The AAMISMS/MISU China 2007 course began Friday, March 30, with a live surgical session at the California Spine Institute Medical Center in Thousand Oaks, California. Posterolateral endoscopic lumbar discectomy as well as translaminar paramedian endoscopic approach to the L5-S1 disc for decompression were performed. The afternoon didactic session included lectures by John C. Chiu, MD DSc, Lawrence Rothstein, MD and Merrill W. Reuter, MD PhD. The keynote lecture by Charles Ray, MD was “Percutaneous Radiofrequency Nerve Blocks: A Surgeon's Perspective.” Pictured below are Drs. John Chiu (left) and Charles Ray.

Before preparing to go to the LAX airport for the flight to China Friday night, the group had a splendid time at the Ronald Reagan Library and Museum. We toured Air Force One and had a BBQ style dinner while being entertained by Norman who played the accordion. Most enjoyable was the after dinner walk along the expansive lawn where President Reagan is buried. This was a site in similar concept to the Ming Tombs we saw a week later in China.

We had over 75 people in our group flying out of LAX. Seven participants traveled from Portugal, Israel, Russia and Hong Kong to meet up with us in Shanghai. Our midnight flight on China Air was long but exciting. Simply being on the plane started the cultural experience. China is situated in east Asia and is the third largest country in area in the world but holds the world's largest population - over one billion people or about 20 per cent of the world's population. As one of the oldest countries, it has a rich history spanning thousands of years. Most of the citizens live in the eastern part of the country where the large cities are and the farming is sustainable. Agriculture is the primary economic force and over half of all workers are farmers. The Communist Party took over the government in 1949 and remains in control today. In recent years the government has loosened control of the economy and allowed more free enterprise. China is now a global economic force where many citizens have improved their impoverished lives but many still live a simple agrarian life.

We arrived in Beijing on Sunday morning, April 1, local time. Clearing Customs in Beijing was very organized and the immediate flight to Shanghai was relatively easy. The bus ride to the hotel was like riding from any large metropolitan airport to downtown; JFK to Manhattan, BWI to Washington DC, O'Hare to Chicago. The only difference is that Shanghai is twice the population of New York City. As you can see from the picture above, the city of Shanghai seems endless.

The Jin Jiang Hotel was a wonderful place to stay with clean and comfortable rooms. The hotel was opened in 1929 and has had many dignitaries stay there, including President Richard Nixon in 1972. The upscale accommodations included extensive daily breakfast buffet; from custom omelets to rice porridge to chicken lo mein. Chinese, American and even European items were available. The hotel was located between Changle and Hui Hai Roads. Hui Hai Road was abuzz with high fashion shops and large high-end department stores, yet there were plenty of locals encouraging you to follow them to better deals on the side streets.

Changle Road was the site of the famous Shanghai Acrobats which we were lucky to see on Sunday evening. They really were an exciting and mesmerizing troop with unbelievable talent and skill. Their years of training are evident as feats of controlled contortion, balance and strength are displayed over and over again throughout their magnificent performances.

Our visit to Rui Jing Hospital on Monday morning, which is affiliated with Shanghai Jaio Tong University Medical School, was eye opening. The hospital had cutting edge features like a state-of the-art conference center with table and chairs, which was not to be outdone by any large corporate boardroom. There were airport-like LCD displays in the outpatient center that identified who was next to be seen. They were juxtaposed with 6 to 10 open bed inpatient wards that had patient beds sprawled in the hallways with decor reminiscent of large teaching hospitals of the 1950's and 60's. Spinal fusion and disc replacement surgery is available, but the patients are responsible financially for the implantable devices. For example, a cervical fusion plate and screw system would be about $2,000 U.S., which is approaching the annual income of a rural family. Surprisingly, the implants are all imported. No 'knock-off' industry for medical hardware was evident - or at least disclosed.

After lunch we visited the Yu Yuan Gardens, a classical Chinese garden featuring many pavilions and ponds, including a 9 zig zag bridge. Next we took a short ride on the High Speed train, called the Maglev train (magnetic levitation transport) which maneuvers by electromagnetic force. The train was thrilling and fast as it can travel up to 268 MPH! This is the first ever high-speed train in China and the only operational one in the world.

A formal dinner was held on Monday evening at Beckingham Hall at the Jin Jiang Hotel Shanghai. Among the “Honored Guests” were officials of the Chinese Government Health Department and the Presidents of the Shanghai Jaio Tong University Medical School and Rui Jing Hospital where we visited earlier in the afternoon. It was evident they were committed to education and staying current with medical technology.

