Spinal Surgery

1. Overview of the Specialty

★ National Clinical Key Specialty (the only orthopedic specialty in Shandong Province selected)

★ Shandong Provincial Orthopedic Medical Quality Control Center, Shandong Provincial Clinical Key Specialty, and Shandong Provincial Key Discipline in Medicine and Health

★ Doctoral and master’s degree programs

★ Includes the Shandong Provincial Institute of Traumatic Orthopedics, which is a provincial key laboratory for medicine and health

★ Unit serving as deputy chair of the Orthopedic Branch of the Shandong Nursing Association and deputy chair of the Qingdao Surgical Nursing Association; provincial high-quality nursing demonstration ward

★ Long-term cooperative relationships have been established with advanced medical institutions in the United States, Germany, the United Kingdom, and many other countries and regions

Since the establishment of the Department of Orthopedics, the Department of Spine Surgery at Qingdao University Affiliated Hospital has been a key area of development and a distinctive specialty, with strong clinical and research capabilities. The Department of Orthopedics was founded in 1947 by Professor Shen Fupeng, who was then president of the hospital. Over more than 60 years since its establishment, generations of physicians have carried on the tradition, worked diligently, and pursued progress, achieving fruitful results in discipline development. It has successively been approved as a Shandong Provincial Key Discipline in Medicine and Health, a Provincial Clinical Key Specialty, and the Shandong Provincial Orthopedic Medical Quality Control Center, becoming a leading department in this specialty throughout the province. In 1981, Spine Surgery became one of the first disciplines in the hospital approved by the State Council as a master’s degree authorization program. It has since trained hundreds of publicly enrolled master’s students, including students in the seven-year program, and admits more than 40 academic master’s students, professional master’s students, and students with equivalent educational qualifications each year. Since 2011, it has admitted 4–8 doctoral students in the professional degree program in clinical medicine each year. In 2005, the orthopedic specialty was further divided, and the departments of Spine Surgery, Joint Surgery, and Trauma, Hand and Foot Surgery were established. In 2012, the department was approved by the Provincial Health Department to establish an Orthopedic Medical Center. In 2013, it became the only National Clinical Key Specialty project in orthopedics in Shandong Province, opening a new chapter in its development. As the hospital continued to expand, a new model of coordinated development of Spine Surgery across three campuses gradually took shape from 2013 onward. To standardize technical standards and promote reform of discipline development, the three campuses adopted unified management and planning beginning in 2016, ushering in rapid development of the specialty.

2. Talent Structure

The Spine Surgery team has a well-balanced distribution of professional levels and strong capabilities. It includes highly respected orthopedic authorities and lifelong medical experts with decades of clinical experience, discipline leaders who have absorbed advanced international concepts and possess outstanding technical skills, and young and middle-aged professionals from many leading universities in China. Together, they form a high-level medical innovation team combining senior, middle-aged, and younger professionals. The department currently has 29 full-time physicians, including 16 with doctoral degrees and 11 with master’s degrees. Personnel with a master’s degree or higher account for 93.1% of the team. There are 12 physicians with senior professional titles, 3 with associate senior titles, and 15 associate professors or above, accounting for 51.7% of the total. The department has 3 lifelong medical experts, 3 doctoral supervisors, and 12 master’s supervisors. Department members hold a series of important academic positions in relevant professional and technical fields, including executive council member of the International Chinese Spine Society; members of the Orthopedic Branch of the Chinese Medical Association and its Spine Surgery Group; experts in medical appraisal for the Chinese Medical Association; standing committee members of the Spine and Spinal Cord Injury Professional Committee and the Cervical Spondylosis Professional Committee of the Chinese Association of Rehabilitation Medicine; deputy chair of the China Branch of the International Spinal Cord Society; member of the Orthopedic Branch of the Chinese Medical Doctor Association; deputy chairs and members of multiple working committees of the Orthopedic Physicians Branch; deputy chair of the Osteoporosis Branch of the Chinese Gerontology Society; secretary-general of the Orthopedic Branch of the Cross-Strait Medicine and Pharmacy Association; members of the Spine Surgery Group, Osteoporosis Group, and Integrative Chinese and Western Medicine Group of the Orthopedic Society of the Chinese Medical Association; deputy chairs and members of the Orthopedic Professional Committee of the Shandong Medical Association; deputy chair of the Shandong Spine and Spinal Cord Injury Professional Committee; leader of the Spine Surgery Group of the Shandong Orthopedic Society; deputy chair of the Orthopedic Professional Committee of the Shandong Medical Doctor Association; chair of the Orthopedic Branch of the Qingdao Medical Association; and deputy editors-in-chief, executive editorial board members, and editorial board members of nearly 20 core journals, including the Chinese Journal of Surgery, Chinese Journal of Orthopaedics, Chinese Journal of Trauma Surgery, Chinese Journal of Traumatic Orthopaedics, and Chinese Journal of Spine and Spinal Cord. One professor receives the State Council Government Special Allowance, and several professors have received honors including Shandong Professional and Technical Top Talent, National Advanced Worker in the Health System, and Qingdao Top Talent.

