Dr. Gordon W.D. Armstrong

Recipient of the CSS Lifetime Achievement Award for 2004

Gordon W.D. Armstrong gradutated in medicine from Queen’s University in 1947 and completed his residency in Toronto under the late Professor F.P. Dewar. He received further training in Great Britain under J.I.P. James and Sir Herbert Seddon. In 1953, Dr. Armstrong moved to Ottawa and began his career at the Ottawa Civic Hospital. He as a staff surgeon at the Children’s Hospital of Eastern Ontario from the time that it opened, and at the Crippled Children’s Treatment Centre, which he directed in the 1960s.

When he began his practice, in timehonoured orthopaedic tradition, as the newest recruit, Gordon inherited “the most interesting cases” — he was given the dreaded task of caring for those unfortunate patients suffering from scoliosis. At that time, spinal deformity was considered to be an utterly hopeless condition, and treatment was an exercise in
humiliation for the surgeon and frustration for patients. Usually, casting and in situ fusion were followed by bed rest for many months. There was a very high rate of failure, and the disease itself was poorly understood and often had a horrible outcome. To that point, use of implants for deformity was considered absolutely unacceptable.

When Paul Harrington introduced a newly designed rod, the initial response by the American orthopaedic community was hostile; indeed, his career was in jeopardy. Nonetheless, Dr. Armstrong immediately recognized the potential for revolutionizing care, and Harrington implants were used in 1963 in Ottawa, one of the first locations in Canada. Dr. Harrington would not allow anyone to use the instrumentation until they had been trained in its use, so in 1963, Gordon went to Minnesota and learned from Dr. John Moe to use the implant, as well as techniques of spinal exposure and fusion that he continued to use for the rest of his career. In addition to Dr. Moe’s encouragement, teaching and personal kindness, which have remained with Dr. Armstrong throughout his career, he was also influenced by Dr. Edward Simmons’ meticulous surgical techniques and outstanding organizational abilities, as well as by Dr. John Hall, from whom the Dwyer procedure was learned and perfected. Gordon and a few other young surgeons in Canada, notably Dr. Hall, took a particular interest in the scoliosis problem and ultimately met with a small group of likeminded surgeons from the U.S. The Scoliosis Research Society was founded in 1966, with Dr. Armstrong as one of its founding members, and he subsequently served as its President. In 1977, at an international
meeting of this Society in Japan and Hong Kong, he met the Late Professor Shunichi Inoue, a world leader
in orthopaedic surgery, who introduced him to Dr. Nobumasa Suzuki, who ultimately became Dr. Armstrong’s first Japanese Fellow.

Dr. Armstrong’s surgical skills were legendary. He treated patients with the utmost respect and dignity and continually sought to improve their lot through innovative and original research. Early on, a modified Milwaukee brace was made to afford more comfort. In addition, he wrote papers on scapholunate dissociation and a now popular calcaneal osteotomy. For more than two and a half decades, there was a continuous stream of research generated from his relationship with the National Research Council of Canada (NRC).

Devices such as a forcemeasuring tool for distraction of the spine during correction, a rod pusher — now widely used — and a unique rod bender were developed. Because of his original concepts regarding the nature of spinal deformity and its treatment, the Harrington rod was highly modified, and the first effective linkage between 2 spinal rods a “transverse loading device” was invented. Study of the 3dimensional effects of scoliosis deformity and its relation to clinical appearance and the first mass schoolscreening program in Canada led to a novel screening device: Moire topography. The latter ultimately led to a new international spinal research group.

Gordon’s ideas about deformity and its correction resulted in a more effective surgical technique (dual distraction) and fusion over fewer levels, and they were later incorporated into the design and development of new segmental systems. In the 1970’s, long before it was accepted as the standard of care, reliable spinal cord monitoring using an epidural catheter was developed and used routinely in Ottawa. There were even attempts to monitor bladder function intraoperatively. Spinal fractures were poorly understood, but from the enormous number of patients that he had, Dr. Armstrong and his fellows developed a morphologic classification, and one of his fellows, Dr. Francis Denis, developed a standard method for analyzing them.

Dr. Armstrong developed and effectively promoted new surgical techniques for treatment of spinal fractures. With the NRC, a new anterior spinal implant was invented: the Contoured Anterior Spinal Plate. Using an original surgical technique with combined anterior/posterior fusion with reduction instrumentation and decompression, Gordon treated a large number of patients with highgrade spondylolisthesis. He reported the associated sacral deformity and abnormal position in these. Because of his new observations about the deformity of the posterior elements, he successfully treated a large series of Scheuermann’s patients with posterioronly surgery using osteotomy and dual compression rods.

