本期仁醫(yī)醫(yī)療特別邀請到國際著名脊柱專家Daniel J. Rosenthal教授做專題訪問。Rosenthal教授現(xiàn)任德國巴德洪堡高陶努斯醫(yī)院脊柱外科主任，曾擔任德國脊柱學會主席(2013年)。

Daniel J. Rosenthal教授出生于阿根廷并在阿根廷完成了醫(yī)學學業(yè)，畢業(yè)后他赴德國法蘭克福大學進行進一步的醫(yī)學研究，并取得博士學位。他從 1992 年到 1996 年擔任德國法蘭克福大學附屬醫(yī)院神經外科主任和副院長。在胸腔鏡脊柱手術方面，他有極大的成就。

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1、您出生于阿根廷并在阿根廷完成了醫(yī)學學業(yè)，能否分享一下您早年在祖國的經歷？

As you was born and finished your medical study in Argentina, could you please share with us your early experience in your home country?

我在英文學校接受了14年的教育，后來我在家鄉(xiāng)羅薩里奧學習醫(yī)學。當時的羅薩里奧是阿根廷的第二大城市，現(xiàn)在是第三大城市了。24歲那年我通過考試正式成為了一名醫(yī)生。40年后回想起來，我在家鄉(xiāng)度過了最美好的時光，我有很多陪伴我的朋友，我的學習充實，空余時間我會去打橄欖球，所以我的時間安排得很滿。

I was educated for fourteen years in an English school. And after that I started my medicine studies in my hometown, that's Rosario. At that time, it was the second biggest city in Argentina, now I think it's the third. And at the age of 24, I was fully approved as a medical doctor. So those were, forty years later, the best times I had. A lot of friends, a lot of stress with study and tests, and apart from that I was playing rugby, so I had a pretty occupied timetable.

2、畢業(yè)后，您為什么會選擇赴德深造并決定留在德國開啟您的醫(yī)學職業(yè)生涯？

After graduation, why did you choose to further your study in Germany and decide to stay there to start your career in medicine?

雖然我出生在阿根廷，但是我的家族、我的父母都是德國人。我和我的兄弟是我們家族700多年來唯一不在德國出生的成員，我們的家譜也可以證實。
我選擇到德國深造的原因很簡單，因為我想在更好的教育環(huán)境里完成學業(yè)。所以當時我?guī)缀醢阉械纳暾埿哦纪度チ说聡膶W校。我本來也有機會去西班牙或者瑞士的學校，但是當時我有一位在法蘭克福的舅舅，他是城中資歷最深的醫(yī)師，他和我說：“你來德國吧，我會盡力指導你的學業(yè)”。所以我在德國的前十年我的舅舅非常照顧我。其實我在德國完成?？七M修后已經很熟悉德國醫(yī)院的日常工作流程，而且當時我的事業(yè)也在快速起步階段。這就是我選擇留在德國繼續(xù)醫(yī)學事業(yè)的原因。

I was born in Argentina, but my family, it's a German from father and mother's side. And in fact my brother and I were the only ones born outside Germany in almost 700 years of history that we were able to follow back in our genealogy. The reason why I chose Germany was simply that I wanted to have a better education in my specialist career. And that's why I sent all my applications, not only to Germany, but the vast majority of them were sent to Germany. I had also the chance to be accepted in Spain or in Switzerland. But at that time, I had in Frankfurt an uncle of mine who was the oldest physician practicing medicine in the city. So he told me, “Just come over here and I will try to guide you and help you.” And he did it for almost ten years after I arrived in Germany.

In fact, I forgot to say I decided then, when I finished with my specialization, I was already pretty much involved in a clinic daily routine and I was just climbing positions, so that was the reason why I stayed here and continued my medical career.

3、您為什么學醫(yī)，又為什么決定專注于脊柱微創(chuàng)手術呢？

Why did you decide to pursue a career in medicine and why, in particular, did you decide to specialize in the minimally invasive spine surgery?

