Two Decades of Orthopaedics in HKSH Modern Lifestyles and Cervical Spine Disorders

Dr. WU Wing Cheung, Stephen

Head, Department of Orthopaedics and Traumatology

Director, Orthopaedic & Sports Medicine Centre

Honorary Consultant in Orthopaedic Surgery

Specialist in Orthopaedics and Traumatology

Established in 2004, HKSH Orthopaedic & Sports Medicine Centre is the first and only orthopaedic and sports medicine specialty medical facility in Hong Kong’s private hospitals. Over the past two decades, we have kept pace with the times, assembling a strong multidisciplinary team to address patients’ evolving needs. In 2024, HKSH launched a new Spine Centre, marking a step toward further development of subspecialties. We are committed to comprehensively addressing patients’ diverse needs as well as providing more precise treatments and services.

The history of orthopaedics in Hong Kong mirrors the city’s social changes and medical advancements. In the post-war era, orthopaedics primarily dealt with a high volume of injury cases. During the 1960s and 1970s, rapid industrialisation led to a rise in workplace injuries among factory workers, and thus a pressing demand for hand surgery. As society grew more affluent, citizens became more concerned about long-term health and quality of life. And the specialty expanded beyond trauma care to focus on the treatment and prevention of chronic and degenerative conditions, including procedures like knee replacement surgery.

Two decades ago, cancer metastasis was often incurable despite surgery. In the past decade, breakthroughs in targeted therapy and immunotherapy have led to better outcomes, with many cases now being effectively managed or even curable. Comprehensive care provided by multidisciplinary teams with diagnosis, treatment, and rehabilitation also ensures holistic patient support.

A Miracle of Standing Again

One inspiring case involved a female colon cancer patient in her forties who was working overseas. The cancer had already spread throughout her body and compressed her spinal cord. In the absence of severe symptoms, she simply dismissed her condition until lower limb weakness prompted her urgent return to Hong Kong. Our medical team acted swiftly, and under our care the patient received spinal tumor resection, spinal cord decompression, and spinal fixation surgery, followed by chemotherapy for disease control. With the support of the physiotherapy team, the patient embarked on a challenging yet inspiring rehabilitation journey.

Acute Stage (1 month post-surgery):
The patient experienced lower limb paralysis, making her fully dependent on others. She could not even turn in bed. Physiotherapy included lower limbs stretching and mobility exercises helped maintain her joint mobility to prevent contracture; bed mobility training to improve physical function and prevent pressure sores; and basic muscle training, such as tilt table exercises with hard corset, to prepare for standing.

Mid-Term Stage (2-3 months post-surgery):
The patient’s muscle strength improved, allowing her to sit up with support and perform standing exercises with the assistance of two people. Bed mobility also improved. Physiotherapy focused on strengthening lower limbs and trunk muscles, with moderate functional activities to enhance sitting and standing balance. Gym training, corset, and VR games were used to optimise gait and build walking endurance, facilitating recovery of mobility.

The physiotherapy team maintained close communication with the patient’s orthopaedic and oncology specialists, adjusting rehabilitation exercises based on the cancer treatment plan.

Consolidation Stage (3+ months post-surgery):
The patient showed obvious improvement in muscle strength and endurance. She was able to regain independent bed mobility, and walk with a frame assisted by two people. Rehabilitation focused on preparing for home life and restoring high-level daily functioning. Key physiotherapy included advanced functional training, such as climbing stairs and getting in/out of a car; transitioning from frame to a quadripod for independent walking; cardiopulmonary exercises with cycling and cross trainer exercise to boost endurance and fitness; and balance and coordination training to enhance walking stability and confidence.

From suffering lower limb weakness to gradually regaining walking ability, the patient deeply appreciated the medical team’s expertise and dedication, which helped her achieve the seemingly unattainable goals. Thanks to the team’s encouragement, she was able to overcome the initial fear of fall after surgery. She also regained confidence in her body after consistent training. The whole rehabilitation journey exemplifies the power of multidisciplinary teamwork, and the team was profoundly moved by the patient’s resilience and positive attitude. This case also underscores modern medical progress: once incurable, the same condition could now be effectively managed with high-precision surgeries.

Trends and Health: Hidden Warning Signs of Cervical Spine Issues

As times change, so do lifestyles. In our fast-paced modern world, prolonged use of electronic devices, fitness trends, and more have a profoundly impact on cervical spine health. As a critical structure supporting the head, the cervical spine is prone to overexertion and degeneration when overworked for extended periods. Neck pain, a subtle warning sign, demands particular attention.

The Cervical Crisis of "Phubbers" and "Work-from-Home" Lifestyles

Today, smartphones are an indispensable part of modern life, with "phubbing" (lowering the head to use devices) now being a hallmark of daily routines. However, prolonged head-down postures while using electronics keep neck muscles in a constant state of tension, leading to muscle strain and weakness. This can affect the cervical spine’s joints and surrounding muscles over time, potentially causing degeneration, inflammation, or even bone spurs.

These issues are not exclusive to middle-aged or older adults. Many students, as a result of exposure to electronic devices from a young age, develop poor habits that manifest years later, and significantly increase the risk of cervical spine disorders. Additionally, the hustle of urban life often leads to inadequate rest, as most people underestimate the importance of adequate sleep for cervical health. Chronic overexertion of the cervical spine can result in pain or more severe complications.

Due to the "work-from-home" norm after the pandemic, suboptimal ergonomic setups and prolonged sitting also contribute to further cervical strain.

Cervical Degeneration and Herniated Disc Treatments

Cervical degeneration is becoming more common in our aging population. A 68-year-old patient, after a minor accident, experienced numbness in the hands and feet due to cervical degeneration. Examinations revealed multiple herniated discs compressing nerves, necessitating surgical intervention. Cervical degeneration often results from years of wear and tear, and can lead to paralysis if severe and not addressed early.

While exercise is vital for its health, improper techniques may harm the cervical spine. Due to long-term incorrect posture, a 43-year-old weightlifting enthusiast developed herniated discs at the C4/5 and C5/6 levels, compressing nerves and causing hand numbness and weakness. Since the patient’s father had undergone surgery for a similar issue with unsatisfactory results, artificial disc replacement was recommended instead.

Conventional treatment involves cervical fusion surgery, where the damaged disc is removed, and screws are used to fuse two vertebrae into one. However, this approach may limit cervical mobility and increase stress on adjacent vertebrae, increasing the risk of further degeneration.

Artificial disc replacement can preserve cervical mobility while addressing nerve compression. Thanks to advances in medical technology and materials, patients are now offered more and better treatment options.

To Maintain Cervical Spine Health

• Adequate rest: Sleep at least 7 to 8 hours a day.
• Proper use of device: Maintain an appropriate eye level when using electronics to avoid prolonged head-down postures and reduce neck strain.
• Ergonomic workspace: Use ergonomic equipment and ensure proper computer positioning.
• Early treatment: Seek medical attention promptly when symptoms like neck pain or numbness in the hands and feet occur.