Then and Now
The Division of Spine Surgery in the National University Hospital was established in 1987, soon after the relocation of the University Department of Orthopaedic Surgery from the Singapore General Hospital to the National University Hospital. The first head of the Division was Professor P Balasubramaniam. On his retirement in 1994, Assoc. Professor Aziz Nather took over as Head of the Division with Professor Wong Hee Kit subsequently replacing him in 1997.
Professor P Balasubramaniam
The Division was also an early adopter of innovative spine surgical techniques with the introduction of pedicle screw instrumentation (Roy-Camille system in 1989 and Cotrel-Dubosset system in 1990) replacing the traditional hook or wire systems for posterior spinal instrumentation.
1996 proved to be a watershed year for the Division of Spine Surgery. There were 4 major developments that year:
The National Scoliosis Screening Programme
Scoliosis is an abnormal curvature of the spine that occurs in up to 3% of schoolgoing children in Singapore (mainly girls). As a result of intiatives from spine surgeons in the University Department of Orthopaedic Surgery, routine examination for spinal deformity as part of the national school health screening program was introduced in Singapore in 1981. This groundbreaking program screens more than 150,000 students in local schools for spinal deformity each year with early intervention through bracing resulting in a significantly reduced incidence of severe deformities requiring surgery.
Prevalence studies by surgeons from the Division of Spine Surgery including Professort P Balasubramaniam & Assoc Professor JS Daruwalla (1982) and Professor HK Wong in 1997 were instrumental in determining the optimal age points for the nationwide scoliosis screening programme. Soon after this, in 1984, specialist Spine and Scoliosis clinics began operating at the School Health Service, initially sited at the Institute of Health and then the Health Promotion Board, both on Outram Road. In 2018, the Department began using microdose EOS radiographs for the assessment of adolescent scoliosis to further reduce the dosage of radiation received by these paediatric patients. The dose received in these radiographs is close to natural environmental background radiation.
In 2026, this screening programme will also be offered to students in the international schools in Singapore.
Schoolchildren being screened by nurses sent to the schools
In 2008, the University Spine Centre was established in Kent Ridge Wing in NUH. This Centre brought together surgeons, care coordinators, radiologist and physiotherapists to provide patient-centric and seamless care, driven by well-defined clinical pathway protocols.
The opening of the University Spine Centre on 17 June 2008
The Centre also acquired the first EOS scanner in Singapore. This unique radio-imaging system, based on Nobel prize-winning technology, allowed for whole body scanning using low dose X-rays and has become essential in the assessment of spinal deformities in adults and children.
The Centre is also a recognised regional base for hands-on surgical training in thoracoscopic spinal surgery, spinal deformity surgery, cervical spine surgery, vertebroplasty as well as artificial disc replacement. The first of these instructional courses was conducted in 1990. In coordination with the National Scoliosis Screening Programme, the Spine Centre provides thoracoscopic, non-fusion (spinal tether) and conventional options for the surgical management of scoliosis. It was the first in the nation to perform artificial disc replacements of the spine in 2002. It has also sought to stay at the forefront of new and emerging techniques including endoscopic and minimally invasive spine surgery. In 2016, the Centre performed the first robot-assisted spine surgery in Singapore.
Amongst other achievements, the Spine group introduced interval halo-gravity traction for the treatment of very severe scoliosis curves, the use of O-arm navigated surgery employing paediatric radiation doses, the use of 3D printing in planning for complex spine curvature correction, the use of microdose EOS X-rays for scoliosis assessment, the intra operative use of spinal cord ultrasound post decompression to assess the adequacy of neural decompression and the introduction of endoscopic spine surgery.
In 2024, the University Spine Centre evolved into the National University Spine Institute (NUSI) with an intentional and deeper collaboration between orthopaedic spine surgeons, neurosurgeons and rehabilitation physicians. The aim is to provide seamless patient-centric and evidence-based care.
NUSI utilises well-defined clinical pathways with strict audits to produce clinical outcomes which are benchmarked with the best centers across the world.
A thoracoscopic spine surgery workshop being conducted at the ASTC (Advanced Surgical Training Centre) in NUH
Endoscopic discectomy with the decompressed nerve root traversing from the 3 to 8 o’clock position. The annulotomy opening is visible at the 6 o’clock position
The acquisition of the O-arm, with its intraoperative CT and navigational capabilities, has added significantly to the safety and accuracy of spinal surgery in the Department
With the aging of the general population the National University Spine Institute has, seen a rise in the number of patients with complex spinal deformities requiring surgical correction
The National University Spine Institute has also been at the forefront regionally and globally in non-fusion, motion-sparing surgery for moderately severe flexible scoliosis curves in very young children. The X-rays on the left are of a 12 year old girl who underwent a thoracoscopic ScoliTether procedure and on the right of a 10 year old girl who had a MAGEC adjustable growing-rod procedure. Both post-operative X-rays were done 3 years post-procedure.
