Operation Straight Spine Activities Report 2012
Spine Education and Research Foundation
Activities Report of Operation Straight Spine
Kolkata, India
Jeff McConnell, MD
Submitted 2/26/2012
16 FEB 2012
US team consisting of Jeff McConnell, MD, Holly Tavianini, RN, Johanna Zeigler, CST, and Dan Welsh arrive in Kolkata from New York (via Dubai, UAE) on Emirates Airlines at 19:15. They are accompanied by Mike Tacca, Patrick Gooing, and Niko Wiesnet, who are filming the activities of Operation Straight Spine. Team is met by Dr. Debnath at the airport and we travel to the Tollygunge Club where the team will stay for the coming week.
17 FEB 2012
Ramakrishna Mission Hospital: We conduct a clinic to see patients. Several patients we had operated upon previously. All were doing well. Saw two year old boy with fibular hemimelia and a congenital scoliosis due to hemivertebra. Agreed we would list patient for surgery. Made rounds on the wards to see patients already admitted for planned surgeries. These included several young children with congenital scoliosis. One 6 year old boy with Neurofibromatosis and severe, progressive, thoracic kyphoscoliosis. X-rays from 2010 showed significant, dysplastic type approx 60 degree curve. New chest x-ray shows curve has siginificantly progressed to approx 100 degrees. He is the most worrisome case as his respiratory function is already compromised.
Sorted out equipment in the store room including the many boxes of implants and instruments shipped to RKMSP by Globus Medical from Audobon, PA via Chennai. Discovered one of the eleven boxes of supplies that I sent from the US has not arrived. It contains antiseptic skin preparation solution. Told by the monk in the front office said that it could not be shipped by air from New Deli because it contained liquids and must be shipped via ground. Hopefully it will arrive in the next day or two.
With as much sorting work that could be done that day we returned to the Tollygunge club to prepare for the evening’s events. Drs Debnath, McConnell and Cacciola and the entire team from the US and UK were being honored by the Rotary Club International of Kolkata for their work through Operation Straight Spine. We were all given a bouquet of flowers and a plaque recognizing our contributions to the local community. This was proceeded by a series of speeches from Uttam Ganguli, President of the Rotary Club, Swami Satyadevananda, from RMSP and Brojen Gogoi, Director of TaTa Medical Center and others including a talk on the history of Operation Straight Spine by Dr. Debnath.
Following the formalities of the meeting we were pleased to be entertained by the most amazing dance troupe from the Hope Foundation. The Hope Foundation is an Irish based charity that cares for the orphaned and indigent street kids of Kolkata and have a number homes and schools where they care for these children. The foundation is where we transferred Juli Sharma whom we had operated on in March 2009 for a tuberculous abcess in the cervical spine causing bone destruction and partial paralysis. Juli recovered well and cured her TB under the care of the Hope Foundation. Juli was also now a member of the dance troupe that entertained us that evening. The troupe performed a series of theme-based dances and wore the most colorful costumes. There were about 30 girls and boys who performed and it was very special to see Juli happy, healthy and well looked after. Juli agreed to be interviewed by the film crew as part of the documentary about OSS.
18 FEB 2012
Traveled to the Fortis Hospital to perform a first surgery on Bulu Mitra, a 51 year old woman. She had been operated upon 6 months earlier for spinal stenosis and and leg pain. Initially she did well but then developed recurrent left leg pain and the inability to work or stand without severe pain. She had developed advanced degenerative disease and a spondylolisthesis at L4-5. Lacking the funds for another surgery we agreed to take up her cause and perform the surgery which consisted of left sided L4-5 decompression with combined TLIF fusion, placement of 9 x 28mm PEEK interbody cage and pedicle screw stabilization at L4-5. Surgery went well with minimal blood loss.
In the afternoon Dr. Debnath and I participated in a seminar on Low back pain and Degenerative Spondylolisthesis for local physicians and sponsored by the Fortis Hospital. I gave a lecture on the surgical management of degenerative spondylolisthesis with spinal stenosis.
That evening the entire team was invited to the home of Anil Bhargava, a prominent businessman in Kolkata for drinks and a delicious meal. His lovely wife, Ritu, had arranged for a gentleman by the name of Gautam Ghosh to accompany the film crew and act as an interpreter for the film crew for their interviews. He is an extremely pleasant and knowledgeable gentleman. He is normally an academic and a freelance writer. The film crew was extremely delighted to have his services. Caroline Davies, Marion Barry and Rachel Hunt arrive from the UK.
19 FEB 2012
Mostly a rest day. The team split up to do various activities with some visiting Mother Theresa’s orphanage. The film crew went to do interviews with witnesses and survivors of the AMRI Hospital fire disaster which happened a month earlier. Tragically, 90 people died in the disaster, most of them patients.
Dr. Debnath, Neena Seth and I return to RKMSP and make rounds to do patient assessments. We are all concerned about the six year old with Neurofibromatosis and whether he can withstand the operation and especially if post-op ITU care will be adequate given that he will likely need prolonged intubation. We also see a 16 year old girl with paraparesis and inability to ambulate due to tuberculous abcess and vertebral destruction at L2. We agree she will need surgery and she is added to the list.
It is the 175th birthday celebration of Sri Sri Ramakrishna so it is a holiday at the RMSP. The whole place is decorated and very colorful with many flowers adorning the courtyard area. There is a large picture of Swami Vivekanada, disciple of Ramkrishna, set among the floral display in the courtyard. A special luncheon is served for all the staff and the OSS team participates. Some of the team found it challenging to eat the rice, dal and fish with their bare hands.
Dr. Debnath and I travel to the TaTa Medical Center Cancer Hospital and given a personal tour by Dr. Gogoi. It is a brand new facility built by the charitable trust of the TaTa company. The facility has state-of –the-art laboratory and diagnostic radiological services and operating theatres. Returned to Tollygunge Club and invited to dinner and outdoor music show after club sponsored golf tournament.
20 FEB 2012
First day of full operations at RKMSP. We got started very late in the morning. The anesthetists had to spend quite a bit of time in the morning gathering all their supplies from the store room and establishing a home base in OT #6. Finally got our first patient in the room around 11:30 AM. Debleena Sengupta is a 12 year old girl with a Lenke Type 5 primary left lumbar scoliosis. Pre-op her curve measures 50 degrees from T11 to L4 and the compensatory right thoracic curve measures 46 degrees. Tough getting started with the case. Typical problems occur like the suction machine does not work and the Bovie machine is incompatible with our hand piece. Neuromonitoring equipment is not working properly so we did the whole case without the security of monitoring. Despite the equipment glitches the case went well and she was fused from T11 to L3 with all pedicle screw construct. Was able to derotate the spine to a degree and an excellent correction was achieved.
We had planned to do a second scoliosis case but because we started so late with our first case we decided it was best to postpone the second case until the next day. Dinner at local Bengali restaurant.
21 FEB 2012
Second full day of surgeries. Day started late due to some technical issues with the anaesthesia machine. The electrical wiring in the room is very old and therefore prone to power surges. The anaesthesia machine is sensitive and will shut off when a surge occurs and then has to be rebooted. Christine Reiber , neuromonitoring specialist informs us that she has sorted out the issues with neuromonitoring equipment. Apparently one of the boxes was overheating causing the machine to suddenly stop working. It’s a relief to know that is working.
Caroline Davies and Neena Seth, our anaesthesilogists from the UK, make another assessment of the young boy with neurofibromatosis and severe, dysplastic scoliosis. With reluctance and great sadness we elect to not perform surgery on the boy. It is simply too risky for the boy from a pulmonary standpoint. Even if the boy survived the surgery he would require prolonged ventilator support and intense aftercare which would be extremely difficult to provide at the RMSP. Caroline informs the boy’s mother of the decision. She tells Caroline that she would rather see him die soon then to see his childhood robbed and watch him die slowly. We all know the boy will eventually die from his condition and it difficult to leave him to this fate.
