Having National Fellowship
By Biswaranjan Nayak
Apollo Hospitals, Bhubaneswar, India

AOSpine Center:
Sakra World Hospital, Bangalore, India
Spine Director:
Satish Rudrappa

Assisting a case of minimal invasive TLIF

At the beginning of my report, I want to thank to the AOspine Asia Pacific group for supporting my clinical fellowship. It was one of the best experiences of my professional life, I learnt a lot, more than I was expecting, it helped me to increase my knowledge in spine surgery, in practical and theoretical field. This was a very useful and impressive experience.

I spent 8 weeks during 06 Aug 2018 to 28 Sep 2018 with Dr Satish Rudrappa, Sakra Hospital, Bangalore, India. During the fellowship, I observed many patients with various spine problems and their management. I improved my theoretical knowledge with attending the weekly clinical conferences presenting unusual cases.

I was involved in the clinical diagnosis of patients. I spent most of time with spine team, it was well- organized, highly qualified team. It was unforgettable for me to see the patients who were admitted in the hospital with sever disability and in a few days their disability getting minimal. It was very interesting for me when we had discussion about treatment strategies, and surgical approaches, about indications and contraindications. I attended many surgical procedures in OT. I want to thank to Dr. Satish Rudrappa for giving me chance to spend these eight weeks with him. He is very attentive and educated person. He kindly accepted my attendance at the department. I had an opportunity to attend his outpatients' consultations and ward rounds. After this we had an interesting discussion about patients' current conditions, diagnostic methods, treatments strategies. He was always delighted to give answers about my question. All these gave me a good experience.

Giving round with Dr Satish Rudrappa and team

In the OPD

Special thank also go to Dr Swaroop Gopal for his support and kind attitude to me. I was well received by him and he was trying to integrate me in all daily activities from first day to the end. His ward rounds are unforgettable for me, every day spent with him was a great opportunity to enrich my clinical and theoretical experience. I can say that he is a symbol of perfect doctor for me, he is a neurosurgeon with a great experience. I would like to thank all the doctors in Sakra World Hospital, specially Dr N Chandrashekar, all of them were very helpful and highly qualified. I am very proud to be a member of their team.

I consider that this fellowship was very important for me as a young spine surgeon. Particularly because of my interest in spine surgery, treatment strategies, I improved my abilities in this field.

Again, special thanks for supporting me. I am definitely a better spine surgeon than before. I hope this program continues supporting young spine surgeons to improve their knowledge and they will be able to implement new methods of treatments in their localities.

Practicing microsusurgery after daily routine work.

Having Regional Fellowship
By Richie Sorilla
Southern Philippines Medical Center, Davao City, Philippines

AOSpine Center:
Showa University Hospital, Tokyo, Japan
Spine Director:
Tomoaki Toyone

I am very fortunate to have been matched in Showa University Hospital for my 2-month AOSpine Fellowship. I was able to scrubbed-in with all daily elective spine surgeries and observed in out-patient consultations together with the Showa University Spine Team. Not only that they showered me with kindness and very warm hospitality, my Professors are all very generous to share their knowledge and expertise. They would walk me through with every inch of the management and every detail of each surgical procedure. They would politely answer all my queries with both eagerness and patience.

I have been exposed to the ideal setting of a Spine Center with all the technologies and expertise at Showa University Hospital. This will serve as my “barometer” from now on to continuously strive harder to work and provide the same ideal management and treatment for my patient when I go home. I can say that I gained a lot from this experience, increased my knowledge and improved my confidence in dealing with spine cases.

I was fortunate enough to regularly attend Spine Conferences and other meeting in Tokyo attended by other Japanese Spine Surgeons. I got the chance as well to rotate in Ebara Hospital. I was allowed to assist in Spine surgeries and learnt from Dr Yoichi Jin, the spine surgeon who developed the LSPSL technique. Most of the associate professors and residents tagged me along during parties and events, to show me around Tokyo and the Japanese way of life.

Special thanks to my mentors, Dr Tomoaki Toyone and Dr Kudo. Likewise to the rest of the Spine Team - Dr Hiroshi Maruyama, Dr Ryo Yamamura, Dr Akita Matsuoka and Dr Yusuke Dodo. Thank you very much!

