Keith KD Luk converted his childhood love of handiwork into a medical degree and numerous fellowships, eventually specialising in spinal surgery. Over his career, he has researched, lectured and led societies around the world. His research in intervertebral disc transplantation—from conceiving the idea to his team’s performance of the first allograft transplantation into a human in 2000—is widely regarded as a pioneering non-fusion alternative, with the potential to preserve motion as well as adjacent segments. As well as his extensive research and teaching experience, Luk has also initiated one of the most successful scoliosis screening programmes for children in the world, involving all school children in Hong Kong. As he comes to the end of his 2016/2017 presidency of the International Society for the Study of the Lumbar Spine (ISLSS), he talks to Spinal News International about his career, about his current research interests, and about the future of spinal surgery.
How did you first get into orthopaedic surgery, and what was it that appealed to you about spine in particular?
Since I was a kid, I have always liked handiwork using tools. Gross anatomy was my favourite subject in medical school, and thus becoming a surgeon was a natural desire when I graduated.
Between the many surgical specialties, orthopaedics—at least I thought at that time—does not deal with too many life threatening pathologies, but rather focuses on improving quality of life which is as meaningful, if not more, as saving lives.
After my residency I honed down my interests to two subspecialties: hand and spine surgery. In fact I did my overseas fellowships in both, and I started off as a hand and microvascular surgeon. Soon I found that doing long hours of surgery under the microscope was not my cup of tea! Also, our department has a long tradition of being very strong in spine surgery, and so I could get the best training even without leaving home.
I decided to gradually switch to spine surgery four years later, and have been fully committed to spine work since 1990.
Who have been your career mentors and what wisdom have they imparted?
I have had many mentors at the different stages of my career. Professor GB Ong, a world expert in oesophageal cancer, impressed upon me that a surgeon is a physician who can operate. Professor Arthur Yau, the head of the Department of Orthopedics who recruited me, was the best technician I have ever met. In the late 1970s when we did not have the most sophisticated tools and implants, he could treat severe tuberculous spinal deformities with a hammer and chisel like a master carpenter.
Mr Douglas Lamb in Edinburgh was my mentor in hand surgery. His clinical examination skill could tell much more than the modern expensive investigations and imaging. Professor SP Chow taught me how to be a passionate doctor besides hand surgery. Professor JCY Leong was a good thinker and gave me the opportunity to develop my career in spine surgery.
There are too many other teachers from around the world that I have learned from to mention, but I am most grateful to them.
What has been your proudest career achievement so far, and why?
Over the years I have trained many residents and fellows from across the world. Many of them have become professors, competent spine surgeons or researchers.
They are the ones who will take this subspecialty forward to newer heights, above and beyond my modest achievements.
Please could you tell me a little about your scoliosis screening programme?
In 1995 I started a comprehensive scoliosis screening program for all school children in Hong Kong in collaboration with the Student Health Services of the Hong Kong Health Authority. A three tier referral system was used to improve the sensitivity and positive predictive value of the program.
Although it is not the first such program in Asia, it is to my knowledge the only comprehensive program that has proven to be sustainable, clinically effective, cost-efficient, and that has followed all children to skeletal maturity. We have published a series of papers since 2010.1
In a recent Position Statement by the American Academy our work was heavily cited.2 This has helped change the sentiment on the value of scoliosis screening worldwide.
What do you think has been the biggest development in spinal surgery during your career?
The biggest development I have witnessed in my 30-year career in spine surgery is the development of spinal instrumentation that enabled correction and stabilisation of severe spinal deformities. This was made possible through better understanding of biomechanics, advancements in material science and, more recently, biologics.
Motion preservation instead of spinal fusion should be the next goal.
You have been involved extensively with spine surgery research, publishing over 390 refereed articles and 30 book chapters. Which piece of research are you most proud of, and why?
In 1990 I conceived the idea of transplanting the intervertebral disc for the treatment of discogenic pathologies, borrowing the successful stories of kidney, heart, lung and cornea transplantations.
After 10 years of laboratory work and animal experiments, my team successfully performed the first allograft transplantation in a human in 2000. Our early result was published in the Lancet in 2007.3
To date, at the 20-year follow up, we are extremely pleased with the long-term result which is as good as—if not better—than artificial implants.
I am very proud of my team for bringing this innovative, pioneering idea into fruition through strong belief and persistence. We have also opened a new scope for future research in the understanding of intervertebral disc degeneration, regeneration and treatment of back pain.
What are your current main research interests?
I have four ongoing research directions at the moment:
- Intervertebral disc allograft transplantation
- Genetics of adolescent idiopathic scoliosis and congenital scoliosis
- Scoliosis population screening for children
- Functional magnetic resonance imaging of the spinal cord
Outside of your own work, what has been the most interesting paper that you have seen in the last 12 months?
The most interesting piece of research that I have come across over the past year is DT Grimes and colleagues work on the link between cerebrospinal fluid defects and spinal curvature in a zebrafish model.4
You have been a visiting professor at universities across Asia and North America. What have you found most valuable about these international appointments?
The most valuable part is the international friendship. Through these networks we can share knowledge and experiences, understand similarities and differences in diseases and healthcare systems, and identify deficiencies and needs across the world, so that we can contribute as global citizens.