First case was a 14 year old boy, Hemant Kumar with severe right thoracic scoliosis of 55 degrees. The curve was very stiff. His surgery consisted of posterior fusion and instrumentation from T3 to L1. We had to utilize a lot of hooks in the case due to the fact that his pedicles were very small. The small pedicles, especially around the apex of the curve made it very difficult to place screws for fixation. The hooks made it more difficult to get good curve correction, but we achieved our primary goals of arresting curve progression and restoring better truncal balance.
Our second case was Rupam Pal, a four year old boy with severe congenital scoliosis of the lumbar spine involving multiple vertebral anomalies including an ipsilateral bar and contralateral hemivertebra. He had significant pelvic obliquity complicated by leg length discrepancy. Our goal is to improve alignment, especially kyphosis of the lumbar spine, and arrest growth on the convexity via a hemivertebrectomy at the L3 level. We stabilized the spine with cervical lateral mass screws and 3.5mm rod.
We did not complete our day until 9:30 PM. Go back to the hotel at 10:30PM and had a meal of take-out Chinese food.
22 FEB 2012
First and only case for the day is Bipasa Majumdar, a 15 year old girl with a 95 degree right thoracic scoliosis. She presented the year before to have her operation performed however she had a chest infection and so the team decided to cancel the case. Her scoliosis had progressed over the ensuing months. The curve was very stiff, correcting very little on side bending X-ray. The case was difficult especially getting fixation points around the apex of the curve. To aid correction of the curve we performed Ponte osteotomies from T5 to T9 and concave rib osteotomies at four or five levels. Instrumentation extended from T2 through L2 including three titanium sublaminar cables at the apex of the curve in order to help translation or the spine. The cable had to be purchased from Synthes for 25,000 Rs. The case was a bit stressful due to the fact neuromonitoring was never adequate. Christine, the neuromonitoring specialist was unable to get adequate signals from the lower extremities form the start. She thought that the child may have been getting too much propofol (which is normally used in conjunction with fentanyl) and the signals were greatly suppressed. Overall we were satisfied with the operation given the circumstances and we estimate correction was about 50%.
23 FEB 2012
It is formally Ramakrishana’s birthday and RMSP is mostly shut down due to the holiday. We are allowed to have two operating theatres for the day so we booked three cases. Got started a bit late once again due to a variety of problems.
The first case is Quadra Ritam Mitra, a 3 year old boy with multiple congenital anomalies including left fibular hemimelia, mild hydrocephalus, absent kidney, hypospadius, T11 hemivertebra, T10 butterfly vertebrae and semi-segmented hemivertebra at T9. The vertebral anomalies cause a 66 degree kyphoscoliosis. Surgery consisted of T11 hemivertebrectomy and instrumentation with Protex CT cervical screws and rods from T9 to T12 plus fusion. Surgery worked well but the boy had to be reintubated later in the day due to respiratory problems.
The second case was Dolan Naskar, a 15 year old girl with thoracolumbar scoliosis of 45 degrees from T10 to L3. The curve is treated by Drs Debnath and Cacciola with all-screw construct T10 to L3 resulting in excellent curve correction.
Third case is Neil Lama, a six year old boy with congenital right thoracic scoliosis, absent ribs on the right hemithorax, L1-2 syrinx and a tethered spinal cord at L3. It is elected to perform convex fusion at the apex of the curve and placement of “growing” rod construct with cervical lateral mass screws and 3.7mm rod at T10 and T11 and hook claw over the third rib on the left.
Finished in the OR at 9:30 PM and the whole team is exhausted.
24 FEB 2012
Our last day of surgery. The final patient is a 16 year-old girl Sandeepa Biswas who has been in the hospital for 6 weeks suffering with tuberculosis of the spine. She originally developed a febrile illness and malaise but was misdiagnosed by her village doctors. Eventually she came to RMSP where she was diagnosed with TB and during that time she went “off her legs” and was unable to ambulate due to weakness in the legs and pain in her back. X-rays and MRI revealed destruction of the L2 vertebrae with circumferential abcess, kyphosis and compression of the thecal sac. There is also involvement of the T12 vertebrae on the right but no collapse or canal involvement. Surgery involved a dual approach with a posterior approach with reduction of kyphosis, fusion and instrumentation from T11 to L3. The anterior approach involved and drainage of abcess, L2 corpectomy, decompression and placement of a titanium expandable cage from L1 to L3.
We pack up our supplies and return them to the store room. The team is beginning to gather in the courtyard so that we can get in our cars and go back to the Tollygunge Club. The father of the 3 year old boy from yesterday’s sugery approaches me to ask for an update on his condition. The boy had some breathing problems the first night post-op and had to be reintubated. As I am speaking with the father, Marian comes running through the courtyard shouting that the “child has arrested, emergency!” We all run back into the hospital, but must first stop at the store room to get a paediatric ambu bag and oxygen tubing which is not available in the (adult) ICU. Marian and Holly run up the 5 flights of steps to reach the ICU. Caroline Davies, our paediatric anaesthesiologist tells us what had happened. Sandeepa was fully awake and breathing but then she apparently chewed on her ET tube, causing it to kink, and shut off the airway. Her oxygen saturation levels quickly dropped and she went into respiratory arrest. Luckily, Caroline and the orthopaedic resident were in the ICU checking up on one of our other patients when the event occurred and were able to intervene quickly. After reintubating the patient, administering fluid and a unit of blood her condition stabilizes.
25 FEB 2012
Wrap up day. Dr. Debnath and I go to the Fortis hospital and discharge the woman with the L4-5 TLIF procedure. We return to RMSP and meet up with the rest of the team in the ICU. Sandipa is doing very well and she is now extubated and complains about her NG tube. The 3 year-old boy pulled out his ET tube and his bladder catheter. Dr. Davies fears he may have aspirated. The chest x-ray doesn’t look too bad. Dr. Davies suctions the ET tube and, all things considered, he appears relatively stable. We sign out the 3-year-old boy to the attending paediatrician at RMSP who will care for the boy after we leave.
The OSS team completes ward rounds on all the remaining patients and all are doing quite well. The team returns to the hotel to finish packing after which we travel to Dr. Debnath’s mother prepares us a wonderful send-off lunch. We are sad to leave but glad to be going home.
Home » Activities Report » 2010
2010
Activities Report of Operation Straight Spine
Ramakrishna Mission Seva Pratishtan Kolkata, India
January 01-15, 2010
January 1st:
The US contingent of the OSS team departs from JFK airport, New York at 16:00 on Air India. Team members consist of; spine surgeon Jeff McConnell, MD; Lehigh Valley Hospital Neuroscience unit head nurse, Holly Tavianini, RN; surgical scrub nurse from St. Luke’s Hospital, Marion DeMillio, RN ; neuromonitoring specialist, Ms. Hillary LeClair; and Globus Medical representative, Mr. Larry Nelson.
January 2nd:
Connecting flight from New Delhi to Kolkata is delayed for four hours due to severe fog in Delhi (not an uncommon occurrence this time of year).
January 3rd:
Finally arrive at Kolkata airport at 01:15. All baggage accounted for and clearance through Immigration and customs with no difficulty. Our party is met by Bitu Debnath (sister of Dr. Ujjwal Debnath), her friend and drivers for transport to Oberoi Hotel. Two vehicles are required to transport the team and all their bags. A small glitch occurs on the way to the hotel when one car is stopped by Kolkata Police at a make-shift road block. This is presumably a random stop for police to extort money for most trivial (and often contrived) infraction of the rules. It turns out our driver has an invalid driver’s license. A prime opportunity for the police to take advantage of the situation, but after some negotiating and the “fine” of 4,000 Rs is paid we are happily on our way again.
We check into the Oberoi Grande Hotel around 02:30. No one is particularly tired due to the time change and the fact most us slept on the plane. So we stay up and chat about the excitement of being in India and the challenges facing us over the coming weeks. For two of the team members, it is their first time in India. Most finally go to bed around 05:30.
