Hans-Joachim Wilke from Ulm, Germany, current president of Eurospine, told Spinal News International how driving around with the chief of emergency physicians roused his interest in medicine, and how when he joined a biomechanics lab, he quickly realised that the field of spine research was still predominantly a white sheet of paper.
How did you become interested in medicine? Why the spine?
Actually, I always wanted to become an engineer. In Germany, after graduation from high school and before you enter university, you have to do military service or civil service. I decided to do my service in a hospital, where I became fascinated with medicine. I was so interested in each discipline that I often stayed after work or came back to the hospital in the evenings or weekends, where I spent hours in the different departments. So I soon made friends with the physician Dr Udo Stirner of the cardiology department, who was also the chief of the emergency physicians. I found it extremely exciting to join him when he was on duty and to accompany him in the emergency physician’s vehicle. I then had to decide whether to become an engineer or whether to go to med-school.
I finally decided to become a mechanical engineer, but was never completely satisfied. So, I continued to join my friend in the emergency vehicle, while I was studying in the engineering school at the University of Stuttgart.
I was wondering how I would be able to combine both interests, engineering and medicine, until I finally found out about biomechanics, which was still quite new in that time but an ideal combination of both.
What are your main interests in spine research?
My area of interest is basic research and the translation of answers into clinical application. The spine is so complex that we still have a lot to do in order to get a better understanding of this organ. We are beginning to understand more about the loading of the spine, and gain a better understanding about the differences in the kinematics in the various regions of the spine. However, we still do not understand enough of what happens if the different spinal structures are altered due to degeneration and aging processes, injuries, or deformities. In order to better understand the mechanical consequences, we also have to know more about the biology and what is causing these changes. This knowledge is a prerequisite if we want to develop new strategies for the treatment of the patient, either with implants or with biological approaches, to stimulate a regenerative potential.
Who has inspired you in your career, and what advice of theirs do you remember even today?
I was lucky to get a position in the biomechanics lab of professor Lutz Claes, one of the leading biomechanical engineers in the world. Although his main focus was fracture healing and biomaterials, my first project was about the loading of the spine. Coming from an engineering background, I could hardly believe that we knew so little about such fundamental principles, which are so essential for the understanding of a structure, like the spine and its treatment.
In my first project, I had to determine the load in the lumbar spine during different activities. The idea was to instrument an external fixator with strain gauges to measure the deformation of the screws and use these data to calculate the load of the spinal column, which was responsible for this deformation.
Through this project I met professor Fritz Magerl, who was the chairman of the orthopaedic department in St. Gallen in Switzerland. I was very proud to be able to work with him because he was one of the most innovative pioneers in spine surgery and he was famous for his fracture classification system of spinal fractures. More importantly, he was so interested in our work that we used to spend sleepless nights discussing the results. His friendly character was extremely motivating. Through these discussions I learned so much about the open questions and about many unproven hypotheses. I soon realised this field of spine research is still predominantly a white sheet of paper.
Another important person in my career was professor Manohar Panjabi, the godfather of spine biomechanics at the Yale University in New Haven. While I was working on my PhD thesis, I had the honour to visit him for a while. Then, of course, professor Alf Nachemson, was the pioneer investigating the loading of the spine and one of the best spine researchers ever. He influenced my research a lot. And last but not least, I would not have been able to develop my own profile if professor Lutz Claes, my boss and mentor over more than 20 years, had not allowed me to follow my own research interests whenever I wished.
Could you identify some current exciting developments in the treatment of the spine?
Although the indications are not quite clear yet, surgical procedures, which preserve the motion in the spinal segments are extremely exciting. The three-dimensional complexity of the spinal segment, which is different in each region of the spine is so challenging, that it will keep us busy for many more years. There is still a long way to go before we have “perfect” mechanical discs or semi-rigid fixation systems available. Parallel solutions for disc regeneration, either with nucleus implants or suitable cell therapies, are even more ambitious because they combine both mechanical and biological challenges.
What is the most interesting paper you have come across recently?
New surgical methods, particularly using new types of implants should be tested before using them in patients. Many such preclinical evaluations can be done with mechanical or biomechanical studies. Sometimes however pre-clinical tests also involve animal experiments. But, of course, this can cause a dilemma because animal models may not be appropriate. Differences in anatomy between the various species and in loading of the spine between bipeds and quadrupeds can lead to differences in biomechanical properties. There are also known differences between species in spinal biology, e.g. cell populations and tissue composition. Moreover human spines of interest are mature or even elderly; animal models are usually immature. These differences can all influence outcomes when using animal models.
In order to discuss these issues a workshop was organised where leading scientists studying animal models elucidated the value and the limitations of such animal models. The output of this workshop was a comprehensive review article, which discusses the factors, which should be considered when using animal models for studying disc disorders or degeneration. Alini M, Eisenstein SM, Ito K, Little C, Kettler AA, Masuda K, Melrose J, Ralphs J, Stokes I, Wilke HJ. (2008) Are animal models useful for studying human disc disorders/degeneration? Eur Spine J 17:2-19. I do recommend this paper because I hope that this paper will provide a path for avoiding meaningless animal experiments. If we want to justify the use of animals in spinal research, it is our responsibility not to waste research capacity, manpower and finance and, most importantly, not to sacrifice animals in vain.
