From October 14th to October 18th, 2024, Prof. Siepe, Head of Spine Center of Sch?n Klinik München Harlaching and Secretary General of EUROSPINE, visited Guangdong Provincial Hospital of Traditional Chinese Medicine (TCM) as an international visiting professor, and carried out a series of academic exchange activities, including outpatient consultation, ward rounds, surgical guidance and practice, internal lectures, discussions on department management and complex cases, and public lectures, etc.

A Visit to Guangdong Provincial Hospital of TCM after Five Years

At 9:00 a.m. of October 14th, Prof. Siepe arrived at the demonstration room of the Dept. of Minimally Invasive Spine Surgery (MISS) of Guangdong Provincial Hospital of TCM. He met with Prof. CHEN Bolai, Vice President of the Orthopedics Hospital of Guangdong Provincial Hospital of TCM, and his MISS team, and had an internal meeting at the department. Prof. Siepe had visited this department twice in 2019, and this was his first meeting with Prof. CHEN Bolai since five years ago.

After the warm welcome, Prof. Siepe and Prof. CHEN Bolai shared their experiences during the past five years with each other, and had a series of academic discussion on advancement and innovation of spine surgery techniques, such as uniportal and biportal endoscopic techniques, application of stem cell therapy in postoperative trauma, etc.

In addition, Prof. CHEN Bolai introduced a case of spinal infection to Prof. Siepe, and scheduled a lateral anterior approach for debridement and interbody fusion surgery for the patient in the afternoon. The two professors engaged in an in-depth discussion regarding the choice between autologous iliac graft or allograft, whether to use a fusion cage, and whether to place a drainage tube postoperatively.

At 3:00 p.m., the surgery began as scheduled, performed by Prof. CHEN Bolai with the assistance of Prof. Siepe. Following the morning discussions, they decided to use the patient's iliac bone as the implant. Before implanting the autograft, they opted to a use a trial cage to widen the intervertebral space then placed the autologous bone without a permanent cage. Regarding the drainage tube, Prof. Siepe shared from his experience that it is rarely needed, typically only in cases of significant bleeding. Prof. CHEN Bolai accepted Prof. Siepe's recommendation, and no drainage tube was placed. The surgery ended successfully after three hours.

Surgical Guidance and Practice

In the morning of October 15th, Prof. Siepe joined the MISS team for ward rounds. Director SU Guoyi introduced a case of cervical spondylosis scheduled for an anterior cervical decompression and fusion under endoscopy later in the week. Prof. Siepe, noting that endoscopic spinal fusion remains uncommon in Germany, showed great interest in this case.

Later, Prof. Siepe observed two endoscopic spine surgeries performed by Director SU Guoyi. During the first, a lumbar decompression procedure, he was surprised to see the patient under just lumbar anesthesia. Director Su explained that lumbar anesthesia for single-segment lumbar decompression offers benefits, including real-time feedback on the patient's condition, shorter recovery, and faster surgical turnover. Prof. Siepe noted this as a promising way, expressing interest in trying it in Germany.

In the second procedure, an endoscopic lumbar decompression and fusion, Director Su used a reamer instead of a high-speed drill, which is more commonly used, to quickly remove soft tissue and the ligamentum flavum. Bone grafting under endoscopy was also smooth. Prof. Siepe spoke highly of Director Su's proficient surgical skills.

In the afternoon, Prof. Siepe and Prof. CHEN Bolai jointly conducted outpatient consultations, attending to over 20 patients. After thorough diagnostics, both professors provided consistent treatment recommendations, showing their seamless collaboration.

At 7:00 p.m., Prof. Siepe and Prof. Chen collaborated on a posterior decompression and anterior fusion for cervical stenosis under microscopy. Due to the narrow spinal canal of the patient, highly precise techniques were required. But with the two professors' fine skills, the surgery concluded smoothly.

Visit to Fangcun Hospital of Guangdong Provincial Hospital of TCM

On October 16th, Prof. Siepe visited the Spine Surgery Dept. of Fangcun Hospital, Guangdong Provincial Hospital of TCM. Prof. CHEN Bolai, Vice President of the hospital, Prof. CHEN Wenzhi, Director of the Spine Surgery Dept., and their team gave a warm welcome to Prof. Siepe.

Prof. Siepe expressed his honor at the third visit to the hospital for continued academic exchanges. He also hoped that Chinese surgeons would gain valuable insights and techniques from discussions.