The team meets for Sunday brunch around 11:15. Two vehicles and Dr. Ujjwal Debnath arrive at the hotel to transport the team to the Ramakrishna Mission Hospital. We begin sorting through boxes of supplies in the store room to gather enough consumables for the planned surgical cases on Monday. As was the case last year, our 13 boxes of fresh supplies shipped from the US are held up at the customs office. Thankfully we had enough supplies in the store room left-over from last year to get us through the first few cases. The boxes were caked in a layer of dust so we had to do a little house-cleaning as well. We also learn that the Globus spine instruments and implants have not yet arrived in Kolkata – again an issue with the customs office. Mr. Nelson frantically works the phone, talking with the Globus India team to find out when the implants might be available. We located our general and spine surgical instrument sets and had them divided into two trays, wrapped and sent to the autoclave to prepare for the surgeries on Monday.
We are all a bit nervous not knowing if we will have implants for the cases tomorrow, but with little else to do, we head back to the hotel. We all hope and pray things work out.
The area immediately surrounding the hotel is a large market district so the team ventures out for a little shopping. The streets and the market are clogged with people. We negotiate our way across the busy intersection to Eliot Park, an expansive area of open ground in an otherwise congested city. We walk past fields crowded with people playing cricket and soccer to the other end of the Park to the Victoria Monument. Kolkata used to be the capital of India under British rule and the Victoria Monument was built in honor of Queen Victoria’s 50 years on the thrown. It is a magnificent marble building with a towering white dome at the center. A ticket was required to enter the Monument but since the que was so long for tickets we abandoned the idea. We took a taxi back to the hotel as it was a rather long walk and jet lag was catching up.
We ate dinner at the Thai restaurant in the hotel. The team members from the UK finally arrive at the hotel around 20:30 after also being delayed by the Delhi fog. The four team members from the Guys and Thomas Hospital in London include anaesthetists Drs. Neena Seth and Caroline Davies, operating theatre Sister Marian Barry, and anaesthesia technician Sister Jane Holley. We exchange greetings and the new team members get to know each other over drinks at the pub.
January 4th
We ate breakfast at 0800 and got the disappointing news that our 13 boxes are still in customs and that the Globus equipment will not arrive today. Mr. Nelson makes arrangements with local Globus vendor to bring implants from local inventory for our one instrumented case in the afternoon.
Dr. Debnath and Dr. McConnell attend spinal clinic to screen potential surgical candidates and see follow-up cases. One patient is a follow-up from March 2009 mission trip. Ankita Panja is a 3-year old girl who came to us very ill with tuberculosis of the spine. She could not walk. She was losing weight . TB had destroyed the 11th and 12th thoracic vertebrae and the MRI showed a large epidural abcess extending to L1 with extraspinal abcess involving both psoas muscles. We operated front and back, draining the abcesses and stabilizing the spine with cervical spine instrumentation and rib grafts. Her follow-up showed her to be neurologically normal, happy, healthy and thriving with a stable, straight spine fused from T9 to L2. Great to see her!.
By the time the team gets organized and enough supplies put together, we did not start our first case in the Operating Theatre until after 12:00.
Case #1: 40 year old man with back and right greater than left leg pain. Diagnosed with right L3-4 disc herniation and L4-5 spinal stenosis. Surgery consists of L4-5 decompression and L3-4 hemilaminotomy and discectomy on the right.
Case#2: 55 year old female with a L4-5 lytic spondylolisthesis, bilateral foraminal stenosis and right greater than left leg pain. Procedure consists of decompressive laminectomy, TLIF with 7mm PEEK cage and ProTex pedicle screws and rods.
Team finally finishes in the OT at 20:30 and everyone returns to hotel for late dinner.
January 5th
The boxes of supplies from the U.S. are still not available. Luckily we have enough supplies from last year to get through the day.
Case #3: 60 year old female with two level spndylolysis at L3 and L4 with grade-2, L4-5 spondylolisthesis and spinal stenosis. Congenital fusion of L5-S1. Surgery consists of L4-5 TLIF with PEEK cage, posterior fusion and instrumentation L3 to L5.
Case #4: 12 year old boy with congenital lumbar kyphoscoliosis due to left L3 hemivertebra. Surgery performed with posterior excision of L3 hemivertebra and posterior fusion with instrumentation L2 to L4.
Our second day in surgery again concludes late at 20:30. Back to hotel for well deserved rest.
January 6th
We have an unanticipated day off due to a holiday observed by the Ramakrishna Mission. It is apparently the birthday of the hospital founder’s wife. The team takes the opportunity to locate one of our patients who had surgery during our trip in 2009.
Julie Sharma was a 9 year old girl who presented to the OSS team in extreme pain and unable to walk with severe weakness in her arms and legs. She was suffering from tuberculosis of the cervical spine. Julie’s social situation was equally dire. Her mother was dead, her father, an unemployed farmer, could not afford to care for her and gave her up to a family to work as a house servant. On admission to the hospital her x-rays and MRI revealed destruction of several cervical vertebrae, kyphosis of the neck, epidural abcess with spinal cord compression and a large pre-spinal, retropharyngeal abcess. Her spine was stabilized posteriorly with lateral mass screws and rods from C2 through C6 followed by anterior drainage of the retropharyngeal abcess, evacuation of the epidural abcess, decompression of the spinal cord, multi-level cervical corpectomy and reconstruction with fibular autograft. Postoperatively she did well, but follow-up was short. The entire team knew Julie’s long-term survival would depend on her receiving appropriate medical treatment with 18 months of 4-drug chemotherapy to eradicate the tuberculosis. She remained at the mission hospital approximately three weeks and arrangements were made for her continue care through the HOPE Foundation, Ireland.
On Wednesday morning the OSS team drove to the headquarters of the HOPE Foundation in Kolkata. There we met the director, got a tour and saw some of the small children being cared for in a day program. We thought we would see Julie there but were informed she was actually living in an all-girls home on the other side of town. We returned to the RKMSP hospital and made rounds on the surgical patients from Monday and Tuesday.
After lunch we returned to the HOPE Foundation and were escorted across town to the group home where Julie Sharma was living. It was a 4-story home, a very clean and safe facility housing 60 girls ages 7 to 13 years. Julie looked wonderful and what a beautiful smile! She had gained weight and had no complaints with her neck. She was attending school, learning to read, write and draw. She had made us a card ahen she knew we were coming. It was sad to have to say goodbye as the entire team had great affection for her, but we were all happy to see her healthy, happy and safe.
That night the team enjoyed a traditional West Bengal cuisine, served in clay pots and dishes at the Kewpie Resataurant in old Kolkata.
We also received good news that at least a portion of the Globus implants would finally be arriving from Chennai. However, still no word on the boxes of supplies from the U.S.
January 7th
Back to work.
Case # 5: 30 year old male with left leg pain and L5-S1 disc herniation. surgery consisted of left L5-S1 hemilaminotomy and discectomy.
Twelve of the thirteen boxes of supplies were finally cleared through customs and delivered to the hospital. They arrived just in time as we were running out of many things. The team spent the time between cases unpacking the boxes and transporting supplies to the OT.
Case #6: 4 year, 18 month old male with congenital kyphosis at T10. Underwent posterior fusion without instrumentation T8 to T12.
While the anesthetic nurses recover the surgery patients in our makeshift recovery room in a converted OR room, the rest of the team makes rounds on the patients. We find we must constantly remind the nursing staff in the hospital to get the patients out of bed. Holly Tavianini, RN spends a lot of time instructing the nurses and patients in how mobilize. The hospital is very rudimentary . The beds are simple cots that do not raise up or down and have no side rails. There is no physical therapy. All the patients are noted to be doing well however.
January 8th
Case #7: 19 year old female with severe back pain and bilateral leg pain. X-Ray and MRI demonstrate destruction of the L5-S1 disc with an associated large tuberculous abcess in the pelvis. Surgery consisted of an anterior, retroperitoneal approach with drainage of the abcess, debridement of the L5-S1 disc space and placement of a 9mm titanium Sustain cage with Tricalcium phosphate and BMP. Posterior approach performed for placement of L5-S1 pedicle screws.
