Hee Kit Wong, professor of Orthopaedic Surgery, National University of Singapore, Singapore, is on the board of directors for the International Society for the Advancement of Spinal Surgery (ISASS) and was recently awarded the Singapore National Outstanding Clinician Award for his contribution to the development of spinal surgery in Singapore. He spoke to Spinal News International about his career and the need to accurately image pain.
Why did you choose a career in medicine and, in particular, why did you choose to specialise in orthopaedic surgery?
I was sick many times during my childhood and my parents were always taking me to see the family doctor. Therefore, after a while, being very impressed with the way they treated me, I became interested in becoming a doctor myself—perhaps, thinking, I could find out what was causing me to be sick; and I could treat myself!
My internship was in orthopaedics and I found that I liked it because it is very mechanically oriented. I found that I could translate what I saw on the X-ray into choosing the appropriate treatment. Perhaps, I like orthopaedics because I have an interest in the “human machine”.
Who were your mentors and what influence did they have on your career?
One of my mentors was my brother-in-law, Dr Lim Swee Lian, who is an orthopaedic surgeon, but he was not my brother-in-law at the time that he encouraged me to take up orthopaedic surgery! Professor Balasubramaniam was my mentor in spinal surgery. He guided me through my early years in spinal surgery, stressing the importance of discipline in patient evaluation and knowledge application, over just learning surgical technique.
During your career, what has been the most important development in spinal surgery?
The understanding of the pathologies in the spine and, more specifically, the biomechanics of the spine has enabled us to better treat patients. When I first started in spinal surgery, we did not have as good implant systems as we have now to allow us to reconstruct the spine. At that time, after spinal surgery, patients often had to receive “spinal nursing”—meaning that they had to be mobilised very carefully to avoid destabilising the spine and causing further injury. Now, only the odd patient will need “spinal nursing” because the patients’ spines are fully stabilised after surgery. Also, advances in pain medication have led to patients having much less pain than patients I treated in the past.
What are your current research interests?
We are developing advanced techniques of achieving spinal fusion and we have been looking at developing alternative growth factors. Additionally, we have been looking at using growth factors, such as bone morphogenetic protein (BMP), in a more controlled way. My current research interests include achieving fast, consistent spinal fusion without, or with much less of, the current complications that are seen today.
What research have you published in this area?
In the last two years, we have published a number of papers on the effect of lowering the dose of BMP in fusion and we have also published data on using a new carrier that can carry the growth factor much more efficiently what we call “ultra low dose”. So far, these studies have only been animal studies but we are planning, in the appropriate time, to do more research in humans.
What are the unanswered questions in spinal surgery?
How to achieve fusion with fewer complications is one unanswered question. Also, I think the ability to accurately image pain is a really important concept. All of the current X-rays, CT scans, or MRIs do not show us the source of the pain.
Using imaging, we look at structural changes in the spine and try to correlate these changes with the patient’s symptoms to see if they fit a certain pattern but we cannot exactly pinpoint what is causing the patient to be in pain we cannot “see” pain. Although pain may be non-specific or even psychosomatic in some individuals, in most patients, pain is caused by a specific source. I think technology will advance so that we will be able to accurate image pain. Maybe, one day, we could see pain represented as different colours—orange, blue, or red etc—and this would enable us to directly identify and treat the source of the pain. In fact, I am just doing some preliminary work at tagging proteins and peptides that have been shown to be related to the expression of pain. There are lot of hurdles to getting to stage where we are able to accurately image pain, but I think we will eventually have the technology.
What has been your most memorable case and why?
I have two cases. One was a young female patient, who was around 12 years old, with a recurrent tumour. The first surgery did not work and we discovered the tumour had spread to the adjacent vertebrae. This meant we had to remove three entire vertebrae, which involved a 23-hour complex surgery to reconstruct the spine. I just saw it as a technical challenge at that time, and worked through the night, but the interesting part has been watching the young woman grow up. There has been no tumour recurrence and she is doing well—she went to university and she is getting married this year. Actually, she has invited me to the wedding! It is nice to see patients do well without recurrence.
