Famous Doctor Interview: Yang Cao, Associate Professor of Spine Surgery, Peking Union Medical College Hospital, Wuhan, China Reporter: Liu Jun Correspondent: Huang Dongxiang Famous Doctor’s Name Card Yang Cao, Associate Professor, Associate Chief Physician, Master’s Degree Supervisor, studied spine surgery at Mater Hospital, Brisbane, Australia and Princess Alexandra Hospital, The Chinese University of Hong Kong as a visiting scholar. He was a postdoctoral fellow at Massachusetts General Hospital of Harvard University, a visiting scholar at Stanford University, a spine surgeon at Mater Hospital and Princess Alexandra Hospital in Brisbane, Australia, and an orthopedic trauma surgeon at Prince of Wales Hospital of the Chinese University of Hong Kong. He is currently a young member of the Orthopaedic Association of the Chinese Medical Association, a member of the Minimally Invasive Group of the Orthopaedic Association of the Chinese Medical Association, a member of the International Society of Internal Fixation (AO), a deputy head of the spine group of the Hubei Orthopaedic Association, and a member of the Orthopaedic Trauma Committee of the Combined Western and Traditional Chinese Medicine of Hubei Province. Yang Cao, Department of Orthopaedics, Wuhan Union Medical College Hospital His main specialty is spine surgery, and he has more in-depth research on spine diseases, including scoliosis, cervical spondylosis, lumbar disc herniation, lumbar stenosis, lumbar spondylolisthesis, spine tumors, and spine fracture, etc. He can use minimally invasive surgery methods to treat spinal injuries. He is able to use minimally invasive surgical methods to treat spinal surgical diseases, such as discoscopic treatment for lumbar disc herniation and thoracoscopic treatment for scoliosis. The importance of the spine is like the mast of a sailboat, with which the boat of life can set sail. A beautiful body and an upright posture are what everyone wants. Due to many parents’ lack of understanding of adolescent idiopathic scoliosis and the shortage of specialized doctors in underdeveloped areas, children with scoliosis are difficult to get timely treatment and eventually allow the condition to progress to the point where it can only be treated through surgery. Although the current scoliosis orthopedic technology has become mature, but such patients due to the operation area of the many nerves and blood vessels, the local anatomy is extremely complex, coupled with the difficulty of surgical exposure, high technical requirements, great risk, only a few large hospitals in China to complete such difficult surgery. For this reason, this reporter specially interviewed Yang Cao, Associate Professor of Spine Surgery at Wuhan Union Medical College Hospital, to understand where the subtlety of scoliosis correction surgery lies. Scoliosis of unknown etiology Reporter: It is understood that scoliosis is most common in young people between the ages of 10 and 16 years old, the incidence rate is generally in the 1.0%-1.5%, women are significantly higher than men, may I ask, why is there a trend of ageing of this disease? Yang Cao: How is it caused and what is the cause of the disease? Unfortunately, the cause of scoliosis is still not clear. There are many types of scoliosis. Congenital scoliosis is an abnormality of the spinal structure that occurs at birth, resulting in a tilted scoliosis or kyphosis of the spine; neuromuscular scoliosis is caused by abnormal muscular or neurological disorders, and can often be found in patients suffering from poliomyelitis, cerebral palsy, spinal cavernous disease, neurofibromatosis, and Marfan’s syndrome; and degenerative scoliosis can be caused by trauma to the spine, previous spine surgery, disc degeneration, or osteoporosis. Degenerative scoliosis can be caused by spinal trauma, previous spinal surgery, disc degeneration, or osteoporosis. The most common type of scoliosis is idiopathic scoliosis, which does not have a specific cause and has no structural abnormality in the spine, but is caused by an imbalance in neuromuscular forces, resulting in a pathological curvature of the spine from its original physiologic curvature. Although many theories have been put forward, there is no satisfactory explanation. What is certain is that idiopathic scoliosis is closely related to heredity. Reporter: What is the ultimate consequence of untreated scoliosis? Yang Cao: The biggest threat to patients with scoliosis is that it seriously affects their cardiorespiratory function until it shortens their life span. Therefore, from the health point of view, suffering from scoliosis, must find a specialist to see a doctor, so as not to miss the condition. Missing the optimal period of surgical treatment and then doing surgery will not achieve the best therapeutic effect. Untreated or delayed treatment of scoliosis in younger children may eventually lead to limited cardiorespiratory development or even death. Surgical program “individualized” Reporter: scoliosis is now the development of low age, some patients were born only a few months old, found that the scoliosis situation. Some hospital doctors recommend conservative treatment, such as medication, some doctors recommend waiting for the child a few years old before treatment, what do you suggest to deal with better? Yang Cao: It depends on the individual’s condition to determine the individualized plan, and the main principle is to try to treat it as early as possible. Some congenital scoliosis patients, surgery can wait until after the age of 7, 8 years old or older, because too early surgery surgery risk is relatively large, at this time, can be in the early with a brace, to slow down the development of deformity, and then delay the time of surgery. In some children, if the surgery is not done in time, the curvature of the deformity will