After surgery completed Dr. Debnath and Dr. McConnell saw a number of patients in the clinic who were potential surgical candidates. First was a 14 year girl with a thoracolumbar scoliosis who we booked for the following week. The second was a 28 year old woman with a grade 2, L5-S1 spondylolisthesis who is also added to the list for the following week. The third patient was a 37 year old male who works as a nurse in the OR at the hospital. He has a large C5-6 disc herniation with cord compression and early myelopthy. He is encouraged to have surgery however he feels he cannot get time off of work.
January 9th and 10th
The OSS team takes the weekend off and travels to Puri, south of Kokata. We visit the ancient sun temple of Konark and walk the beach on the Bay of Bengal. It was a good time for the team to refresh before more surgery.
January 11th
Because of the busy holiday season in India the OSS team could only lodge at the Oberoi hotel for a limited period of time. The team and all the luggage are moved to our new accommodations at the Tolleygunge Club. The move provided us time for only one surgical case on Monday.
Case #8: 73 year old male with severe spinal stenosis at L3-4 and L4-5 with a degenerative spondylolisthesis at L4-5. Treated with decompression at both levels and TLIF with pedicle screw instrumentation at L4-5.
Dinner on Monday evening was at the home of Neena Seth’s brother
January 12th
Case #9: 70 year old female with spinal stenosis at L4-5 and L5-S1. Surgery consisted of decompression at both stenotic levels.
Case #10: 3 ½ year old male with severe congenital scoliosis. Several vertebral anomalies including a hemivertebra, and an absent rib on the right. Surgery consisted of posterior T5 hemivertebra resection with posterior fusion and instrumentation using Protex CT from T3 to T7.
Following surgeries we made rounds on all the patients. Everyone is doing well.
Return to the Tolleygunge Club for dinner and bed.
January 13th
Began the day with rounds in the pediatric ICU to extubate the baby boy after his congenital scoliosis correction yesterday. Extubated well – he is awake, moving all extremities and crying for his mother. Doing better than expected after such a big surgery.
Case #11: 13 year old female with right thoracolumbar scoliosis with significant coronal plane decompensation. Surgery performed with Revere Deformity set – posterior approach using all fixed angle pedicle screws and dual rods from T9 to L2. We used the derotation set, linking the screws at each vertebrae together with cross connector bar then derotating each vertebra individually. Excellent correction was achieved.
Case #12: 28 year old female with Grade 2, lytic, L5 – S1 spondylolisthesis. Experiencing both back and L5 nerve root mediated leg pain. Surgery consisted of TLIF with 7 mm PEEK cage. Very difficult to place L5 screws due to extreme medial angulation of 40-45 degrees. Would have been a good case for percutaneous pedicle screws using Revolve as it would be easier to get medial angulation of screws at L5 under X-ray guidance. Although difficult, surgery went well.
Following surgeries made rounds on patients in the various wards throughout the hospital. Again, everyone looks good and are pleased with their results. Kudos to the OSS team.
January 14th
Case #13: Our second patient from the week before, the 55 year old woman with spondylolisthesis, developed right leg pain when she began to mobilize out of bed. A CT scan revealed possible pedicle violation of the right L5 screw. She returned to the OR for a reexploration we found that the medial wall of the right L5 pedicle had fractured and pushed inward encroaching onto the L5 nerve. Luckily we were able to reposition the screw and salvage the procedure.
Once again we made rounds on all patients with the orthopaedic resident staff. Other members of the team began to gather our instruments to be cleaned and sterilized for long-term storage.
January 15th
The final day. It has been a stressful and exhausting yet rewarding experience. We check out of the Tolleygunge club after breakfast and take the cars to the Mission Hospital. We spend most of the morning packing up all unused supplies and transporting them to the store room for safe keeping until our return visit (date to be determined). We receive our surgical instruments from the autoclave and return those to the store room. Ironically the final shipment of the majority of the Globus implants and instrument sets finally arrive. The boxes are placed in the store room with the rest of the gear.
We met with the head Sister for the Operating Theatre to present her with a donation of 8,000 rupees to be used for their upcoming Puja (religious celebration) that the surgery department is organizing for the staff at the hospital. She is very appreciative for the donation. We in turn share our appreciation for she and her staff who were most accommodating and helpful throughout our stay.
The OSS team makes final ward rounds on all the patients. Very emotional for the team. Several of the patients and their families bend to touch our feet – a traditional West Bengal sign of respect and appreciation. They call us “Gods”, but of course we are not worthy of such praise. A simple smile on a patient’s face is all we need to remind us why we came here. All the patients are doing well and they ask when we will return again. The entire team is appreciative of the opportunity to have made a difference in the lives of those patients we came in contact with during our short stay in Kolkata.
We depart for the airport around 3:30 in the afternoon. Sad to leave but glad to be going home.
2008
ACTIVITIES OF ‘OPERATION STRAIGHT SPINE’ IN SEPT ’08 AT RAMKRISHNA MISSION SEVA PRATISTHAN, KOLKATA
Arrival in Kolkata, on 25th Sept 08
Arrival of Ms Marian Barry on 26th Sept 08
(Sister in-charge from spinal operating theatres in St Thomas’ Hospital, London)
Collected her from the Kolkata airport by transport organised by Swami Sarvalokananda, Secy RKMSP
OPD Clinic on 26th Sept 08 at 10AM – 1PM
Booked five cases for surgery
1. 46Y/F for L4/5 decompression
2. 60Y/M Stable Grade 3 spondylolisthesis L5/S1
3. 40Y/F Stable Grade 2 spondylolisthesis L5/S1
4. 52Y/F Revision posterior fusion L4-S1 and decompression L5/S1
5. 19Y/M Thoracolumbar 50deg rt sided scoliosis
Booked two patients for injections
Visit to OR and introduced sister from London to theatre sisters and organised the theatre for 27th -30th Sept 08
Checked our donated Anaesthetics machine which is in operating condition
Collected all the Boxes containing disposables sent from US in Sept 08
Collected a yellow box containing instruments sent by Dr J R McConnell from US
Organised the required disposables for each case in individual bags
Collected last years remainder of disposables and organised them in packets
We got confirmation of arrival of BIOMET instruments and implants from US (SYNERGY Deformity set) and UK (SPINELINK Pedicle instrumentation set). The US sets required custom clearance which was initiated a week before my arrival. The sets sent from US had to be cleared by the RKMSP institute by depositing a sum of INR 52300 (approx USD 1200). These did not arrive till 30th Sept 08. Therefore they were not used. The UK sets arrived on 2nd Oct 08. Therefore they also remained unused.
The Secretary of the institute provided us with a large room for storage of these instruments and implant sets. Before my departure I organised to keep all these valuable donations from BIOMET and disposables from US in the room and secured it with new locks. The one set of keys are with me and the other set with the hospital matron.
Since our meeting on the 14th Sept 08 at Allentown and request to Mr Dave Kelly, Medtronics for providing me with implants for the revision and the other cases so that I can have a back up in case the BIOMET implants didn’t arrive in time. This was dealt locally by Mr Mainak Maitra from Medtronic since he recived directions from US/Delhi. But the set did not arrive until late on Monday 29th Sept 08. Therefore I had to cancel the two cases which were booked for 30th Sept 08 i.e. Case 3 and 5. I could only do the case 2 and case 4 with the help of restricted numbers of Medtronic screws and rods. I also got message from Delhi Medtronic chairman, Mr Pawan Arora that I am not allowed to use the implants for any other case other than the revision posterior fusion. But I had used them for two cases i.e. the revision case (case no 4) as well as the case no 2.
