surgeons who are inexperienced in anterior surgery/OLIF surgery in the hospital as well as other doctors in China, and provided guidance for the development of this technique in the hospital in the future.

After the live broadcast of the surgery, Dr. Rosenthal also observed another lumbar endoscopic surgery performed by ZHAO Zhou, Director of Dept of MISS, which provided a deeper understanding of the hospital's rich experience in endoscopic technique.

Difficult Cases Discussion Sparks New Ideas

In the afternoon, doctors from the four spine departments of the hospital shared a number of difficult cases with Dr. Rosenthal, which led to heated discussions. For example, they discussed how to deal with calcified discs, cerebrospinal fluid leakage during/after surgery, postoperative fever, cauda equina injury; the necessity of neuromonitoring in spine surgery; how to determine whether to remove the nerve inside a tumor; and the future trend of spinal endoscopy. The topics were wide-ranging, answers constantly brought to new questions and spark new ideas, which left the doctors wanting more.

Wrap-up Meeting of Sino-German Academic Exchange Week

On the morning of June 1st, the wrap-up meeting of Sino-German Academic Exchange Week kicked off, and Dr. Rosenthal shared his lecture "Educating spine surgeons - The german (DWG) experience", which provided Chinese colleagues with an in-depth introduction of the training of spine surgeons in Germany.

Dr. Rosenthal also shared his insights on surgeons and scientific research, hoping to inspire Chinese doctors. He said, "It is more important for surgeons to learn to know when not to operate than to learn operate well," and "In the field of scientific research, there are no wrong questions, only wrong answers, and building a large and full patient database is the foundation of scientific research."

Then, the directors of each spine department as well as the doctors present shared their feeling about this week's exchange, and all of them gained a lot. The vast erudition, rigor, professionalism, sense of humor, and insightful understanding of spine surgery of Dr. Rosenthal all left a deep impression on the Chinese colleagues. He is a role model for them to follow.

After the sharing, President LI Xugui made a wrap-up speech for this week’s activities, "Dr. Rosenthal has been deeply involved in the clinical, surgical, outpatient, and scientific research work of our hospital as a visiting professor during this week, which has brought a different experience for our hospital to develop the spine surgery and spine surgery techniques, shortening our gaps with the international-level hospitals and further promoting the high-quality development of spine surgery in our hospital. We should learn from German hospitals of their experience in the establishment of patient databases and collecting typical cases, so as to be able to make better summaries for research. Young doctors should also pay more attention to the study of literature, follow the development of technologies at home and abroad, and enrich themselves with new knowledge. In the future, our hospital will always follow the policies of our country, strive to improve the diagnosis and treatment level and quality of service, meet the rising demand for patients with bone diseases, and promote the strategy of "Healthy China" and the construction of health service system in communities, so as to contribute to the bone health of the people!”