For the "Backbone" of Human Beings: The Story behind the two National Science and Technology Progress Awards

Vertebral fractures caused by osteoporosis is considered as the "hidden killer" of the senior population; many patients would suffer from complications as a result of such fractures and it has been statistically demonstrated that if the fractures are not treated properly via surgery, the death rate could be as high as 49.4% for within four years. As China is entering into an aging society, more than 1.81 million patients of this category would be added each year, and the number is estimated to reach around 50 million in 2020.


Lead by Professor Yang Huilin, a team of experts in orthopedics of Soochow's First Affiliated Hospital have been working on this thorny issue for 17 years. On January 8th, the program of "Establishment and Application of Minimally Invasive Treatment System for Osteoporotic Vertebral Fractures" led the team was conferred the Second Prize of the National Science and Technology Progress Award. This was also the second time that the research team of orthopedics to have obtained this top-honored award in China, with the previous one achieved in 2004.



From a screw to an injection of "bone cement"


Human vertebral column, or the "backbone" of person, is like a moveable "skyscraper" for human beings; any problem with any "floor" of this "skyscraper" would lead to danger for the whole column. Thus, any illness of the vertebral must be fixed effectively to ensure the stableness of the column, which decides whether a person can stand up or not.


In the 1980s, Professor Yang Huilin, following Professor Tang Tiansi, his supervisor and also a leader in spinal surgery in China, found best solution for fixing the "floors" of vertebral column at that time — the technique of internal fixation through pedicle of vertebral arch of posterior spine, which was then applied in clinic and acknowledged as a "milestone in Chinese spine surgical studies". This technique has been a key solution in spine surgeries in the past 30 years and was honored with the Second Prize of National Science and Technology Progress Award in 2004.


However, in the aging society, more and more vertebral fractures are caused by osteoporosis, which cannot be fixed using this screw-based technique. "It is as if the 'floor' itself is problematic and a screw cannot fix it at all", as Yang explains. Many aged patients with severe osteoporosis would fracture simply because of a sneeze of a cough; and such fractures may not be sensed by the patients themselves or their family members; they go to the hospital just because of the inconvenience caused by long-term pains, without any awareness of the fractures.


Therefore, since the beginning of the new century, Yang Huilin and his orthopedics team have been focusing on the technology of kyphonplasty, which is a cutting-edge minimally invasive surgical technique in international orthopedics studies. Kyphoplasty means a series of medical spinal procedures in which "bone cement" is injected through a small hole in the skin into a fractured vertebra with the goal of relieving back pain caused by vertebral compression fractures. It is not only quickly effective but also minimally invasive so that most of the patients can stand up and walk the very day after the surgery.


Nevertheless, vertebral column is entwined by ligaments, blood vessels and nerves so that any slight imprecision would result in serious problems. Meanwhile, although the surgery is minimally invasive, any inaccuracy of the injection or the osmosis of the bone cement may cause damage to the spinal cord or even lead to pulmonary embolism, which can potentially result in paralysis or even death.


Hence, headed by Yang Huilin, the team of orthopedics spent more than ten years studying the issue and finally brought up new concepts and criteria for the treatment, such as "vertebral sections responsible for pains" and "non-connection of bones"; they also developed new techniques like "bone cement-bone anchor" so that potentials of spinal cord damage and pulmonary embolism can be avoided, which largely improves the applicability of kyphonplasty. These findings have changed the understandings about vertebral fractures caused by osteoporosis and enabled integrative diagnosis and treatment for patients. The new technology has been applied widely in China and proved effective in clinic, which has been highly appreciated and valued by peers both home and abroad.


Professor Hansen A. Yuan, a globally reputed expert in spine surgery and also the former Executive Chair of the North American Spine Society, tags Yang's findings as "Suzhou Theory"; and as he states, "the 'Suzhou Theory' has made remarkable contributions to the development and promotion of the minimally invasive treatments for osteoporotic vertebral fractures".