Following the successful surgical sessions on 30th Sept 08 we had a closing dinner in Taj Bengal. We also assessed all the requirements for our next visit in Mar 2009 when the whole team from US headed by Dr J R McConnell and from UK will be arriving. I have booked accommodation in the Tollygunj club this time since the feedback from Ms Marian Barry was good. I had emailed regarding this information to Dr McConnell on the 1st Oct 08. The booking is confirmed for 7th Mar to 19thMar 2009.
I had subsequently visited Delhi on the 2nd Oct 09 for Scoliosis Society meeting (International meet). I met Dr Munish Gupta, MD spine surgeon from Sacrameto who was the chairman of the Global Outreach programme from SRS. He suggested this to be put on the SRS site with the help of secretary Amy Miller. He also wished to come with us on one of our visits and help in operating. I gave our information to Ms Amy Miller who promised to put our organisation as one of the recognised outreach programme by SRS. There was good interest shown by other American surgeons as well. There were interest shown by the Indian Spine Surgeons who wish to come for symposium and live workshop during our visit in Mar 2009. I had tentatively mentioned for the date 14th Mar 2009 (Saturday).
Following my return I had followed up the cases which were operated upon. They all were discharged with alleviation of symptoms.
I also did a further clinic and assessed few cases for our next visit. 3 congenital scoliosis aged 3-5 years with progressive lumbar and thoraco-lumbar scoliosis due to hemivertebrae. There were three cases of idiopathic scoliosis (thoracic x 1 and thoraco-lumbar x2 including the cancelled case). There were at least 4 cases of spondylolisthesis. The doctor interested in the whole project and wished to be trained a s a Spine Surgeon Dr Abhisekh Das, MRCS had been of great help. He had assisted me in everything from the onset to the end. He has promised to follow-up the cases and also collects patients for our surgical workshop in Mar 2009.
Dr Tapas Chakraburtty supported as usual. Dr Bhubon Pal had active support and he scrubbed with me for the revision case.
Sister Marian Barry had been an excellent support throughout. She left for London on the 1st Oct 2008. She confirmed her safe arrival and is motivating her team to collect all the necessary things from London for our next trip in Mar 2009.
On 11th Oct before my departure I met Swami Sarvalokaknda and have given him my letter with the dates for our next trip. He is now prepared to talk and carry our project in the institute for longer term.
It was again a successful endeavour amidst confusion and chaos.
Thanks
Yours sincerely,
(Ujjwal K Debnath)
Home » Activities Report » 2007
2007
Activities of Operation Straight Spine Dec 2007
Arrival of U K Debnath in Kolkata on 2nd Dec 2007
At RamaKrishan Mission Seva Pratisthan, Kolkata
1st Clinic: 6th Dec 2007
Patients consulted at the OPD:
Low back pain: 8 patients
1 pt (17yr/M) with Gr 1 S’listhesis
2 pts (51/F, 52/M) with Gr 2 S’listhesis
2 pt (48/F, 68/F) with Gr 3 S’listhesis
1 pt (49/M) with chronic Cauda equina lesion (7weeks)
2 pts with discogenic back pain
(68Y/M from Bangalore – requiring Decompression +fusion)
Scoliosis: 4 patients (2 idiopathic, 2 congenital)
TB Spine: 2 patients (35/F with paraplegia of three years duration, 60/F with
acute onset 3 weeks paraplegia D8/9 lesion)
Follow-Up: 2 post operative patients from 2006 with TLIFs +PLFs –
reduced Back pain with no leg pain
Arrival of team from USA on 9th Dec 2007
Dr Jeffrey R McConnell, MD – Spine Surgeon
Ms Holly Tavianini, – Neurosurgical Nurse Specialist
Ms Andrea McAloose, – Theatre Scrub Specialist Nurse
Dr Laboni Choudhury, MD – Anaesthetist
Ms Hilary Le Clair – Neural Monitor Tehnician
From UK the team consisted of
Dr Kinnari Mehta, FRACA – Anaesthetist
Mr Hemang Mehta, FRCS, MS (Orth) – Orthopaedic Surgeon
10th Dec 2007
Following meeting with Swami Sarvalokanandaji, Secretary of RKMSP we went round the admitted patients who were booked for surgery
1. 68Y/M (from Bangalore): Degenerative disc disease at L4/5 and L5S1 with foraminal disc compressing Right L5 nerve root causing severe radiculopathy.
2. 52/M: Low Back pain and bilateral neurogenic claudication due to Isthmic Spondylolisthesis Grade 2 at L5/S1
3. 51/F: Low back Pain and right sided leg pain with neurogenic claudication due to Isthmic Spondylolisthesis Grade 2 at L5/S1
4. 49/F: Low back Pain and bilateral leg pain due to Isthmic Spondylolisthesis Grade 3 at L5/S1
5. 60/F: Acute onset paraplegia (3 weeks) D8/9 Tuberculosis with bladder and bowel involvement
6. 13/F: Adolescent Idiopathic Scoliosis with large rib hump and 80degrees major thoracic curve.
OPD Clinic on 10th Dec 2007
Further screening of patients was done at the OPD clinic.
Surgery on 11th Dec 2007
The anaesthetic machine at the RKMSP was used
1. 52/M: Low Back pain and bilateral neurogenic claudication due to Isthmic Spondylolisthesis Grade 2 at L5/S1
Operation: Decompression + TLIF + L5S1 fusion (BMP +Vitoss)
1. 68Y/M (from Bangalore): Degenerative disc disease at L4/5 and L5S1 with foraminal disc compressing Right L5 nerve root causing severe radiculopathy.
Operation: Discectomy + decompression + L5S1 fusion (PLF)
Ward round in the evening
Draeger Anaesthetic machine was delivered at 9PM from the customs at Kolkata Airport and was fixed by the representative
Surgery on 12th Dec 2007
1. 51/F: Low back Pain and right sided leg pain with neurogenic claudication due to Isthmic Spondylolisthesis Grade 2 at L5/S1
Operation: ALIF with Peek Cage + BMP + Vitoss + PLF
1. 49/F: Low back Pain and bilateral leg pain due to Isthmic Spondylolisthesis Grade 3 at L5/S1
Operation: TLIF + PLF (BMP +Vitoss)
Ward round in the evening
Surgery on 13th Dec 2007
1. 60/F: Acute onset paraplegia (3 weeks) D8/9 Tuberculosis with bladder and
bowel dysfunction
Operation: Left sided thoracotomy + corpectomy & debridement + cage fusion
at D8/9 + Posterior Fusion T5-T11
Ward round in the evening
Workshop and Symposium on 14th Dec 2007 at 11AM
Surgery with Live demonstration
1. 13/F: Adolescent Idiopathic Scoliosis with large rib hump and 80degrees major thoracic curve with Lumbar decompensation
Operation: Posterior approach, Pedicle screws serially introduced under neural monitoring,
Intra-operative complication: at apex and concave side when introducing the D8 pedicle screw we lost the monitoring and did not return, Wake up test concluded evidence of spinal cord injury at that level, decided to remove the screws + fuse the spine in situ with Vitoss and local bone graft
Post operative ward rounds at 9AM
Concluding meeting with Swami Sarvalokananda, Dr T Chakraburtti and Dr B Pal @10AM on 15th Dec 2007
Departure at 5:30PM Kolkata to Jabalpur
Activities report in Jabalpur 2007
Arrival in Jabalpur at 3:30AM of 16th Dec 2007
Flight reached Nagpur at 8PM
We were transported to Jabalpur by 3 cars
Had dinner at 11:30PM half way through (Seoni,MP)
On the 16th Dec 2007
Warm welcome at Spinal Injuries Centre, Medical College Campus, Jabalpur
Symposium commenced with Spinal Surgeons who came from Delhi (Dr HS Chabbra), Mumbai (Dr Abhay Nene) and Hyedrabad (Dr Ragav Dutt M and Dr Suryaprakash Rao) in India.
We had a warm welcomg by the local medical school PG residents
We had seen 15 patients in the morning session. We saw another 10 patienst in the afternoon. Symposium finished at 4Pm.