The second case is perhaps the most striking—I operated on my wife! I had to seek clearance for the operation from my hospital’s medical ethics committee, which involved several recommendations and processes. Fortunately, the operation went well. Perhaps the purpose of all of my years in spinal surgery was being able to help my wife!
You have won several awards during your career. Which one are you most proud of?
The one that I am most proud of is the one that I just received in 2012. It is the Singapore National Outstanding Clinical Award and it is recognition of my contribution to care of patients and the development of spinal surgery in Singapore.
What key advice would you give to someone who is starting a career in spinal surgery?
I would say that a person needs a lot of patience. In Singapore, becoming a spinal surgeon is a long process. The exposure to spinal surgery in our residency programme is just six months, barely enough to learn even the basics of spinal surgery. After completing residency, one literally has to start from scratch to train in spinal surgery. To succeed, you also need to have a good mentor and a passion in the subject.
You are on the board of directors for ISASS. What can we expect from this year’s meeting (3–5 April) in Vancouver?
This year’s meeting in Vancouver (Canada)will feature educational sessions on the latest spinal care options, non-invasive treatments, advancements in spinal research, new device technologies and the latest information on biologics and biomechanics. There will also be Case Study World Cafes featuring cervical disc herniation and lumbar spinal stenosis and spondylolisthesis. ISASS is very much surgeon oriented. Our annual meeting is a great opportunity for spinal surgeons to network and share knowledge with other spine surgeons from around the world. With our main focus on spinal surgery, they will have the opportunity to concentrate on their specialty without the distraction of other areas of spinal care.
As a member of several societies, how can being a member of a spinal society help your career?
You have access to a lot of information, which has been provided by fellow surgeons. Societies provide news about new developments in spinal surgery and provide information about future trends. They have resources that enable you to have a breadth of understanding about what is happening on an international level.
Outside of medicine, what are your hobbies and interests?
My interests are listening to my favourite music using audiophile quality equipment and building and tinkering with desktop computers. I have never bought any desktop computers, but have always assembled them myself!
- Professor of Orthopaedic Surgery, National University of Singapore, Singapore
- Head, Department of Orthopaedic Surgery, National University of Singapore, Singapore
- Chair, University Orthopaedics, Hand & Reconstructive Microsurgery Cluster, National University Health System, National University of Singapore, Singapore
- Head, University Spine Centre, University Orthopaedics, Hand & Reconstructive Microsurgery Cluster, National University Health System, National University of Singapore, Singapore
1988 Master of Orthopaedic Surgery, MCh (Orth), University of Liverpool (awarded the Liew Weng Chee Scholarship, NUS) (Awarded the Examiners’ Prize for Best Overall Results in the MCh(Orth) examination)
1986 NUS-JSPS Exchange Scholarship for Basic Research, Kobe, Japan
1984 Master of Surgery, M Med (Surgery), National University of Singapore
1984 Fellow of the Royal College of Physicians and Surgeons of Glasgow (FRCS, Glasgow) Part II, United Kingdom
1982 Fellow of the Royal Australian College of Surgeons (FRACS) Part I (Awarded the Howard-Eddey Medal for overall best candidate)
- Singapore Medical Association
- Singapore Orthopaedic Association (President 2006/2007)
- Asia Pacific Spine Society (formerly Spine Section of the Asia Pacific Orthopaedic Association), (Chairman 2008-2011)
- Pacific Asian Society for Minimally Invasive Spinal Surgery (Board Member)
- International Society for Advancement of Spinal Surgery (ISASS) (Board Member)
- National Outstanding Clinician Award 2012
- National University Health System Master Clinician Award 2011
- Outstanding Oral Paper Award: “Fusion Performance of a Bioresorbable Cage used in a Porcine Model of Anterior Lumbar Interbody Fusion”. The 13th International Conference on Biomedical Engineering (3–6 December 2008, Singapore)