Our first patient is an 18-year-old female with a double major curve. This means that she has a significant curve in the thoracic area and another one in the lumbar area that do not straighten out below 25° when she bends from side to side. They are each over 50° and will progress if left untreated. The treatment is fusion and placement of pedicle screws and rods from T5 to L4.
One thing you learn when you operate in a Third World country is how to improvise. They had scrub sinks but no scrub sponges. The ancillary services were not anything like the way we have it in the United States. There was a fluoroscopy machine, but it was kept in plastic wrap in a corner of the holding area. Dr. Ibrahim showed us a technique for freehand insertion of pedicle screws. As the patient’s back was being prepped for surgery, we used this time to review films and surgical planning. We had a finite inventory of the different types and sizes of pedicle screws for this trip. Therefore, we have to consider our entire surgical schedule and plan on using our different screws in an efficient manner.
The surgery goes well, and her spine is straight again. She is admitted to the intensive care unit. Initially we were planning on doing a second case. But we realized that it takes over three hours to sterilize our equipment. So, we would have to postpone our next case for the next day. We took a trip to the ICU. They have monitoring which sounded like a new addition. They do not have any intensivists, but instead, the emergency room physicians help manage those patients. Dr. Ibrahim goes over many of the basic orders that he wants on these patients, parameters that we take for granted in the United States.
Somehow our scrub tech and our Nuvasive representative figured out how to minimize the time it takes to sterilize instruments by having some of them be done at a nearby hospital. So now we were back on track on having the possibility of doing two cases a day.