We selected few cases for surgery
3 Thoracolumbar fracture with neurological deficit (1.L1#7days old paraplegia, 2.T12#one month old paraplegia and 3. T8# with paraplegia)
1 neglected scoliosis in 22 year old man
1 L4 TB spondylosis in 14 year old girl
1 Thoracic decompression at T10/11 and L1/2 for disc disease
17-19th Dec operated from morning till evening in the MahaKaushal Hospital
We had meetings with the local Collector Mr S Dubey on 16th Dec 2007
We had meetings with the Health Minister Mr Ajoy Vishnoi on the 20th Dec 2007
We departed via Nagpur on the 20th Dec 2007.
Jabalpur Seminar
OPERATION STRAIGHT SPINE
Dear Colleague,
Operation Straight Spine is the first ever charitable project of its kind in India and consists of outpatient clinics, major spine surgery interventions, ward rounds and teaching seminars for local support staff and physicians. The organization successfully completed a pilot project along with the Ramkrishna Mission Seva Pratisthan in Kolkata in November 2006 when eight patients who were from little to no income families received surgical intervention free of charge.
Establishing a charitable mission project to provide treatment of spinal disease and deformity for the poor and underserved in India was a dream shared by two orthopaedic spine surgeons – Dr. J.R. McConnell. MD from Allentown, USA and Dr. Ujjwal K. Debnath, FRCS, from Cardiff, UK. Dr. Debnath is a native of Kolkata and worked with the Ramakrishna Mission to help implement this project.
For 2007 our goal is to continue this mission. Together with Professor H.K.T. Raza, who is also the head of the Orthopaedics Department and the current president of the Indian Orthopaedic Association, and other colleagues at the Spinal Injuries Centre in NSC Bose Medical College we are organizing the Spinal Surgical Camp. This event will be chaired by Mr. Sanjay Dubey, who is the Collector of Jabalpur, MP and will take place December 16th-20th, 2007.
Globus Medical, Inc a Philadelphia, USA based spinal implant company has donated implants for the surgeries and has organized the seminar and hands-on workshop “Spine Reconstruction in Deformities”, which will take place on December 16, 2007 in Jabalpur. This course will be followed by live demonstration of common deformity surgery.
This meeting is designed to be informal, and interactive discussion and case study presentations are encouraged. The faculty will consist of respected spine surgeons from India who are interested and willing to share their knowledge and experiences with spinal deformity.
Please note that the timing on the agenda may change slightly the day of the course due to incorporating a live surgery, but all topics will be adequately covered. We will wrap up the session with a group dinner that evening.
We all look forward to meeting you at this upcoming interesting and interactive course in the city of Jabalpur, MP.
Prof H K T Raza, Ujjwal K Debnath, Dr Jeffrey R McConnell
WELCOME TO JABALPUR
SPINAL RECONSTRUCTION IN DEFORMITIES
Symposium & Workshop on 16th Dec 2007 at Spinal Injuries Centre, NSB Medical College, Jabalpur, MP, India followed by Live surgeries on 17th-19th Dec 2007
Moderator : Prof (Dr) H K T Raza
8:30 AM: Registration & Coffee
9:00 AM: Growing Spinal Problems in India : an insight into solution :
Dr H K T Raza, Jabalpur
9:20 AM: New Approach & Principles of Deformity Correction:
Dr J R McConnell, USA
9:40 AM: Determining levels of instrumentation and fusion in
Adolescent Idiopathic Scoliosis: Dr U K Debnath, UK
10:00 AM Correction of Kyphotic deformity:
Assessment and Treatment: Dr H S Chhabra, New Delhi
10:20 AM Role of SMEPs in Monitoing spinal cord during deformity
surgery : Vijay Tambi, USA
10:40 Coffee/ Tea
11:00 AM Introduction and opening by Maj Ahulwalia, Chairman ISSIC,
New Delhi
11:20 AM Principles of treatment and instrumentation in congenital scoliosis:
Dr Surya P Rao, Hyderabad
11:40 AM Role of instrumentation in Traumatic spinal deformities :
Dr Ram Chaddha, Mumbai
12:00 noon Deformity correction in infections of spine: Dr Abhay Nene, Mumbai
12:20 Spinal reconstruction in neuromuscular deformities:
Dr Raghava Dutt Mulukutla, Hyderabad
12:40 Adult Spinal Deformity: When & How? : Mr K N Subramaniun, UK
1:00- 2:00PM Lunch
2:00 PM Workshop 1: Video and live demonstration on models
Pedicle Screw Constructs for Deformity Correction Techniques?
3:00 PM Case discussion
4:00 PM Coffee/Tea
4:15 Workshop 2: with video and live demonstration on models
Dynamic stabilization of spine in Trauma
4:45 PM Closing by Mr Sanjay Dubey – Collector, Jabalpur
http://www.spine-health.com/PRO/difference/straightspine.html
2006 News Report
INDIAN EXPRESS – KOLKATA NEWS ONLINE
3rd December 2006, Sunday
Back straight, head held high
NRI surgeon Ujjwal Debnath comes to his home town to perform spinal surgery free for the needy, finds our correspondent
Pragya Paramita
Sixty-year-old Nibha Rani Dey’s eyes light up when she spots the familiar figure making his way towards her bed. Standing next to her bed she pulls herself straight to hug the man and says ebar tumi a amar poribarer shodosho. Tomader shobar chobi diyo aami tangiye rakhbo. (Now you are a part of my family. I will put your photographs on the wall).
For Dey and many other patients of Shishu Mangal Hospital, Dr Ujjwal Debnath has been a familiar figure over the past few weeks, a figure that has given them a new lease of life.
Coming back to his hometown and performing surgeries for the needy was a dream that the doctor had cherished for a long time and it was a chance meeting with Dr Jeffery McConnell that made it possible. “When Dr McConnell had come down to Cardiff we became friends instantly and he told me his wish of performing spinal surgery free of cost in a third world country. That was when I decided that the best place to perform the surgeries would be in Kolkata,” says Debnath.
With the idea firmly in place the duo went on to set a trust that would fund the entire project. They also involved six other specialists in their projects who would be needed to monitor the patients and use the instruments.
And finally the team came down last month to the city to perform one of the most complicated and expensive surgeries to some of the neediest people in the country free of cost. There are few places in India where these surgeries can be carried out, and there is absolutely none in the eastern region of the country. These surgeries are so expensive not just here but also abroad that it is out of reach for most people, says Debnath.
“Kolkata was an automatic choice for me since I am from here, moreover I had worked for a few years in Shishu Mangal and knew the doctors there so we decided to come here and perform the surgeries. But coming here was a complicated task as they soon realised that they would have to bring down all the necessary instruments and also the specialists who could handle them,” Debnath said.
And finally the six-member team came down last month to perform the surgeries. The doctors also used a bone morphogenic protein, a substance that would help in the healing of the spinal cord, for the first time in India. One of the most expensive substances, it is used by few doctors abroad. “We realised that we would have to use the substance for speedy recovery of the patients,” he said.
For Dey and other patients like 18-year-old Srimanto Mandal and 35-year-old Minoti Sarkar and others Debnath and his teams have been nothing short of miracle workers. While earlier their defects made it impossible for them to stand or even walk for long now they can dream of leading a normal life. Debnath and his team may have gone back for the time being but not for long as Debnath will be back in a few months to check up on his patients.
“Moreover, we are hoping to conduct this camp once again. And we have a long-term project of setting up a full-scale specialty unit here where, local doctors can carry out these surgeries free for the needy. Till then however the team of doctors will be back again and again to help some of those who are too weak to even help themselves,” he said.
