Today our first patient was a 20-year-old male with Scheuermann’s kyphoscoliosis. A normal vertebral body has the shape of a cylinder. In Sheuermann’s disease, at least three of the vertebrae are wedge shaped by at least 10° each. Typically, Sheuermann’s disease results in kyphosis of the thoracic spine. Kyphosis is an exaggerated bend that you would normally see in an elderly woman with osteoporosis, but in this case, we are dealing with an otherwise healthy 20-year-old. This case is also special because he also has thoracic scoliosis. Both the kyphotic and sagittal cures are stiff, and therefore, the treatment involved multiple Smith – Peterson osteotomies (SPO’s). This means that we would resect the posterior part of multiple vertebrae in order to loosen the spine, so it could be made straighter. The surgery is much harder and more time-consuming than the average adolescent idiopathic scoliosis. The surgery went very well.
After surgery, we went to the spine clinic and picked out a few more patients that we thought would be appropriate surgical candidates. One of the patients that we saw in the clinic was so poor that he did not even have a penny. He and his brother walked about 400 km in eight days to come from their city to our clinic. Ethiopia is a country of about 100 million people of which about 70% are Christian. Most of them are very religious. I learned from Birhanu that it is very common for the poor to walk up to somebody’s house and ask them for hospitality in the name of God. They will get a place to wash their hands and feet, eat, and sleep.
Dr. Hodes lives in a house with many chickens ranging the property. We frequently saw him distribute a bucket of boiled eggs to all the people waiting in line to see him. In many cases, this is their only meal of the day.
We went to see the patients we had previously operated on. They were all still in the intensive care unit. One of them was having breathing issues. The chest x-ray showed a large right sided lung collapse with what look like to be pleural effusion. After placement of a chest tube, the issue turned out to be a hemothorax. This is a condition where some of the blood seeps from the back into the chest cavity and pushes on the lung. The situation got corrected promptly and she did very well. It is easy to see how even in the best of hands, the chance of complications in these types of complex surgeries is about 50% in the United States.
Another interesting fact I learned is that because Ethiopia and Kenya are at such high altitudes (over 7500 feet), the average hemoglobin for these people is much higher. As a result, they have a much higher oxygen-carrying capacity. Now I understood why so many marathons are won by Kenyans. If all the other Olympic athletes were really smart, they would all train in Mexico City, Addis Ababa, or Kenya. Then they would not need to dope their blood. It will be acquired all naturally.
Today we operated on a 20 year old female with a T 12 hemivertebrae. As a result of that asymmetric growth, she had developed a significant thoracolumbar scoliosis. Our plan was to place pedicle screws above and below the hemivertebrae. We would then dissect out the hemivertebrae and remove it. Finally we would be able to realign the spine into a much more anatomical position. Since we had operated with each other for the last few days, we had become accustomed with each other’s techniques. The initial dissection and placement of the pedicle screws went very well. We then dissected out the hemivertebrae. This means that we gently dissected around the entire circumference of the vertebral body. One would have to consider the tediousness of this dissection as the diaphragm, aorta, and inferior vena cava are positioned in front of this vertebrae. To add to surgical time, this hospital does not have a microscope or a drill. I asked Dr. Birhanu how he performs craniotomies. He uses a hand drill to make burr holes and a giggly saw to connect the holes. He can then elevate a bone flap. I have been in medicine since 1990 and I have only heard of this type of equipment. We had to remove the vertebrae piecemeal which took a while. Despite that, her lumbar curve was too stiff for us to put it into the normal curvature. We had to perform a number of Smith – Peterson osteotomies which means that we had to take some extra bone from the backside of the spine to make the spine more flexible. We then placed the two rods to connect all the screws together. Placement of the rods can be a time consuming event as it relies on the viscoelastic properties of the spine. This means that we had to take our time as the screws slowly brought the spine toward the rods. We closed the area of the vertebrectomy by compressing the pedicle screws together. As you can see in the pictures, her back now had a normal posture.
Another successful surgery. But given the length of this surgery, we did not have time to do a second surgery as was planned. That one was postponed for a different day.