The day started as usual. Everybody in the ICU was doing well. The chest tube from our first patient would be coming out soon. Today we were operating on a 25-year-old male with a major thoracic curve. The surgery would involve fusion and instrumentation from T2 to T11. We would also perform multilevel SPO’s (Smith Peterson Osteotomies) because of the stiffness of her scoliotic curve. We had become more efficient working with each other. The surgery went well, and we had enough time to sterilize our equipment and start a second case. Between surgeries, we went to the clinic and evaluated a few more patients. Some of these patients would be getting their workup and prepared for surgery when the team would return in six months. We also saw a 13-year-old female with adolescent idiopathic scoliosis. If we wait for six months, then the progression of her scoliosis would make surgery a lot tougher. We changed the schedule for her to be our first of two cases tomorrow.
The second surgery of the day was on a 15-year-old male with a major thoracic curvature due to an unsegmented bar in the mid-thoracic region. This was a right sided curve. Because they are associated with a high degree of intra-spinal abnormalities, an MRI is required. In this case, the MRI was negative. Otherwise, depending on the abnormality, these patients would have been sent to Dr. Boachie in Ghana. Trying to correct these severe curvatures can be a tricky process. Very commonly throughout the week, we would be working with our anesthesia colleague on manipulating the blood pressure during various parts of the procedure in order to maximize blood flow to the spinal cord. Our guidelines were based on monitoring of the nerves in the spinal cord responsible for sensation SEP: (sensory evoked potentials) and strength MEP: (motor evoked potentials). In this case, at one point, we lost the MEP’s of the right leg. We raised the blood pressure and waited for a while, but it did not return. So, we had to wake the patient and test again. This part took about half-an-hour. By the time he woke up, the MEP’s had partially returned. After another 15 minutes, he was able to move his right leg and foot. We decided not to be aggressive in correcting his curvature. Therefore, we fused and instrumented him from T3 to L2 in his current position. Because of the critical nature of this patient’s post-operative care, Dr. Peter decided to stay with him overnight in order to make sure that the blood pressure and neurological status would be well maintained.
By the time we finished this case, it was about 9:00 PM. We decided that we would all show up the next day around 8:00 AM and work efficiently so we could start our first case by 9:00 AM. Then we would have a much better chance of performing two surgeries and finish in a more reasonable time.
I was leaving that night. So Mervat arranged for the driver to drop me off at the airport. Some would say this was a once in a life-time experience. As for me, I am planning on coming back. I thank Dr. Ibrahim for his graciousness, thoughtfulness, and ability to teach; Mervat for all the work she does behind the scene; all the other doctors and support staff without whose hard work none of this would have been possible; and Nuvasive for donating equipment so that these surgeries could be performed.