What are the main challenges facing spinal surgeons today?
There are a number of challenges. For example, we are faced with too many market-driven, unproven technologies. Surgeons also tend to do more and think less.
As well as this, we perform too many spinal fusions without being mindful of the short- and long-term consequences.
You have worked with a number of spinal societies during your career, heading both SICOT and ISSLS. What are the most important things such societies can offer?
I have been involved for many years with national, regional and international spine societies with different missions. Some of these have focused mainly on scientific exchanges eg. the International Society for the Study of the Lumbar Spine (ISSLS).
Others, eg. the Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT), offered more opportunities for training of orthopaedic surgeons and world-wide sharing of resources between developed and less developed countries. The name of the project that I initiated during my presidency at the SICOT—‘Bridge-the-Gap’—says it all.
However, one thing in common amongst these societies is that they all succeeded in bringing like-minded people together from across the globe to advance the art and science of spinal surgery.
What have been your main aims for your term as ISSLS president, and where do you see the future of the society?
The ISSLS is a relatively small society with a limited and exclusive membership. Nevertheless, it is an excellent platform for interaction between basic scientists and clinicians interested in spinal pathologies. I would like to see it grow both in size and in management style so that it becomes more inclusive and sustainable in the long term.
What are the three topics in spinal surgery that still need investigation?
Three topics which need contiuned research are:
- The aetiology of intervertebral disc degeneration
- The genetic basis of scoliosis
- Regeneration of the injured spinal cord
What do you think will be the next big development over the coming years in spinal surgery?
What I would like to see is non-operative treatment for intervertebral disc degeneration. But, what is likely to happen in reality is an explosion on the market of non-fusion devices and technologies.
There are still many unknowns in spine pathologies waiting to be researched and explored. One should not become a technician but should be a physician who can operate.
What advice would you give to someone who was starting their career in spinal surgery?
I would advise them to think more and do only what is necessary.
Outside of spinal surgery and research, what are some of your hobbies and interests?
I enjoy travelling the world. And I try to play golf at least once a week as far as time allows. I also enjoy classical music though I don’t play any musical instruments.
After retirement, I plan to resume water-colour painting which I practiced for more than a decade until medical school.
Education and training
1977 Bachelor of Medicine and Bachelor of Surgery, University of Hong Kong, Pok Fu Lam, Hong Kong
1981 Fellowship, Royal College ofSurgeons, Edinburgh & Glasgow, UK
1984 Master of Orthopaedic Surgery, University of Liverpool, Liverpool, UK
1985 Fellowship, Royal Australasian College of Surgeons, Australia
1987 Fellowship, Hong Kong College of Orthopaedic Surgeons, Hong Kong
1993 Fellowship, Orthopaedic Surgery, Hong Kong Academy of Medicine, Hong Kong
Selected clinical appointments
1992–1994 Medical Director, The Duchess of Kent’s Children’s Hospital, Sandy Bay, Hong Kong
1992–1994 Hospital Executive, The Duchess of Kent’s Children’s Hospital
1996–2000 Professor (Reader), University of Hong Kong
1997–present Director, Center for Spinal Disorders, The Duchess of Kent’s Children’s Hospital
2000-2015 Chief, Division of Spine Surgery, University of Hong Kong
2000–present Chair Professor, University of Hong Kong
2003–2011 Cluster Chief of Service, Orthopaedics & Traumatology, Hong Kong West Cluster, Hong Kong
2003–2012 Chief of Service, Queen Mary Hospital, Pok Fu Lam, Hong Kong
2007–present Tam Sai-Kit Professor in Spine Surgery, University of Hong Kong
Selected society involvement
1993–1994 President, Hong Kong Orthopaedic Association
1999–2000 President, Hong Kong College of Orthopaedic Surgeons
2002–2008 Vice President, SICOT
2002–2011 National Delegate, SICOT
2004–2007 Chairman, Asia Pacific Board, AOSpine Chairman, East Asia Council, AOSpine
2011–2014 President-Elect, SICOT
2014–2016 President, SICOT
First Vice President, ISSLS
2016–2017 President, ISSLS
- Daniel YT Fong, Kenneth MC Cheung, Yat-Wa Wong, Yuen-Yin Wan, Chun-Fan Lee, Tsz-Ping Lam, Jack CY Cheng, Bobby KW Ng, Keith DK Luk. A population-based cohort study of 394,401 children followed for 10 years exhibits sustained effectiveness of scoliosis screening. The Spine Journal 2015; 15: 825-833
- American Association of Orthopaedic Surgeons. Position Statement: Screening for the Early Detection of Idiopathic Scoliosis in Adolescents 1984. Revised 2015.
- DK Ruan, Q He, Y Ding, LS Hou, JY Li, KDK Luk. Intervertebral disc transplantation in the treatment of degenerative spine disease: a preliminary study. Lancet 2007; 369:993-999
- DT Grimes, CW Boswell, NFC Morante, RM Henkelman, RD Burdine. Zebrafish models of idiopathic scoliosis link cerebrospinal fluid flow defects to spine curvature. Science June 2016; 352: 6291