Home » Activities Report » 2006 BOA Report
2006 BOA Report
British Orthopaedic Association Newletter
“OPERATION STRAIGHT SPINE” – a project for underprivileged in India
In Nov 2006, two surgeons, Dr Jeffrey R. McConnell, MD, Consultant Spine Surgeon from OAA Orthopaedic Specialists, Allentown, Pennsylvania, USA and Mr Ujjwal K Debnath, FRCS, MS (Orth), Senior Registrar, University Hospital of Wales, Cardiff, UK had set out with a team (comprising of five specialists) to perform spinal surgical camp and workshop at Ramakrishna Mission Seva Pratisthan (a teaching hospital) in the heart of Kolkata, India. The team members were three clinical nurse specialists (Sharon Monahan-Anaesthesia, Andrea McAloose- Scrub, Holly Tavianini – Spinal care), one Neural monitoring technician – Vijay Tambi and Instrument specialist from Meditronik, USA – David Kelley.
The project named “Operation Straight Spine” – a transatlantic collaboration between the two surgeons for solving spinal problems in the underprivileged people in India esp. poor children with spinal deformities. This project took four years in its development under the auspices of Spine Education and Research Foundation (SERF), USA which has expanded the realm of possibilities for surgeons to deliver complex equipment intensive surgeries in under-resourced regions of the world e.g. India.
The spinal project lasted twelve days comprising of regular clinics, case selection, resident’s teaching, pre-operative planning, surgeries, post-operative care and rehabilitation. A spinal symposium was held for the hospital professionals and local orthopaedic surgeons. At least 50 patients were seen in the clinics with various spinal problems e.g. Low back pain (Disc disease, spondylolysis, spondylolisthesis etc), cervical and thoracic disc disease, post-tubercular kyphotic deformity, ankylosing spondylitis etc. Five patients underwent decompression and fusion for grade 3 spondylolisthesis at lower lumbar spine. One young man had direct repair of spondylolysis at fifth lumbar pars lesion.
Ten children with spinal deformities were also evaluated during the clinics. Spinal deformities included idiopathic scoliosis, congenital scoliosis and neuromuscular scoliosis. One sixteen year old boy with thoracic idiopathic scoliosis had instrumented surgical correction with fusion.
Meditronik-Sofamor Danek, USA funded the spinal equipments worth approx 5 million USD along with implants and packs of BMPs (Bone Morphogenetic Protein) for fusion and deformity correction. It is very generous of the company to have donated implants free of cost to these poor patients (each ranging 20000-40000 USD). Neural monitoring (motor evoked potentials) was performed in all patients. No intra or post-operative complications were encountered. All patients were discharged home with healed surgical wounds.
The whole surgical team was applauded by the patients, local orthopaedic team headed by Prof (Dr) Tapas Chakraburtty, MS(Orth), the state orthopaedic association headed by Prof (Dr) Tapan Moitra and the media (TV and newspaper) for the tremendous success of the first such spinal surgical camp organised in India.
2006 Activities
“OPERATION STRAIGHT SPINE”
SUMMARY REPORT 2006
Location: Ramakrishna Mission Seva Pratisthan (RMSP), Kolkata, India
Director of RMSP: Swami Sri Sarvalokanandaji Maharaj
Surgeons:
1) Jeffrey R McConnell, MD
OAA Orthopaedic Specialists
Pennsylvania Spine and Scoliosis Institute
250 Cetronia Rd, Allentown, PA, USA
2) Ujjwal K Debnath, FRCS, MS (Orth)
Dept. Of Orthopaedics
University of Cardiff
Cardiff, Wales, UK
Team Members from USA:
1) Sharon Monahan, CRNA (Nurse Anaesthetist, Lehigh Valley Hospital)
2) Andrea McAloose, RN (Operating Room Nurse, Lehigh Valley Hospital)
3) Holly Tavianini, RN (Neuroscience Unit Head Nurse, Lehigh valley Hospital)
4) Vijay Tambi (Neurophysiologist, Spinal Monitoring Associates)
5) David Kelley (Spinal Consultant, MedAlliance Inc., Distributor for Medtronic – Sofamor Danek)
RMSP Orthopaedic Surgeons:
1) Dr Tapas Chakraburtty, MS (Orth)
Chief, Department of Orthopaedics, RMSP
2) Dr B. Paul, Ms (Orth)
Consulting Surgeon, RMSP
RMSP Orthopaedic Residents:
Dr. Partha Pal
Dr. Nirjhar Maji
Dr. Suman Mishra
Dr. Abhishek Das
Dr. Debmalya Banerjee
Dr. Feroz Alam
Dr. Rajshri Basu
Dr. Anirban Bhattacharya
Dr. Sanjay Bal
Sponsors:
Medtronic Sofamor Danek
Draeger International
Lehigh Valley Hospital and Health Network
B Braun
Aesculap
Spinal Monitoring Associates
Nuvasive
DePuy Spine
MTF Musculoskeletal Transplant Foundation
Synthes Spine
MAP International
3M Medical Division
Cardinal Health
Molnlycke Healthcare
Bard Medical
King Pharmaceuticals
Charitable Foundation:
Spine Education & Research Foundation (SERF)
Headed by J. R. McConnell, MD
OAA Orthopaedic Specialists
Pennsylvania Spine & Scoliosis Institute
250 Cetronia Road
Allentown, PA 18104
NOTABLE HIGHLIGHTS OF OPERATION STRAIGHT SPINE
• First ever charitable project to provide spine surgery services to poor and underserved in India
• Performed eight major spine surgical procedures
• Performed first scoliosis correction surgery with pedicle screw instrumentation at RMSP hospital
• Used Bone Morphogenic Protein (BMP2) for spinal fusion for the first time in India
• State-of-the-art SSEP, MEP and EMG neurophysiological spinal monitoring techniques used for first time in India
• Featured on national DDNews TV program
• Featured in “The Telegraph” newspaper
• Conducted SPINAL SURGICAL SERVICES FOR SPINAL PATHOLOGIES conference
• Trained RMSP Orthopaedic residents and nursing staff in spine surgery and perioperative care techniques
SURGICAL PROCEDURES SUMMARY
1. 32 year old male w/ L4-5 isthmic spondylolisthesis, L4-5 herniated disc, leg pain/radiculopathy and LBP.
Procedure: Posterior decompression of L5 nerve roots, TLIF w/ PEEK cage + posterolateral fusion with pedicle screw instrumentation L4-5
1. 35 year old female w/ grade-3, L5-S1 isthmic spondylolisthesis, bilateral L5 radiculopathy and LBP
Procedure: Posterior Gill laminectomy w/ bilateral L5 nerve root decompression, L5-S1 discectomy, TLIF w/ PEEK cages, local bone graft and BMP-2 + pedicle screw instrumentation
1. 62 year old female w/ grade-2 degenerative spondylolisthesis L4-L5, spinal stenosis, severe neurogenic claudication, LBP.
Procedure: Posterior decompression of L4 and L5 nerve roots bilaterally, TLIF w/ local bone, BMP-2 and PEEK cage, pedicle screw instrumentation
1. 63 year old female w/ multi-level cervical spondylosis, spinal stenosis and radiculo-myelopahy
Procedure: “Open door” cervical laminaplasty w/ laminar reconstruction using allograft rib strut grafts and titanium mini-plate arch fixation system C3 through C7
1. 15 year old boy w/ right sided thoracic idiopathic scoliosis (Lenke 1AN) and Cobb angle of 55º
Procedure: Posterior pedicle screw instrumentation w/ dual rods and fusion w/ local bone graft, ß-TCP and BMP-2 T3 through T12
1. 58 year old female w/ severe lumbar spinal stenosis and degenerative spondylolisthesis at L3-4 w/ bilateral leg pain, gait disturbance and sensory-neural deficit at L4 on the left side.
Procedure: Posterior decompression L3-4 + TLIF w/ PEEK cage, local bone graft and BMP-2 + pedicle screw instrumentation L3-4
1. 42 year old female with grade-1 L5-S1 isthmic spondylolisthesis, right L5 radicular symptoms and LBP.
Procedure: Decompressive right posterior L5 hemilaminectomy, foraminotomy, unilateral TLIF with PEEK cage, local bone graft and BMP-2 + pedicle screw instrumentation L5-S1
1. 26 year old male with painful L5 spondylolysis.