Dr. YANG from the team gave an overview of Fangcun Hospital and its Spine Surgery Dept., and presented two lumbar disc herniation cases for discussion. Prof. Siepe recommended to only remove the sequestered disc, and noted that it is not always necessary to open the intervertebral disc so as to preserve the annulus fibrosus.

Recognition of Freehand Screw Placement

As returning to the main hospital on Dade Road, Prof. Siepe observed Director Su performing an anterior decompression and fusion for C4/5 and C5/6.

Prof. Siepe was particularly impressed by Director Su's freehand screw placing technique, achieving precise implantation without intraoperative X-ray image guidance. Following the procedure, the two experts also engaged in an in-depth discussion on freehand techniques.

After that, Prof. Siepe also observed a lumbar anesthesia injection and noticed that although the patient was put at a prone position during the surgery and the operating bed did not have any inclination, anesthetic agent would not flow cranially, ensuring no adverse effect on the patient's brain or breath. Prof. Siepe later commented on the advantages of lumbar anesthesia, and intended to introduce this technique back to his team in Munich for simple lumbar procedures.

World-Class Endoscopic Spine Surgery Lectures

As a world-class expert in endoscopic spine surgery, Prof. Siepe has been active in spine surgery conferences worldwide. For this academic exchange, he also prepared several lectures on endoscopic spine surgery.

In the morning of October 17th, Prof. Siepe began with a presentation for the MISS team, entitled "How to identify and recognize intraoperative challenges and complications". With images, radiographs, and surgical videos, Prof. Siepe illustrated detailed and essential techniques to manage intraoperative challenges and avoid postoperative complications.

He emphasized the importance of case selection for a surgery, preoperative planning, surgical approach, clear intraoperative view, and precise techniques to safeguard nerve roots, etc., all aimed at reducing complication rates. Following the lecture, Chinese colleagues engaged Prof. Siepe in extensive discussions on instrument use, achieving complete decompression, and whether to open the intervertebral disc.

In the afternoon, Prof. Siepe presented the second lecture, "Factors that influence the invasiveness of endoscopic spine surgery". He highlighted that "minimally invasive" entails not only smaller incisions but also reduced trauma to spinal structures. Then, Prof. Siepe listed factors affecting the invasiveness of endoscopy, including surgical approach, bone resection range, ligamentum flavum preservation, and effective instrument use (including the drill and bipolar coagulation). He advocated for using the surgeon's most familiar techniques to ensure optimal outcomes.

Director SU Guoyi subsequently joined Prof. Siepe in a discussion on the efficacy of uniportal coaxial large-channel endoscopic lumbar interbody fusion, with both experts sharing valuable insights.

Academic Salon at the Orthopedics Hospital of Guangdong Provincial Hospital of TCM

In the morning of October 18th, Prof. Siepe observed a posterior thoracic endoscopic decompression at T3/4 performed by Director LI Yongjin of the MISS Dept. The unique challenge of this case lay in the patient's congenital condition, possessing only 11 pairs of rib, making the thoracic T3/4 localization confusing.

Prof. Siepe shared that in such cases, his team uses a consensus-based "blind counting" strategy to ensure accurate segment localization. Despite the significant spinal canal narrowing at the T3/4 level, Director Li's meticulous technique enabled a smooth procedure, eventually concluding the surgery successfully.

In the afternoon, the Academic Salon of the Orthopedics Hospital of Guangdong Provincial Hospital of TCM commenced. Prof. Siepe delivered a lecture on "OLIF and ALIF Techniques". He detailed the procedures of OLIF and ALIF, and their advantages over posterior approaches, including less damage to surrounding tissues, larger fusion cage implantation, higher fusion rate, and improvements of coronal and sagittal alignment and stability of the spine.

Prof. Siepe's lecture was followed by a robust discussion with Directors LI Yongjin, WANG Yufeng, and other Chinese colleagues, focusing on lumbar foramen stenosis, artificial disc dislocations, etc.

At the close of the academic salon, Prof. Siepe expressed his satisfaction for this rich exchange. Despite it being his third visit already, he noted this trip's particularly high value. Prof. Siepe could see the open mind of Prof. CHEN Bolai and the entire MISS Dept. in adopting new techniques, which he believes fosters invaluable learning opportunities for young doctors. He also expressed his pleasure in sharing and learning from the Chinese colleagues and hopes to continue leveraging this exchange for mutual development.