I will continue to be an active member of AOSpine and to continuously engage with international collaborations with AOSpine community, not only to enhance the aspect of knowledge and skills but as well further improve sharing of evidence-based developments that help bridge the technical and academic gaps between institutions in different countries. Specific medical management and surgical treatment may vary from nation to nation due to certain limitations, of which health insurance and financial capacity of patients is the most important defining factor. Thus, variety of surgical options which were proven effective with evidence-based studies may now be applied to a certain institution to fill in the void brought about by the financial constraints.

I would like to introduce in my institution the concept of LSPSP (Lumbar Spine Process Splitting Laminectomy) which I learned significantly from this institution during my 2-month training. In our Department, our standard of practice for decompression of Spinal Stenosis in elderly is wide laminectomy with posterior instrumentation. This surgical technique will greatly benefit our patient since we can perform outright procedures without the need to wait for the time when the patient can finally be able to purchase the implants. We have a lesser elderly population in the Philippines as compared to Japan, but it’s only a matter of time when there would be a surge of older patients seeking medical or surgical treatment for spine problems. Hence, this learning will greatly impact the socio-economic aspect of the treatment of Spinal Stenosis among elderly patients in our institution.

I would also like to make a study on the Functional Outcome of LSPSL vs. conventional laminectomy in our local setting in the future.
Having International Fellowship
By Ryo Ugawa
Okayama University Hospital, Okayama, Japan

AOSpine Center:
Spinal Surgical Unit, Royal National Orthopaedic Hospital, Stanmore, United Kingdom
Spine Director:
Alexander Gibson

I had a great opportunity to spend 10 weeks at Royal National Orthopaedic Hospital (RNOH) as an AOSpine fellow under the guidance of Mr. Alexander Gibson. My fellowship was from 3 Sep to 9 Nov 2018. I am extremely pleased to write a report about the RNOH because I had many wonderful experiences and learned a lot there.

I attended daily morning MDT (Multi Disciplinary Team) conferences in which difficult and complex cases in wards or outpatient clinics were discussed to plan treatment strategies, both surgical and non-surgical. Various experts (spine surgeons, radiologists, pain anesthesiologist, etc.) attended and they had clinically and academically high-level discussions. The radiologists showed images of each cases smoothly and explained them clearly, so it was very helpful to understand them. I was extremely satisfied because I learned so many things at the MDT meetings.

In RNOH, there are ten spinal surgery consultants. They do spinal surgeries almost every day for a wide variety of spinal disorders: deformity, degenerative spine, infection, tumor, and various revision cases. At RNOH, cases of high deformity and many complex cases have been consulted from many places in the UK, and I was able to observe many surgeries that I had not often seen before. I was able to observe all consultants’ surgeries and learn from their specific skills and techniques. Moreover, I was able to scrub-in for several surgeries, which was helpful for me to understand and learn their detailed techniques. I was especially impressed by Mr. Gibson and Mr. Lehovsky’s multiple stage surgery for big curve scoliosis cases. In the first surgery they performed anterior release of intervertebral discs with thoracotomy and dynamically destabilized the spine. They taught me their technique to completely resect the discs and endplates from an anterior approach. In the final surgery they performed posterior fixation and inserted pedicle screws precisely and quickly. Their technique of posterior surgery for scoliosis was amazing and extremely quick.

I also observed at outpatient clinics. For scoliosis patients, the consultants indicated not only surgical treatment but also more conservative treatments like braces or physiotherapy and explained them patiently. In addition, I learned some of the differences in the medical system and situation between the UK and Japan (National Health Service, General Practitioner, etc.)

All consultants and their fellows were really kind and helpful to me, which made my fellowship more beneficial and enjoyable. Although my fellowship was only 10 weeks, I will make the most of what I have learned at the RNOH and never forget about this great experience. I would like to express my sincere thanks to all RNOH staff, especially to Mr. Gibson for his warm hospitality. Lastly, I would like to express my gratitude to AOSpine Asia Pacific staff for giving me this great opportunity and for their help and support.