On Tuesday morning we had a breakfast scientific session where lectures were presented. It was an impressive group of speakers from across the United States and the world.

In the afternoon we made a trip to The Bund, a famous street and waterfront in China, where major firms of the far east were headquartered. We even took a short cruise on the Huang Pu River. This too, is reminiscent of the many industrial waterways of metropolitan cities throughout the world. Most exciting was Paul Allen's Octopus, a magnificent royal blue and white yacht docked along the river bank, thought to be owned by this software tycoon.

We also toured the famous TV tower, also called the Oriental Pearl. This magnificent tower is 1,536 feet high - the world's third tallest TV and radio tower. The entire area was impressive with its seemingly endless skyline of tall buildings, which were all distinct, no two being the same.

This active and fun-filled day was completed by our dinner at the famous Lu Bo Lang restaurant featuring Shanghai cuisine. The restaurant has hosted many heads of state, including President and Mrs. Clinton.

Wednesday morning began with our second breakfast scientific session in China. Again, we were presented with lectures and had time for questions and answers. The ability to have high quality meetings in an informal setting was a real asset of this trip to China.

Some of the group joined the Shanghai Jewish Center in the celebration of Passover. This was an exciting experience as well. It confirmed for the group that a Seder is very similar no matter where you are in the world. The chicken soup with Chinese noodles is what made it special.

The rest of day was spent touring more of what Shanghai had to offer. We were simply amazed at the impressive collection of art, coins, furniture and other relics at the Shanghai Museum. There was an impressive collection of ceramic pottery dating back to the Neolithic period (7000 to 5800 BC). The calligraphy section chronicled the ancient Chinese writing art form from it's beginning in the Shang Dynasty (1776 to 1050 BC). On display was a chronological order highlighting the calligraphic masterpieces of the different Dynasties. The bronze section featured over 400 pieces from the Xia Dynasty (2070 to 1600 BC) through the Warring States Dynasty (475 to 221 BC). Ever since the Shang and Zhou Dynasties, bronze pieces have been important treasures, symbolizing ancient China's cultural heritage and civilization. Of special note, many in our group noticed Henry Kissinger being escorted into a private area of the Museum. It was not until the next morning that the newspaper reported Mr. Kissinger's visit to Beijing earlier on Wednesday. It felt good to have such an international activity level, made us feel like we were on the right track visiting Shanghai and Beijing.

We then toured Nanjing Road. Here we found a bustling upscale shopping area with modern “Times Square” style lighting and signage. Also, Shanghai's most famous department store, No. 1 Department Store, which opened in 1934, has all the typical items; clothing, shoes, children's wear, gifts, books, watches, toys, jewelry, cosmetics, house wares, sporting equipment, and electronic goods. The store has renown and volume, but not necessarily the best prices. Just down the street was an east/west retail pharmacy. Here you could find everything similar to a U.S. pharmacy with prescription and over the counter drugs available. But in an equally clean and organized fashion, many under glass, herbal and animal preparations were also available by prescription and over the counter.

We shared a special dinner in Shanghai on our last night there. Four full days in Shanghai was not enough to see everything but we were grateful to get a glimpse of the past history and present culture of the Chinese people. Just being in such a large city was in and of itself cultural, but being in this foreign metropolis added to the travel mystique.

The flight to Beijing was quick and easy on Thursday morning. Upon our arrival we departed for the Great Wall at the Badaling Section and Ming Tombs, with the Spirit Way. What an amazing site. Climbing the Great Wall, along with many dutiful Chinese, really gives a sense of grandeur that can barely be articulated sufficiently. Badaling – in Chinese - means “easily accessible from all directions”. Simple, yet profound. This area of China is also known for magnificent jade sculptures.

The Badaling section of the wall is northwest of Beijing in Yanqing County. The function of this section of the Great Wall was to protect Juyongguan Pass in the Jundu Mountains. This section has been visited by 130 million tourists from China and abroad. The Badaling section of the Great Wall was made using huge stones. The inside of the walls are comprised of mud and stone block. The top floor was made smooth by using square bricks. Fire signal platforms were used in ancient times to send warning signals of encroaching enemies, using the number of fires to signify how many men were approaching.

The Ming Tombs, with its unbelievably large and ornately designed statues along Spirit Way, was on nearly equal grandeur as the Great Wall. Built during the Ming Dynasty back in the 1400's, it is located 50 Km north of Beijing. Thirteen of the Ming Dynasty Emperors are buried in this area. It was interesting to picture long processions to commemorate fallen Emperors that would stretch the distance from the Forbidden City to the Spirit Way and then to the gates of the Ming Tombs. The Spirit Way was lined with huge statues of animals, fictitious creatures and human figures, essentially marking the journey to the next world, or protecting the Tombs from harm. The individual Tombs themselves would hold prized items of the Emperor including concubines. The expansive mountainside vista of these Tombs was also likened to the Reagan resting site, an interesting parallel.