我一直都對醫(yī)學或者說自然科學感興趣，我覺得研究動植物的自然生命周期是非常讓人著迷的。讀完高中后我就決定從事和自然科學相關的職業(yè)。當時我對獸醫(yī)學不太感興趣，因為阿根廷的獸醫(yī)學是個很狹窄的學科。這個學科與農工業(yè)有關，獸醫(yī)的大部分時間都在照顧牛群和豬群，它們是阿根廷農業(yè)經濟中最重要的組成部分。所以我的選擇很有限，實驗室的工作也不適合我，我覺得它很無聊，所以最后我決定學醫(yī)。至于為什么選擇專注于微創(chuàng)手術，其實我并沒有特意選擇專攻微創(chuàng)，更多的是一種機緣巧合。九十年代初，我做了很多脊柱前路手術。1991年我和我的兄弟共同發(fā)明了胸腔鏡手術。從那時起，我就自然而然地專注于現(xiàn)在的微創(chuàng)手術了，因為這種前路手術對脊柱的損傷比較小。

Medicine was always, let's say natural sciences, was always an interesting topic for me, and I found it fascinating to read about the normal cycles of plants or animals. And I think when I was finishing high school, I already took the decision, that I wanted to pursue some careers related to natural sciences. Veterinarian medicine didn't attract me so much, at that time at least, because in Argentina it's a very narrow field. That's mainly to do with the agro-industry, so the majority of the time you are looking after cows and pigs who are the most important economical branch of the Argentinian agriculture economy. So I didn't have too much left over, but laboratory was not an option for me, because it was pretty boring from my point of view, so I decided to get into medicine. That was the reason why I decided to apply for a career in the medical sector.

And concerning minimally invasive surgery, I didn't decide myself to specialize in minimally invasive, it was more a lucky circumstance, because at the beginning of the nineties, I was working a lot with anterior approaches to the spine, and together with my brother we developed the thorascopic technique, that was 1991. So since then I've been mainly or formally pushed into what it is called minimally invasive surgery, in this situation, it would be less aggressive approaches to the spine.

4、您的早年經歷如何塑造你的成就？

How did your early youth experience shape your success?

我的早年經歷對我所取得的成就影響不大。我天生是一個擅長理性分析的人，我對事物充滿好奇，喜歡對復雜疑難問題尋根問底。正因如此，我當時開始研究全新的手術入路。我覺得自己很幸運，能夠有機會進入脊柱外科這個當時剛剛起步的領域?？偠灾也挥X得我的早年經歷對我的職業(yè)生涯，還有我在脊柱領域耕耘近30年取得的成功有太大的影響。

I don't think that my youth experience had a big influence in success. I am by nature a very analytical person, I am curious, I try to find some logical explanations for things that maybe a little bit confused or complicated. And that's the reason why I started developing approaches that at that time didn't exist. I was lucky because I just had the opportunity to get into a field that was just starting to progress and to expand, that’s spine surgery, but I don't think that my youth experience had much influence in the career and the results of almost thirty years of medical practice in spine in my case.

5、您是否有在其他領域投入了您的時間和專業(yè)技能？

Do you have other fields in which you are investing your time and know how?

我和我的朋友在阿根廷投資了一個農場，這個農場運營了大概有10年。這是一件非常有趣的事情，我能盡我所能地投入我的時間和知識。
另一個方向是在脊柱領域，但與軟件開發(fā)有關。我投資了一家做脊柱測量和分析軟件的德國公司。我們計劃開發(fā)出一個先進的系統(tǒng)，幫助外科醫(yī)生在沒有導航設備的情況下進行手術導航。這個軟件系統(tǒng)是一種混合技術，預計在今年年底問世。

Yes, I'm still binding part of it to Argentina where there is a project of agriculture running there since more or less ten years now, together with some of my friends that are also partners, that's a very interesting thing where I'm also dedicating my time and my know how as far as I can. And the other one is in spine field but linked to software. That's a German company that has the software for spinal measurement and analysis. We are pretty far advanced to develop a system that will allow the surgeons to navigate surgery without a navigation device. That's a hybrid and I think we will show it by the end of the year.

6、在您的職業(yè)生涯中，是否有對您來說很重要的導師？他們教會您什么，是如何啟發(fā)您的呢？

Who have been your greatest influences? What have they taught you and how have they inspired you?

年少時，我的父母對我影響深遠。后來是我已故的神經外科老師Lorenz教授，還有當時的骨科主任Schmitt教授。Schmitt教授深刻地影響了我對脊柱疾病的認識。當然我的同事和病人對我的影響也很大，他們總是給我反饋意見。我認為同事和病人是醫(yī)生最重要的導師，因為醫(yī)學是動態(tài)的，它時刻都在變化，你永遠都不可能在醫(yī)學領域內做到完美。完美看似一步之遙，實則觸不可及。所以在醫(yī)學領域真正深刻影響我們的是，我們能否獲得讓自己和病人都滿意的治療效果。

For sure my greater influences were my parents in my young ages, followed by my teacher in neurosurgery that’s Prof. Lorenz who passed away many years ago, and the head of the orthopedic department at that time, who's Prof. Schmitt who also had a big influence in my way of interpreting spine diseases. And the rest are the influence and the feedback I get from my colleagues and from the patients. I think that the last one, the colleagues and the patients are the most important influences you have in medicine, because that's a dynamic process, it is always changing, and you never achieve the perfection in what you are doing in medicine. You may be close to it, but it will never be perfect. So the real influence you have in medicine is, if you are satisfied and if the patients are satisfied with the results of your surgery or your treatment.