3. Specialty Features

Spine Surgery has long been dedicated to basic and clinical research centered on lumbar disc herniation and related series of studies, making the discipline renowned both in China and internationally for decades. The clinical diagnosis and treatment of lumbar disc herniation have developed standardized and regulated procedures. The first, second, third, and fourth editions of the book Lumbar Disc Herniation have become standard textbooks guiding the clinical work of spine surgeons in China. The department has achieved outstanding results in basic research on spinal biomechanics and intervertebral discs. It established the first computer-based three-dimensional finite-element model of the lower cervical spine in the world and was the first internationally to propose the theory of a second induction pathway for intervertebral disc-cell apoptosis. It is at the domestic forefront in areas including stem-cell transplantation for the treatment of intervertebral disc degeneration. The diagnosis and treatment of degenerative spinal diseases have become routine services and have reached a leading level in China, including lumbar spinal stenosis, lumbar spondylolisthesis, degenerative lumbar scoliosis, cervical spondylosis, cervical spinal stenosis, ossification of the posterior longitudinal ligament of the cervical spine, thoracic spinal stenosis, and ossification of the ligamentum flavum of the thoracic spine. In addition, the department has distinctive expertise in the diagnosis and treatment of spinal fractures, spinal cord injury, spinal tumors, spinal infections, scoliosis, spinal deformities, and other diseases. On this basis, it has gradually introduced spinal non-fusion techniques, including artificial cervical disc replacement, posterior lumbar Wallis dynamic internal fixation, and posterior cervical laminoplasty with titanium-cable internal fixation, reaching an advanced level in China. The department is also at the forefront of the diagnosis and treatment of complex spinal disorders, performing highly challenging procedures such as one-stage posterior correction of severe spinal deformities using all-pedicle-screw instrumentation, anterior and posterior procedures for upper cervical disorders, and total spondylectomy with reconstruction for spinal tumors.

In recent years, with the continuous development of minimally invasive surgical concepts and techniques, substantial progress has also been made in minimally invasive spine surgery. The department was the first in China to use a minimally invasive channel to perform posterior cervical Keyhole surgery and the first in Shandong Province to introduce the Quadrant channel for the treatment of lumbar disc herniation. These have now become routinely performed procedures. On this basis, other minimally invasive procedures have been developed, including percutaneous pedicle-screw fixation for the lumbar spine; posterior lumbar decompression, bone graft fusion, and internal fixation through a Quadrant channel (MIS-TLIF); percutaneous balloon kyphoplasty and percutaneous vertebroplasty (PKP/PVP); anterior odontoid screw fixation; percutaneous transforaminal and posterior interlaminar endoscopic discectomy (PELD/PEID); lateral or extreme-lateral/anterior-lateral lumbar interbody fusion (DLIF/XLIF/OLIF); microscopic removal of herniated nucleus pulposus; microscopic laminectomy, decompression, and nerve-root release; and microscopic resection of spinal tumors with spinal-canal decompression. These procedures have produced satisfactory results, received unanimous praise from patients, and are at an advanced level nationally and within the province.