Back in Beijing, we had a sumptuous dinner at Dong Lai Shun Restaurant. That was followed by a high spirited Peking Opera Show. The show is best described as burlesque, Chinese style. There was singing, dancing, magic, physical comedy, martial arts, balancing, juggling, and even hand shadow puppets. It was truly family style entertainment in a relaxed, table-service environment.

We began Friday with the Multi-disciplinary symposium which was well received by the participants. The round table discussion is a vital part of teaching and learning the latest MISS techniques. In the late morning we toured the Temple of Heaven. Constructed in 1420 during the Ming Dynasty, it was created to offer sacrifices to Heaven.

After lunch we made a trip to the Guang An Men Hospital of Chinese Medicine. This hospital focuses on traditional Chinese medicine including herbs and acupuncture. This is a modern big city hospital physical plant. The directory at the main entrance posts departments such as Traditional Chinese Medicine (TCM), Center for Cancer Treatment and TCM Center for Cardiovascular Diseases. We were greeted in a modern auditorium with multimedia presentation highlighting the facets of TCM. Services include acupuncture, herbal preparations, exercise rehab and massage often referred to as Qigong and Tai Chi. It was here that we were exposed to hospital style TCM pharmacy. This was a busy pharmacy. Workers collected varied ingredients, using scales to assess quantity, to fill the herbal prescription. Patients would then boil the prescribed ingredients and drink the “tea.” This treatment would often last one to two weeks and if not successful, a referral to a western clinic would be made. In cases where western medicine was unsuccessful, a return to the TCM clinic was often sought. It was very interesting to see dried reptiles, insects and plants dispensed in plastic bags from what could easily be the pick-up window of any large metropolitan hospital in the U.S.

After our visit to the hospital we went to the Summer Palace. In 1998 UNESCO listed the Summer Palace as a World Heritage Site. This archetypal Chinese garden is considered one of the most classical gardens in the world. It was constructed during the Jin Dynasty (1115-1234). It went on to provide royal families with a splendid garden for rest and entertainment. This escape for royalty was adorned with a long covered walkway replete with magnificent paintings at each support structure. Also, there was a marble boat, just for show. It sat in the water looking like it floats, but it doesn't, yet it served to entertain the easily sea sick Empress Dowager Cixi. In the evening we had a fabulous farewell dinner at the famous Peking Duck Restaurant.

Saturday was our last day as a group in China. In the morning we set off to see Tiananmen Square and the Forbidden City. Tiananmen Square is the largest open space in an urban location in the world. In 1989 it was the site of protests which ended in violence by the government. This event is not discussed to any degree by the tour guides since the tour guides are an arm of the government.

The Forbidden City, also called the Forbidden Palace, is located in the center of the ancient city of Beijing. It was the Imperial Palace during the Ming and Qing Dynasties. In 1987 it was declared a world heritage site landmark and ordered to be preserved for the people of China and the world. It has 800 buildings and over 8,000 rooms and is the largest collection of preserved ancient wooden structures in the world. The grounds are directly south of the Tiananmen Square open area and are accessed through the Tiananmen Gate.

These gaits and open area are not only examples of the grandeur of imperial China but also serve as representatives of the war-like nature of existence at the time. The gates are structured so that approaching enemies can be observed and attacked. A significant defensive position is easily obtained based on the architecture and lay of the land. Also in the Forbidden City are numerous examples of imperial life such as rooms set aside for concubines and theatrical areas to entertain the emperor and his close associates. Further emphasizing the defensive nature is the fact that the Forbidden City sits on nearly 17 feet of stone to prevent entrance from tunnel diggers. The visit to the Forbidden City certainly represents a highlight of the trip and especially characterizes the advancements of the time in the dedication to an imperial way of life that is remarkably preserved.

The afternoon was then devoted to last minute shopping before our early dinner and rush to the airport. The flight home was again long but most slept and were well rested upon arrival in Los Angeles. Saying goodbye to new and old friends at the airport was only temporary since we look forward to seeing each other at the next course, a combined meeting in Hawaii in June of 2008. See you there - more education, more camaraderie, and more lifelong memories.

This was truly an once-in-a-lifetime trip because it was combined with expert MISS surgeons and a world-class travel experience in one of the oldest cultures in the world. Learning about the latest medical technology and the oldest of cultures was indeed unique and a highlight of our lives.