Operation Straight Spine Activities Report 2006
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)