4. Medical Technology

Over the years, Spine Surgery has consistently focused on promising new technologies and new projects, actively expanding the scope of professional development. It has successively introduced a series of advanced and innovative projects, including posterior lumbar discectomy through a Quadrant channel and spinal-canal decompression, bone-graft fusion, and internal fixation; posterior cervical laminoplasty with titanium-cable internal fixation; artificial cervical disc replacement; XLIF minimally invasive interbody fusion; percutaneous balloon-expanded vertebral kyphoplasty; posterior lumbar Wallis dynamic internal fixation; total spondylectomy and reconstruction; and computer-assisted surgical simulation and 3D-printed surgical techniques.

Posterior lumbar surgery through a minimally invasive channel: In 2007, the Orthopedic Center introduced the minimally invasive Quadrant channel system for the treatment of lumbar disc herniation. Through a small incision and minimally invasive instruments, this procedure creates an expandable working channel that allows the surgeon to reach the operative area precisely without extensive stripping of muscles and soft tissues. It enables all the complex procedures required for posterior spinal fusion and internal fixation that previously could be completed only through traditional open surgery, including lumbar spinal-canal decompression, reduction of spondylolisthesis, interbody bone-graft fusion, and pedicle-screw internal fixation. Because illumination is provided by an integrated cold light source, the operative field is clear. The spinous processes, supraspinous ligament, interspinous ligament, and other posterior lumbar structures are preserved, resulting in less tissue injury, less blood loss, and faster recovery. Hospital stays and medical costs are therefore reduced, benefiting large numbers of patients with lumbar disorders. To date, nearly 1,000 procedures have been performed, including removal of herniated lumbar discs or spinal-canal decompression, bone-graft fusion, and internal fixation through a posterior lumbar Quadrant channel, as well as reduction, bone-graft fusion, and internal fixation for Grade I or Grade II lumbar spondylolisthesis. The Orthopedic Center has also successfully and innovatively applied this technique to posterior cervical surgery for the treatment of cervical disc herniation.

Clinical diagnosis and treatment of upper cervical disorders and internal-fixation techniques: Upper cervical disorders mainly include atlantoaxial dislocation and instability, upper cervical tumors, odontoid fractures, and C1–C3 fractures. Because these conditions are located high in the spine and involve substantial risk, relatively little clinical research and application had been conducted. Since the 1970s, we have conducted clinical research on and provided diagnosis and treatment for these disorders, achieving good therapeutic results. Atlantoaxial internal-fixation techniques have gradually developed from the classic posterior fixation techniques using various types of wire to current anterior and posterior internal-fixation procedures, including anterior screw fixation for odontoid fractures, transoral–transpharyngeal odontoid resection and release, posterior atlantoaxial reduction, fusion, and internal fixation, and occipitocervical fusion. These techniques have all undergone substantial development. The annual surgical volume has reached more than 50 procedures, placing the department at the leading level in the province.

Computer-assisted surgical simulation and 3D-printed surgical techniques: The spine is located deep within the body, has a complex structure, and lies adjacent to many important structures such as nerves and blood vessels. A difference of only a millimeter in surgical manipulation may lead to an entirely different result. Traditional X-rays and two-dimensional CT and MRI images cannot display the lesion from all angles, so surgeons have had to plan procedures using spatial imagination alone. In complex cases, even surgeons with extensive clinical experience may find it difficult to ensure absolute precision, and complications such as spinal-cord or nerve injury and paraplegia can easily occur. The use of MIMICS computer-aided surgery technology and 3D printing now enables surgeons to understand the lesion and its relationship with surrounding tissues clearly, directly, and comprehensively before surgery. They can therefore formulate individualized surgical plans suited to the patient’s actual condition, conduct simulated rehearsals, effectively avoid surgical risks, and improve outcomes. Compared with traditional surgery, computer-based three-dimensional simulated surgical design using MIMICS computer-aided surgery technology and 3D printing can create an individualized three-dimensional virtual model and physical 3D model for each patient, assist in designing and simulating the surgical plan, and provide a complete preoperative plan and surgical rehearsal. This significantly improves the precision, predictability, and safety of surgery, particularly highly complex procedures. At the same time, the 3D-printed model allows patients to gain a direct understanding of their condition and surgical plan before surgery, strengthening their confidence in cooperating with the physician to complete the procedure.

