Neurosurgeon explains how computers can make spine surgery safer

SINGAPORE - Dr Ernest Wang, 44, is a neurosurgeon at private clinic Neurosurgery Partners Brain + Spine Solutions at Mount Elizabeth Novena Specialist Centre.

As a fresh graduate from medical school in 1994, Dr Wang was so inspired by senior neurosurgeons at Tan Tock Seng Hospital (TTSH) that he chose to specialise in their field.

In 2001, he secured a two-year fellowship, sponsored by the Ministry of Health, to train with renowned neurosurgeon John Pickard at the Addenbrooke's Hospital in the University of Cambridge in Britain.

A second scholarship in 2008 took him to a very different place - Ganga Hospital in Coimbatore in South India - to train in spinal navigation surgery, which relies on computerisation to be more accurate.

On his return, he spearheaded the use of such surgery at the National Neuroscience Institute (NNI).  He also helped set up a spinal unit at TTSH that combines the expertise of neurosurgeons and orthopaedic surgeons.

He now divides his time between private and public practice. At NNI, he continues to treat patients, train neurosurgical residents and head the clinical trials section.  He also teaches students at the NUS-Duke Graduate Medical School and serves as the president of the Clinical Neuroscience Society.

He is married to a 42-year-old housewife. They have a 16-year-old son and a 14-year-old daughter.

I sub-specialise in spinal navigation surgery because...

It allows the surgeon to carry out complex operations at unseen distant sites more safely.

Surgical instruments are linked to a computer navigation interface - akin to a global positioning system - so that surgery can be planned and performed more accurately and incisions made smaller.

While such navigation techniques have been used widely in brain surgery for the last 15 years, they are now adapted to spine surgery, which translates to faster recovery and reduced risks during surgery.

The human brain and spine are fascinating because...

They comprise the central nervous system and are responsible for our entire make-up and our every movement, sense and thought.

When a nerve - which is thinner than a strand of hair - is dysfunctional, we cannot perform even simple things such as smiling, swallowing or speaking.

One little known fact about the spine is...

The spinal cord contains more than 13 million neurons (nerve cells), yet is approximately only the thickness of a human finger.

If I were to give an analogy for what I do, I would...

Be a big brother in a gongfu (Chinese martial art) clan. This is someone who is skilful, senior and trustworthy whom others will look up to, but is still willing to learn and improve.

A typical day for me...

Starts with dragging myself out of bed and making sure I take my son to school on time. I get to my workplace by 8am, but not before being stuck in the morning traffic and feeling frustrated.

The day gets better when I meet my patients and when I work on my first surgery of the day. It becomes a little more stressful if I have an emergency case.

I end work at about 6pm and sneak in a quick evening run before the best part of the day begins - spending time at home with my lovely family.

I have come across all types of cases...

The most common of which are spinal problems due to the wear and tear that comes with ageing.

The majority of my spine patients are in their 50s, but it is not uncommon for younger patients in their 20s and 30s to suffer from early degeneration of the spine.

Spinal cord growths and bleeding, though rare, can be sudden and debilitating. Some of these growths are incurable and there is sometimes little that doctors can do.

Being paralysed suddenly with one's mental functions still intact is devastating - I cannot imagine what some of my patients go through.

My heart goes out to those who are not only strong and motivated in such a crisis, but remain a great source of inspiration to others.

I love patients who are...

Trusting of our best intentions to help them get better. A healthy doctor-patient relationship is the cornerstone of good patient care. It is important that the doctor earns a patient's respect and trust and that the patient understands this.

Patients who get my goat are...

Those who are unreasonable, though this is very rare.

When this happens, I try to understand why the patient harbours such negative views and deal with the problem from his point of view as much as possible. For a start, I try to get to the root of the perceived unreasonable behaviour.

Things that put a smile on my face are...

Patients coming in with sudden paralysis but end up walking unaided out of the hospital.

For example, if there is a sudden large prolapsed intervertebral disc, a patient typically experiences severe back pain and weakness in the lower limbs and loses the ability to control the bladder and bowel.

If surgery is performed quickly enough to remove the prolapsed disc, there is a good chance of recovery, which may take a few weeks to months.

It breaks my heart when...

I see a spinal cord injury that did not have to happen.

Most severe spinal cord injuries are due to trauma - mostly from road traffic accidents. Many accidents are the result of thoughtless driving - speeding, recklessness or, simply, carelessness.

There are many traffic lights and turns, so we have to drive and ride more carefully. Not enough drivers realise this. Many accidents - and hence, spinal injuries - are preventable.

I would not trade places for the world because...

I am in a position to make a difference in people's lives. Not many people have this privilege and responsibility.

My best tip is...

Be happy and contented because those are the most important emotions in life, aren't they?

joanchew@sph.com.sg


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