7、2013年您當選成為德國脊柱學會(DWG)主席，能否談談德國脊柱學會在德國醫(yī)院和專家中的非凡地位？

In 2013, you were elected as the President of the German Spine Society(DWG), could you please talk about the importance of DWG to the hospitals and specialists in Germany?

德國脊柱學會匯聚了一眾骨科醫(yī)生、創(chuàng)傷外科醫(yī)生和神經外科醫(yī)生多年的努力成果。在德國，這三個學科和脊柱疾病息息相關。德國有一個創(chuàng)建了五十多年的脊柱研究學會，是世界上最古老的脊柱學會。上世紀九十年代末，德國出現(xiàn)了第二個脊柱學會——脊柱外科醫(yī)生學會。多年來兩個學會互融互洽，2000年初雙方理念達成一致，德國脊柱學會應運而生。Michael Mayer教授作為德國脊柱學會的創(chuàng)始主席，他為學會的發(fā)展指明了方向，此后德國脊柱學會一直在蓬勃發(fā)展。德國脊柱學會是歐洲最大的脊柱學會，我認為它的規(guī)模和北美脊柱協(xié)會相當，同樣擁有著享譽世界的知名度。德國脊柱學會提供了一個很好的平臺，讓所有的同行能夠互相交流，彼此分享保守治療、手術治療脊柱疾病的心得。我們也為護士開展了相關的脊柱治療培訓項目。2013年我們在法蘭克福開展了第一次研討會，把脊柱疾病的護理納入到德國脊柱學會的培訓項目中，這個項目已經進行了近10年。
德國脊柱學會的重要性體現(xiàn)在我們的話語權，我們能夠和醫(yī)院、德國衛(wèi)生部以及一些國外組織機構在同一語境下交流。從而避免病人一邊聽神經科醫(yī)生解釋治療方案，一邊聽骨科醫(yī)生分析病情，雖然雙方意見不合的現(xiàn)象在全世界普遍存在。我們開展了一個嚴格的培訓項目，完成培訓的人員會獲得證書。這份證書雖然不是官方認可證書，但對于病人來說，這份證書說明了醫(yī)生掌握了一定程度的知識，能夠有效治療脊柱疾病。
我們?yōu)獒t(yī)院設置了兩種證書，考察醫(yī)院工作質量和醫(yī)院設備情況，這兩種評判指標是基于醫(yī)院規(guī)模和治療病種而設定的。病人在小醫(yī)院和大醫(yī)院接受的醫(yī)療服務是不一樣的，設備有限的小醫(yī)院只能治療簡單的疾病，而大醫(yī)院能夠治療更多種類繁多、病程長的疾病，比如創(chuàng)傷、腫瘤和復雜的脊柱疾病。我們的證書分為不同等級，有一級、二級和三級。醫(yī)院綜合質量最高是一級，最低是三級。所以德國脊柱學會的重要性就體現(xiàn)在為脊柱外科的需求發(fā)聲，無論何時都堅決捍衛(wèi)其立場。

The DWG is the result of long years of trying to match the interests of orthopedics and trauma surgeons together with neurosurgeons. Those are the three main specialties dealing with spine diseases in Germany at least. We had in Germany for more than fifty years a society called the Society of Investigation in Spine that was I think the oldest society related to spine worldwide. And at the end of the nineties, a second society appeared, and that was the Society of Spine Surgeons. So for a lot of years, the research societies were not competing, but trying to adapt to each other, and at the beginning of 2000, the interests of both societies were similar, and we managed to create the German Spine Society. At that time, Michael Mayer was the one who leaded that way or showed the way to follow, and since then this society hasn't stopped to grow. It's the biggest spine society in Europe and I think it’s the biggest spine society or at least as big as the North American Spine Society, although both of them have a very high level of recognition worldwide. The spine society has now got under one umbrella, all the persons that are willing to share their knowledge, but also their field of expertise in spine treatment, not only operative but also conservative.