Patients should be prioritized and the devil is in the details


 "We cannot be too careful when examining the patients and not a single detail should be ignored, which is similar to solving criminal cases", Yang often repeats this to his students. He also advocates that precise treatment is based on precise diagnosis and the devil is in the details. Yang would communicate with the doctors in the Imaging Department and examine the details carefully in order to find out the causes of the diseases. It is with such meticulousness that Yang and his team have solved numerous difficult cases and saved countless patients.


Such priority given to the patients manifests the philosophy of medicine that has been passed on from Professor Dong Tianhua and Profess Tang Tiansi. "Human bodies cannot be treated as objects for experiments; surgeries much be successful and should not be conducted without assurance; serving the patients wholeheartedly is the tradition of the Department of Orthopedics of the First Affiliated Hospital". Yang remembers clearly that during the years when information and technology were limited, Profess Tang Tiansi would discuss with the doctors in the department and ask them to outreach for literature in libraries in Suzhou and Shanghai. Professor Tang also contacted his relative working in Shanghai Library to find sources for the doctors. Moreover, due to the varied shapes of bones and fractures, it was often difficult to find proper materials to be implanted for fixing; to solve the problem, Yang and his colleagues had to travel to other cities to look for factories or partners that can produce the materials for them.


As Yang states, "we must evaluate the plan for the treatment carefully and how much risk will the patient take when we are treating the patients; we should always do what is the best for the patients". And he fits his deeds to these words. Yang had a patient who fractured repeatedly due to osteoporosis; after he was recovered and left the hospital, Yang keeps in touch with him and reminds him constantly about how to treat osteoporosis and how to live a healthy lifestyle.


According to Yang himself, it has been a long yet rewarding journey to win the National Science and Technology Progress Award again, "the achievement results from the hard work of generations of researchers in the team of orthopedics; it is a great honor as well as an acknowledgement; but the most important thing for me is that award can further promote the new treatment systems for osteoporotic vertebral fractures and enhance the public awareness of health, so as to benefit all the human beings".



Pass on the spirit, stand higher, and see the farther


"National Advanced Worker", one of the first young scientists of "333 Project" of Jiangsu Province… Yang has achieved countless compliments since starting his career as a doctor. For him, how to pass on the philosophy and further develop the studies of orthopedics is his top concern as a leader of the department.


However busy he is, Yang always prepares carefully for every lecture and he also highly emphasizes the application of theory into practices; he is good at explaining the theories in the textbooks with practical examples. For 30 years or so, Yang's students are working all over China and many of them are now key figures in their work places.


For himself, Yang is habituated to reading international journal to update his knowledge during his leisure time. When he comes to a new technique or a new concept, he would share and discuss it with his colleagues. The young fellows admire Yang very much and they all agree that even though in his 50s, "Yang is faster and better than us in understanding new ideas".


"How high we stand determines what we can see and how we think determines what we can achieve", Yang often repeats this statement. He has invited many internationally reputed experts in orthopedics to lecture and model in Suzhou. He also encourages young doctors and students to further their study in famous institutes abroad. With his effort, the Institute of Orthopedics has been established to recruit experts in biology, material sciences, and mechanics. Another important of achievement of Yang is that in 2011, an international orthopedic ward was established through collaboration between the Orthopedics Department of the First Affiliated Hospital and the International Spinal and Osteoarthritis Institute of the United States, through which top experts in areas such as spinal surgery and sports medicine are invited to give outpatient services, surgeries and lectures regularly. This has not only made it possible for the patients to receive international-standardized treatments locally, but also enhances the development of an orthopedics team with both expertise and ethics.


As Yang states, "the progresses in medicine must be made with new technologies and new tools; it is only through constant learning that new achievements can be made." The next target for Yang and his fellow team members is to further develop the material of bone cement and incorporate artificial intelligence in their research and clinic practices, which is surely prospective and promising.