What have you achieved as the President of Eurospine this year?
It is not the president who achieves a lot in a one year, it’s the executive committee with the administrative secretary and the active members of the society! I personally was very lucky because I had great support from the Eurospine Foundation.
We have accomplished a big step in the Educational Committee under the chairmanship of professor Finn Christensen specifying and improving education to obtain the Eurospine diploma.
A complete course with a five-module structure has been implemented to provide a consistent and standardised basic knowledge on spine treatment to young orthopaedics and neurosurgeons, to obtain a final SSE Spine Specialist Diploma.
The Tango registry keeps on growing every year and now represents the largest international surgical spine registry, with overseas modules in the USA, South America and Asia-Pacific. More and more national societies are interested in joining the registry, sometimes organised on a national level ready with special contracts to share the data internationally.
The aims of EuroSpine, The Spine Society of Europe, are to stimulate the exchange of knowledge and ideas in the field of research, prevention and treatment of spine diseases and related problems, and to coordinate efforts undertaken in European countries for further development in this field. Many members of our society spend a lot of time supporting all these activities reported above. In order to make these commitments more efficient, we need a professional organisation. Therefore we launched the EuroSpine Foundation and we are happy that we were able to appoint Gerard Vanacker as CEO of our foundation, with the secretariat located in Lausanne in Switzerland. Currently his main task is to professionally support all the organisations of the Educational Committee, Spine Tango, Health Technology Assessment, and a Research Task Force.
Why did you set-up the Grammer award and what is its importance?
Through this award, the European Spine Journal intends to encourage more basic science research in the field of spinal disorders. In contrast to other awards, it aims to reward the entire process of publishing a paper, which often strong self-discipline, starting with the idea for the study, and securing support for employees and supplies, through to the planning and performing of the experiment and the evaluation of the data. Finally, writing up the work and presenting the message in a clear and concise form, and with appropriate graphics/figures/tables, demands many further hours. After submitting the paper, it has to be defended against criticism from at least three reviewers, not infrequently resulting in major revision of the paper. This usually leads to an improved paper, but again, it requires patience and endurance. Unfortunately, there is currently a trend to split larger studies into “tiny publishable units” so that authors can produce a higher number of papers.
The idea of this award, therefore, is to recognise each year, one group of scientists for this huge amount of work and for the completeness of their presentation of an outstanding project.
Very often the basic science disciplines have to perform their studies with limited resources. Salaries – especially for young scientists – are often very meagre. This award attempts to acknowledge their enthusiasm and idealism.
What are your interests outside of medicine?
I am interested in many things: in all areas of sciences (physics, biology, engineering, photography, and of course, medicine). I used to do a lot of “do it yourself”. My outdoor hobbies are skiing and hiking. Unfortunately, I do not have much time at the moment so really the most important thing is spending time with my family.
Education and professional background
2009 Vice-director, Institute of Orthopaedic Research and Biomechanics, University of Ulm
2002–present Professor at the University of Ulm
Since 1998 Head of Spine Research Group
1996 Privat-Dozent (equivalent to associate professor)
1993 Dr biol hum (PhD) in human biology with biomechanical engineering emphasis, University of Ulm
1986 Diplom-Ingenieur (equivalent to MSc) in mechanical engineering at the University of Stuttgart with specialisation in biomedical engineering
Since 2009 President of the Spine Society of Europe
Since 2009 Scientific representative of the International Society for the Study of the Lumbar Spine (ISSLS)
2007–2008 President of the German Spine Society
1997–2007 General Secretary of the German Spine Society
Since 1999 Founder and Chairman of the Committee of the GRAMMER European Spine Journal Award (worldwide largest award for spine research)
Since 2001 Deputy Editor of the European Spine Journal responsible for basic research
2006–2008 Member at Large of the Executive Committee of the Spine Society of Europe
1998 Best Poster Award of the International Society for the Study of the Lumbar Spine
2003 ISSLS Prize of the International Society for the Study of the Lumbar Spine
2005 Poster Award of the German Society of Biomechanics
2005 Merckle Research Award (prestigious award of the University of Ulm)
2008 Founder prize of the State Baden-Württemberg (3. Prize) for the spin off Company SpineServ GmbH & Co KG
A total of 23 prizes (14 times as senior author)
- 160 original peer reviewed articles
- Book editor for 6 books
- 38 Book chapters
Membership in societies (selected)
- Spine Society of Europe
- European Society for Biomechanics
- European Society for Biomaterials
- European Orthopaedic Research Society
- International Society for the Study of the Lumbar Spine
- International Society for Biomechanics
- Spine Arthroplasty Society