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.