Procedures: Flouroscopic lysis block provided temporary pain relief. Discography negative at L4-5 and L5-S1. Posterior lysis repair with screw fixation using Buck’s technique.
PROJECT REPORT
Establishing a charitable mission project to provide spinal disease and deformity treatment for the poor and under-served in India was a dream shared by orthopaedic spine surgeons Jeffrey R. McConnell, MD from the US and Dr. Ujjwal K. Debnath, FRCS from the UK. After four years of hard work and careful planning the dream became reality when the“Operation Straight Spine” team landed in India this past November. In the U.S., Dr. McConnell established the Spine Education and Research Foundation to help fund the project, solicited donors, recruited skilled team members and arranged for donated supplies and equipment. While based in the UK Dr. Debnath, native to India and Kolkata, navigated cultural, political and institutional barriers and tirelessly organized local support for the project through the Ramakrishna Mission Seva Pratisthan (RMSP), where years earlier he had completed some of his orthopaedic training. “Operation Straight Spine” was successfully completed as a pilot charitable project during November 12 – 24, 2006. “Operation Straight Spine” was the first-ever charitable project of its’ kind in India and consisted of outpatient clinics, major spine surgery interventions, ward rounds and teaching seminars for local support staff and physicians.
“Operation Straight Spine” was financially feasible through the generous support of a number of corporate sponsors and made possible by the hard work of a dedicated, highly skilled and compassionate international team of volunteers from the US and the UK. Patients from West Bengal and neighboring states were identified as potential candidates for surgery through clinics conducted by local support surgeons, Dr Tapas Chakraburtty, and Dr. B. Paul prior to the international team’s arrival. Dr. Chakraburtty was indispensable in garnering institutional support and facilitating the project by expending much personal time and energy to arrange the necessary outpatient and Operating Room facilities.
“Operation Straight Spine” successfully managed eight patients requiring major spinal surgery inclusive of a 15 year old boy with a thoracic scoliosis deformity and a 63 year old woman who underwent a hi-tech laminoplasty procedure for cervical spinal stenosis with myelopathy. All equipment, consumable supplies, surgical instruments and implants necessary to perform these modern spine surgical procedures was provided by the international operating team and their generous sponsors. Medtronic Sofamor-Danek (Memphis, TN, USA) our primary sponsor, provided an inventory of 4.5 million USD worth of implants and equipment as well as travel related expenses. Draeger International graciously provided the team with a much needed modern anaesthesia machine delivered to RMSP after a 10 day journey by truck from Mumbai. Spinal Monitoring Associates (Bala Cynwyd, PA, USA) donated 50K USD of sophisticated equipment and a highly-skilled neurophysiologist to monitor patient’s spinal cord and nerve function during surgery. Lehigh Valley Hospital and Health Network supported the project with consumable operating room supplies and medications.
The team of six specialists from the USA and Dr. Debnath from the UK arrived in New Delhi on the 11th of November. They attended the 51st annual Indian Orthopaedic Association (IOA) meeting where Drs. McConnell and Debnath gave lectures to the delegates on scoliosis surgery, disc replacement, spondylolysis repair, and minimally invasive spine surgery techniques. Acting as diplomats for “Operation Straight Spine” the team received important and overwhelming official support from the president and other key members of the IOA ensuring future success and sustainability for the charitable project. The team also had the opportunity to do some sight-seeing highlighted by our visit to the Red Fort and the Taj Mahal in Agra.
The team flew to Kolkata (Calcutta) on the 15th of November and set out to work relentlessly for the next eight days to assure all planned surgeries were safe and successful. Boxes of supplies were unpacked, instruments sorted, a nitrogen tank and regulator to operate a high speed burr was procured, and the anaesthesia machine (arriving by truck at the last possible moment after a 10 day trip from Mumbai) was finally installed. Patients were screened and prepared for operative procedures during clinic sessions on the 16th and 17th of November. Following a morning clinic on the 17th the team attended a symposium held in the hospital auditorium entitled ‘SPINAL SURGICAL SERVICES FOR SPINAL PATHOLOGIES’ which was part of the educational component of out mission to help train staff, residents and nurses at RMSP. Each team member gave a didactic lecture presentation in their respective areas of expertise pertaining to spinal surgery. The seminar was addressed by the Head of the Institute, Sri Sarvalokanandaji Maharaj and attended by local surgeons and members of the West Bengal Orthopaedic Association including its president Prof. T.K Moitra.
Operating theatre sessions took place on the 18th, 20th, 22nd, 23rd and 27th of November.
All patients during the first four sessions were operated on by Dr. McConnell assisted by Dr. Debnath and Dr. Chakraburtty or Dr. Paul. Dr Debnath performed a Buck’s repair during the last operative session on the 27th for a symptomatic L5 spondylolysis. There were no surgical complications and all surgical goals of deformity correction, back or leg pain relief, were achieved. All patients did exceedingly well postoperatively and were satisfied and grateful with their surgical procedures.
Sophisticated, computerized neural monitoring equipment (utilizing Somatosensory-Evoked-Potential, Motor-Evoked-Potential and EMG monitoring) provided by Surgical Monitoring Associates was used for the first time in India. Spinal monitoring was conducted by Vijay Tambi, neurophysiologist, whose expertise in neural monitoring helped minimize risk to the spinal cord and spinal nerves ensuring an extra measure of safety for our patients during surgery.
The majority of the instrumentation and implants supplied by Medtronic were used for the first time in Eastern India, most notably BMP-2 (bone morphogenic protein). BMP-2 and PEEK
(Poly-ethyl-ethyl-ketone) plastic cages placed in the intervertebral space were used to enhance fusion in five of the surgeries performed. These products are very expensive and are most commonly used in highly developed countries like the USA, Europe and Japan. These specialized products and all instruments and consumables were provided totally free of cost to the patients for all surgeries performed.
Despite the difficulties and obstacles presented during the two week mission of “Operation Straight Spine” the level of spine surgical care provided to the patients treated was comparable to the care provided in the USA and the UK. Patients, nurses, doctors, hospital administration and the people of Kolkata were very appreciative of the premier care provided to the under-privileged in this part of the world by the “Operation Straight Spine” project. The local and national media took interest in the project and the story was carried on DDNews (TV news) and in the “Telegraph” & “Indian Express” newspaper. Overall the project was a very great success and the first of its’ kind in India. Each member of the“Operation Straight Spine” team was deeply moved by their experience in Kolkata and felt privileged for the opportunity to selflessly share their time and expertise for a small group of underprivileged patients in need of spinal surgery. The lives of the patients treated were positively and profoundly changed by correcting deformity, eliminating pain and improving daily physical functions, independence and productivity. Although the numbers treated relative to the need was small, the impact of this pilot project was large.
One of the primary goals of this project was to prove the feasibility of providing modern spine care services to indigent patients in Kolkata and other underserved areas in India. The future goal of “Operation Straight Spine” and the Spine Education and Research Foundation is to continue our work started in India. The need for modern spine care in this developing region of the world is tremendous. We hope to raise enough funds and procure equipment to develop a permanent spinal unit that will provide free clinics staffed by local physicians and program administrators. We will improve the service capabilities through a virtual spine clinic where digital photos and x-rays sent via email to consulting surgeons in the US and UK will allow appropriate patient screening and surgical planning. Complex spine surgeries, outpatient spine clinics and education of local surgeons and residents will then be provided by international spine care providers who will visit three to four times per year. Discussions are now in progress with the Indian minister of health and the minister of finance to ensure continued support for our project at the governmental level. Plans are also under consideration for building a free-standing orthopaedic specialty hospital funded through private and corporate donations, the Indian government and low interest government loans. This hospital will not only provide free spinal care services to the underprivileged in eastern India, but comprehensive general and specialty orthopaedic services as well.
Jeffrey R. McConnell, MD
Ujjwal K. Debnath, FRCS, MS (Ortho)