increase over the years, posing a more serious risk for future surgery or having a significant impact on the child’s development. We may then have to advise such children that early surgery is preferable. The optimal time for surgery actually depends on the type of scoliosis. If it is idiopathic scoliosis, surgery can be performed around the time of the second developmental peak female menstruation (12-14 years of age), because after the onset of menstruation, the girl enters the peak of growth and development, when the curvature will have a more rapid development. In case of congenital scoliosis, surgery should be performed as early as possible after eliminating the cause of the scoliosis; in case of congenital scoliosis with obvious deformity, the cause should be eliminated first, and then surgery should be performed to correct the scoliosis when the child is 3 – 5 years old. Orthopedic surgery can not be a slight mistake Reporter: Many patients and their families hear that they have to operate on the spine, will be more worried about the slightest mistake caused by paralysis. Is the risk of this kind of surgery high? Yang Cao: any surgery is risky, scoliosis surgery is a high-risk surgery, so patients need to carefully choose the hospital and doctor, do not indiscriminate treatment. Although the treatment of scoliosis has been improved by orthopedic devices, the difficulty and risk of surgery are still very high, especially for complicated deformity, which is the most difficult type of surgery in spinal surgery. Among them, the biggest risk is nerve damage, the spinal column is the channel between the spinal cord and the cauda equina, spinal deformity indicates that the nerves inside the spinal canal are also deformed, and the spinal cord has to be corrected in the process of correction, and the whole process of correction should not excessively pull the spinal cord or excessively compress the spinal cord, which may result in the impairment of the spinal cord function. Scoliosis surgery has a history of more than 50 years. The Department of Orthopaedics of Xiehe Hospital has started to perform scoliosis surgery since the 1980s, and has accumulated a wealth of surgical experience. In recent years, the surgical techniques and orthopedic instruments adopted by us have been in line with those of the advanced countries in Europe and America, and the corrective effect is as high as more than 90%, and none of the cases has serious complications, so the effect is satisfactory. Classic case: 19-year-old Wuhan girl Xiao He could not stand straight. Two years ago, Xiao He’s mother inadvertently discovered that her daughter’s shoulders were unequal in height, her body was tilted to one side, and her back was obviously formed into a “hunchback”. Scoliosis brought her more trouble than just a deformed appearance; even when she drank a mouthful of water, she felt that she had to turn a corner in her esophagus to get it to flow down – her thoracic vertebrae and thoracic contour were severely deformed, so even her esophagus was twisted. With low self-esteem and pain, Xiao He has sought medical treatment, but her condition has not been effectively controlled. It was not until recently that her mother took Xiao He to the Department of Orthopedics at the Union Hospital. During the examination, the doctor found that Xiao He’s scoliosis had exceeded 70 degrees, and the whole spine was obviously in an “S” shape, so he had to be hospitalized to undergo scoliosis surgery. If he were to undergo a traditional thoracic surgery, he would not only have a large wound, but would also be hospitalized for more than two weeks. Prof. Yang Cao decided to implement thoracoscopic minimally invasive scoliosis orthopedics for him. According to the introduction, thoracoscopic minimally invasive scoliosis orthopedics is a new technology developed in recent years. With the assistance of thoracoscopy, “anterior release and posterior orthopedic fixation of scoliosis” for severe spinal deformity is performed, which is safe and effective, reduces tissue damage, lowers the possibility of infection, alleviates postoperative pain, and shortens the patient’s recovery time. In addition, anterior orthopedic internal fixation of scoliosis under thoracoscopy has the advantages of saving the fixed segments, and the vertebral body de-rotation is superior to the posterior three-dimensional correction. This technique has reached the international advanced level. Compared with the traditional posterior scoliosis internal fixation orthopedic surgery, this procedure has the advantages of minimal bleeding, fast recovery and small incision. On the day of the operation, Yang Cao performed this advanced surgery for the patient by making 4 small incisions on the chest wall under the right armpit of the patient, and with the help of special instruments such as thoracoscopic imaging system, the long orthopedic rods and orthopedic screws were put into the scoliotic spine as the force application points through 4 small “locking holes” devices, and then according to the various corrective methods, the corrective force was applied to counteract the deformity force, so that the scoliosis could be corrected as much as possible within the safety range, and then the scoliosis could be corrected as far as possible within the safety range, and then the scoliosis was treated as a result. The scoliotic spine is then corrected as much as possible within a safe range, and then the spine is fused so that the scoliotic part of the spine is permanently fused together. Before she was hospitalized, Xiao He’s body was twisted and her height was 1 meter 70. On the first day she got out of bed after the surgery, everyone in the ward didn’t expect her to be a standing girl with a height of 1 meter 77, and everyone joked that she could participate in a beauty pageant now.