5. Research and Education

While attaching importance to clinical work, Spine Surgery also emphasizes the integration of clinical practice, research, and teaching.

Research: Spine Surgery adheres to driving discipline development through scientific and technological innovation. As early as 1998, the Department of Orthopedics established the Shandong Provincial Institute of Traumatic Orthopedics, which was approved in 2000 as a provincial key laboratory for medicine and health. It has conducted basic and clinical orthopedic research over the long term. Its basic research on intervertebral discs is at the international frontier and at a leading level in China. It has achieved outstanding results in basic research on spinal biomechanics and intervertebral discs, established the first computer-based three-dimensional finite-element model of the lower cervical spine in the world, and was the first internationally to propose the theory of a second induction pathway for intervertebral disc-cell apoptosis. It is at the domestic forefront in areas such as stem-cell transplantation for the treatment of intervertebral disc degeneration. In recent years, the department has undertaken 1 national Ninth Five-Year Plan key research project, 1 Ministry of Health industry fund project, 1 Ministry of Education fund project for returned overseas students, 7 National Natural Science Foundation of China projects, and dozens of other provincial- and ministerial-level and municipal- and bureau-level research projects, with research funding totaling nearly 10 million yuan. The second edition of Lumbar Disc Herniation, for which department members served as chief editors, won the Ministry of Health Science and Technology Progress Award, Second Prize; it has now been reissued in a fourth edition and has been highly acclaimed by spine surgeons. The department has received one Second Prize of the Ministry of Education Science and Technology Progress Award for Institutions of Higher Education and one Third Prize of the Chinese Medical Science and Technology Award, achieving a breakthrough for Qingdao University Affiliated Hospital in this field. It has also received 3 second prizes and 5 third prizes of the Shandong Provincial Science and Technology Progress Award, 1 first prize of the Qingdao Natural Science Award, and dozens of other scientific research awards. Hundreds of articles have been published in important academic journals in China and abroad. In recent years, particular attention has been paid to publishing high-quality articles; dozens of papers have been indexed by SCI, Medline, and other databases, with generally high impact factors. Faculty members have served as chief editors of 3 academic books, chief translators of 2, and contributing editors of dozens of books.

Education: In 1981, Spine Surgery became one of the first disciplines in the hospital approved by the State Council as a master’s degree authorization program. It has since trained hundreds of publicly enrolled master’s students, including students in the seven-year program, and admits more than 40 academic master’s students, professional degree students, and students with equivalent educational qualifications each year. Since 2011, it has admitted 4–8 doctoral students in the professional degree program in clinical medicine each year. Many of the students trained have repeatedly received honors including Outstanding Doctoral Dissertation of Shandong Province, Outstanding Master’s Dissertation of Shandong Province, and Outstanding Master’s/Doctoral Dissertation of Qingdao University. Young physicians are regularly sent to renowned universities and institutions in the United States, France, Germany, South Korea, Hong Kong, Taiwan, and other locations for advanced training, and participate in the annual meetings of spine surgery societies in the United States and Europe for academic exchange. Each year, the department holds 1–2 national or international academic conferences and several national- or provincial-level continuing-education courses. Faculty members have contributed to the fifth, sixth, and seventh editions of Huang Jiasi’s Surgery, as well as the five-year, seven-year, and eight-year Surgery textbooks for higher medical education. Teaching staff have repeatedly received honors including Outstanding Graduate Supervisor of Qingdao University, Outstanding Teacher of Qingdao University, and Model of Teacher Ethics of Qingdao University.

6. Patient Information

(1) Department locations

Outpatient, Laoshan Campus: Ward Building A, 2nd floor

Shinan Campus: Outpatient Building, 6th floor

West Coast Campus: Outpatient Building, 2nd floor

Inpatient, Laoshan Campus: Ward Building B, 3rd and 6th floors

Shinan Campus: Medical Technology Building, 2nd floor

West Coast Campus: Ward Building A, 15th floor

(2) Consultation telephone numbers

Laoshan Campus: 82913565 (6th floor) or 82913561 (3rd floor)

Shinan Campus: 82911298

West Coast Campus: 82919525