We have even started to develop a program for nurses related to spine treatment. And in 2013 in Frankfurt we started with the first symposium where nursing was included in the scientific program of the spine society, and this has been kept for almost last ten years as well. Now the importance we have with this society is that, we are now in the position to talk with the hospitals with the German health authorities or with other groups outside Germany with one language. It is not that the neurosurgeons are explaining something about treatment on the left, and the orthopedics on the right, and they are struggling against each other as it happens in lots of countries worldwide. Here we have a strict program of education that leads you to a certificate, and that gives you at least there's no official recognition for quality, but it's important as I told you, for the patients, if you have that certificate, it means that you've reached a certain amount of knowledge capable to treat effectively and successfully spine diseases. From there, we've moved two certificates for the hospitals, so we have a structure that looks after the quality of the work you are doing at the hospital, how is the hospital equipped and that's based also the degree of structural and also medical part you are treating in the hospital. So it is not the same to have a patient treated in a very little hospital with low infrastructure where they are only treating simple cases compared with a bigger hospital where they are dealing with a lot of pathologies that are also time consuming, and also needed for the population like trauma or tumors or any kind of complex spine surgery. It has a different level of recognition. And we've graded that in Grade one, two and three, being one the clinics were the highest complexity, and three were the lowest one. So the importance of the DWG is that we have now a society that is expressing the needs of the spine surgery, but also defending their positions against whoever and whenever it's needed.

8、在胸腔鏡脊柱手術方面，您有著極大的成就，請問對此類手術您有什么心得分享？

You have great achievements in thoracoscopic spine surgery, what insights would you like to share about performing this kind of surgery?

我認為胸腔鏡脊柱手術本身并不特別，只是需要外科醫(yī)生學習使用手術器械，因為這類器械的長度比開放手術中常用的長得多。這項技術還有一個問題，就是它采取的是前入路，對于不敢做前入路手術的醫(yī)生來說這就是弊端。
因為當時歐洲的醫(yī)學界認為前入路手術都是一些高難度、危險的手術。但事實恰恰相反，前入路是通往脊柱最直接的入路，而且在治療一些脊柱疾病上，它的創(chuàng)傷性更小。熟悉掌握這項技術最重要的是多花時間學習，獲得更大的信心。
1991年我研發(fā)出這項技術時，很多同行覺得操作這項手術要承受很大壓力，而且對于他們來說前入路手術是一個全新的、未知的領域，所以他們把病人推薦到我的診所。當然我非常感謝他們的推薦，經過大量的手術積累，讓我在胸腔鏡手術治療胸椎退行性疾病方面得到高度認可。

It's difficult to say. I think it's nothing special on the technique, except that the surgeons have to learn how to work with the longer instruments than they are used to in an open surgery. One of the biggest problems, or I don't call it a problem, but the drawbacks of the technique is that, it uses an anterior approach. That's a drawback for those who are afraid to perform anterior approaches, because anterior approaches at least in Europe are surrounded by a sort of aura that means a difficult surgery, dangerous surgery and it's exactly the opposite. It's the most direct approach to the spine and it's the less aggressive technique to treat some spinal diseases. The most important thing is to dedicate some time and use that time to gain confidence in order to get used to this kind of technique and this kind of approach, there is nothing spectacular in the technique itself. The result is that, when I developed that in 1991, a lot of people had decided that they don't have the intention to deal with stress and with all the unknown world of anterior approaches for them, so they are sending the patients to my clinic which I appreciate a lot. And that's the reason why I got such a big recognition concerning thoracoscopic approaches mainly for the degenerative disease of the thoracic spine.

9、能否分享一下您治療過的最具挑戰(zhàn)性且最印象深刻的病例？

Could you please share one case that you think is the most challenging and impressive one?

我回想了很多以前的病例，但是我真的找不出一個最重要或者說最令人印象深刻的病例，你可能會驚訝于病變的復雜程度或者出人意料的手術效果。但是我認為每一個病例都非常重要。其實不用被病例嚇到，比方說很多人看到片子時會先入為主覺得病情很復雜。
我認為我們這里是沒有令人印象深刻的“病例”，但有令人印象深刻的“手術效果”，因為有時手術順利但術后效果不如人意，或是手術進行得不太順利，但術后效果出乎意料。我認為對于醫(yī)生來說，每一個病例都很重要且印象深刻。我可以給你展示大量成功手術摘除大椎間盤突出的病例，我也可以給你展示一個由小椎間盤突出導致嚴重神經功能障礙的病例，這類手術難度不大，病人手術后就完全康復了，所以令人印象深刻這個標準在我看來是相對的。

When I read the question I was trying to remember one. But I really don't have one case that is the most important one if you call it like that or the most impressive, because it may be impressive because of the size of the pathology, it may be impressive because of the results you have achieved with the surgery. But I think every single case for itself is important. It may be not so subjective to surprise, or for a lot of people be extremely complicated when you see the picture. I don't think that there are impressive cases in what we are doing. Maybe we have impressive results because we don't expect to have a bad result in a good surgery or a good result in a bad surgery. But I think every single case is for the surgeon important and impressive. I can show you tons of big discs that have been successfully operated, but I can show you also one small disc causing serious neurological deficits, and after a surgery that's technically really not demanding, the patient recovers completely, so the term impressive is a very relative one in my opinion.