Dr. Armstrong was the first foreign surgeon to be awarded the Gold Medal of the Chinese Orthopaedic Association (Spinal Section) for his contributions to the development of spinal surgery in China. He was appointed Senior Medical Advisor by the Chinese government for the first Chinese rehabilitation centre, built in Beijing under the leadership of Deng Pufang, the son of the Chinese leader, Mr. Deng Xiaoping. Dr. Armstrong operated on Mr. Pufang in Ottawa in 1980 after he suffered a spinal cord injury resulting in paraplegia. The Disabled Persons’ Federation of China, chaired by this former patient, has dramatically improved treatment of the disabled in China. In 1981, Dr. Armstrong presented a number of lectures throughout several centers and operations in Beijing. This was followed by 3 more visits to China with equipment donated by the Canadian Government through CIDA. With this relationship, Dr. Armstrong initiated training for over 14 Chinese doctors in various specialties, including orthopaedics.

Dr.Armstrong trained many fellows and residents from around the world and encouraged many orthopaedic careers and research ideas. In addition, while President of the Canadian Orthopaedic Association in 198485, Dr. Armstrong established that association’s ethics committee and was its first chair. Through his tireless international efforts, Gordon Armstrong has helped to raise the profile of Canada as a leader in spinal research, and, as the 2001 citation granting him the Order of Canada states, “He improved the quality of life of people with spinal injuries”.

With the vast experiences and knowledge that Dr. Armstrong has passed along over the years, he reminisces in the following passage.

Reminiscences

Having reached the mandatory retirement age at my hospital of 65, it would seem to be an appropriate time for reflection and analysis of my years of surgical endeavor.

My interest in spinal surgery was first stimulated during my residency in Toronto by the late Professor R.I. Harris and his successor Professor F.P. Dewar (the latter having trained with Dr. John Cobb in New York), and by Dr. Ian Macnab who was engaged in low back pain research. Subsequently, while training at the Royal National Orthopaedic Hospital in London, England, where Sir Herbert Seddon and J.I.P. James were both doing spinal surgery, I learned the anterolateral (Capenar) approach to the spine for treatment of tuberculosis. Professor James had a large volume of scoliosis patients and was an excellent teacher, arousing my further interest in spinal deformities.

This background experience gave me confidence in the management of scoliosis patients when first starting practice in Ottawa in 1953. Scoliosis at that time was considered to be the “cancer” of orthopaedics. Polio was still a common condition, and during the late 1950s, I recall looking after some 55 paralytic cases in one year. This led to my first involvement with the National Research Council of Canada, with which I’ve had an ongoing relationship in various fields of research.

Some early work was carried out at this time modifying the Milwaukee brace using a plastic pelvic support with fluid pads in the iliac crest to prevent pressure sores. In 1958, the Dewar Orthopaedic Society was founded, with the first meeting taking place in Ottawa. Membership demanded the annual production of a paper to be read before an audience of fellow members, thus providing excellent encouragement to produce new material on a regular basis with the valuable addition of constructive criticism.

Since first coming to Ottawa, I have utilized Canada’s National Research Council (NRC) to develop ideas in relation to spine research. Expert engineering and technical help has been made freely available to me for which I’m very grateful.

The following were projects and developments:

• A Force measuring distracter tool and outrigger for Harrington instrumentation
• A transverse loading system for scoliosis surgery
• Research in spinal cord monitoring
• A machine for use in Moire topography
• A rod bending tool
• A contoured anterior spine plate

I am continuing to work at the NRC on a parttime basis. In 1976, 1 established a Fellowship Program in Spinal Surgery, which was accredited by, and received financial assistance from the L.L. Boyce Fund. Five Fellows from China were funded by CIDA. Former Fellows are as listed:

• Ian Adair, Belfast, N. Ireland
• Nobumasa Suzuki, Tokyo, Japan
• Francis Denis, Minneapolis, Minnesota
• Norman B. Livermore III, Walnut Creek, California
• Raul Marquez, Indianapolis, Indiana
• Jack Powell III, Noonan, Georgia
• Akira Shinoto, Tokyo, Japan
• Yuan-ming, Zhou, Shanghai China
• Glenn Trent, Greenville, South Carolina
• Vance Gardner, nine California
• Peter Sturm, Boston, Massachusetts
• Don Chow, Ottawa, Ontario

Fellows from Bejing China:

• Chibin Ye, PUMC Hospital
• Shiying Li, PUMC Hospital
• Kacang Rui, ‘U MC Hospital
• Guizing Qui, PUMC Hospital
• Hua Guan, China Centre for Rehabilitation and Research

In retrospect, it has been most gratifying to have trained Fellows from several countries and to count them as my close personal friends together with their families. My life has been truly enriched both academically and personally by these associations.

G.W.D. Armstrong