10、至今您最自豪的職業(yè)成就是什么，為什么？

What is your proudest career achievement to date and why?

我覺得讓我最引以為豪的就是身邊每天和我共事的同事。我們不僅僅是一個部門，還是一個團隊，管理團隊需要很多的精力和經驗。我的團隊就是我最自豪的成就。除了行政管理上的成就，我還很自豪這40年來病人和同事對我的認可。

I've also been thinking about that question as well. I believe that my proudest achievement is the group of people I have around me working with me every day. I don't call it a department, but it's a team, and to keep that team working, you need a lot of efforts, a lot of experience, and I think that’s the proudest achievement I have. That's the part of the administrative part and the rest is the recognition of the patients and my colleagues during the last forty years.

11、您的科室一年的手術量有多少？以及您至今做了多少臺胸腔鏡脊柱手術？

Gloryren adds: How many spine surgery that are performed in your department every year and how many thoracoscopic spine surgery that you have performed so far?

現(xiàn)在我們一年的手術量是1100到1200臺，這只是脊柱手術的數(shù)量?？赡苓@個手術量在中國不足為奇，但是在德國已經算很多了。到2021年為止，我已經主刀了3000多臺胸腔鏡脊柱手術。

We are performing now about eleven to twelve hundred surgeries a year. And that amount is being done for spine surgeons. For China, these numbers are not so big, but for Germany, they're big enough. I've just made a summary until 2021, and I went above 3,000 thoracoscopic spine surgery performed by myself.

12、您對年輕的脊柱外科醫(yī)生有什么建議？

What advice would you give to young spine surgeons?

保持好奇心、忠于你的身份和職責、永遠相信一切皆有可能。這是我給年輕脊柱外科醫(yī)生的三個建議，也是我職業(yè)生涯里一直奉行的準則。如果我沒有保持好奇心，只是隨波逐流，跟著主任醫(yī)師或者其他同行做一樣的手術，我就不會發(fā)明出胸腔鏡手術還有其他入路的手術。要常問自己：這件事可行嗎？這件事可能做得成嗎？如果你不能堅持初心，后果將是一事無成，即使前方困難重重，只要我們堅持，事情就會有轉機。

Be curious, be committed to what you are and what you are doing, and never accept the words “it's not possible”. I think those are the three advice that I can give them, and those are the three things I've always been doing during my career. I wouldn't have developed thoracoscopic surgery or all the other approaches I'm using if I would have just done what my chief was doing or what the others are doing, and that was the result of a curiosity. Can it be done? Is it possible to do it? And if you don't stick to your plan, you will end up doing nothing, so even if you have drawbacks, you should keep working on it and it will happen that as some sort of solution appears in the horizon and leads you to the solution of the problems you are facing.

13、假如您不從醫(yī)的話，您會從事什么行業(yè)？

What would you have been if you had not been a medical doctor?

這是個好問題，我想可能我會成為一名農業(yè)工程師。越是了解這個行業(yè)，你就會發(fā)現(xiàn)它還涉及生物知識、商業(yè)知識，而且這個行業(yè)有很大的空間讓你發(fā)揮創(chuàng)意?，F(xiàn)在我們在研究如何以更快速、經濟實惠的方式運輸農作物，長途運輸農作物對于阿根廷來說是個問題，我想中國應該也有同樣的問題。我們可以等時機成熟再討論這個技術，現(xiàn)在它還是個雛形。

Another good question, probably I would have been an agricultural engineer, because the more I get involved with the topic, you have the biological parts, you have the entrepreneur part and you have also the room enough to develop new things. So in fact, we are working on an idea I have in order to have crops transported in a very quick and cheap way, that's a problem in Argentina because of the long distances, and it should be a problem in China as well, but we'll talk about it when the time is mature for it, now it's just a project.

14、除了學醫(yī)外，您還有什么興趣愛好？

What are your interests and hobbies outside medicine?

我的愛好就是足球、旅游和烹飪。

That's easy, soccer, traveling and cooking.