Operation Straight Spine 2017: Another Successful Mission Delivers Spine Care to Those in Need

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Spinal surgery at the Ramakrishna Mission Hospital

Spinal surgery at the Ramakrishna Mission Hospital during OSS 2017.

For ten consecutive years Operation Straight Spine (OSS) has been performing complex spinal surgeries for Indian patients who cannot afford or do not have access to treatment of their spinal deformities or diseases. In 2017, Dr Jeffrey McConnell and a team of specialists from the United States, England and India returned to the Ramakrishna Mission Hospital in Kolkata, India to treat patients of all ages suffering from a variety of spinal conditions.

Operation Straight Spine 2017 team members from the USA, India and England.

Supported by generous donations from companies such as Globus Medical Inc., Implanet, and Nuvasive Spine Foundation the OSS team was able to provide state-of-the-art implants and equipment for their surgeries.  Emirates Airlines Foundation was kind enough to donate the airline tickets for all team members which provided a huge boost to the project’s operating budget.

The youngest patient treated during this year’s trip was just 18 months-old and suffered from a congenital scoliosis.  The oldest patient was a 63 year-old woman with a painful and severe case of spinal stenosis with a slipped vertebra in the lumbar spine.  Other cases treated during the two week mission trip included adolescent scoliosis, early onset scoliosis and tuberculosis of the spine.  The work was challenging and all surgeries were successful in their outcomes and proved to be a truly life-changing experience for the patients.

Dr. McConnell with three of the patients treated as part of Operation Straight Spine 2017.

Case Study: Congenital Scoliosis in an 18 Month-old Boy

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baby scoliosis surgery

18-month old Arannya Adhakary with congenital scoliosis waiting for his surgery

Operation Straight Spine (OSS) is an annual mission trip to Kolkata, India, where doctors, nurses and spinal monitoring technicians from the US, England and India treat patients with spinal disorders. During the 2017 trip, Dr. Jeffrey McConnell and the OSS team treated an 18-month old boy with congenital scoliosis.

Arannya Adhakary, 18 months old, was the youngest patient treated during OSS 2017.  He was diagnosed with congenital scoliosis when he was just 3 months of age.

 Congenital scoliosis can be caused by a number of different defects in the development of the spine during the first trimester of fetal growth. Abnormalities occur when part of a vertebra fails to form or several vertebra fail to separate during the very earliest stages of fetal development when the spine and other major organs are starting to form. Patients can have a single abnormality or multiple defects throughout the spine. 

Arannya’s congenital spine defect was known as a hemivertebra, which occurs when the vertebra is triangular in shape instead of the normal rectangular shape.   This type of congenital defect has a very high propensity to cause a severe and progressive deformity of the spine, usually a kyphosis or scoliosis,  as the child grows.

Arannya’s hemivertebra was located at the 11th thoracic vertebra, approximately in the middle of his spine. Hemivertebra are best treated at an early age by removing the abnormal vertebra, correcting the deformity and fusing the growth plates above and below the hemivertebra so the deformity does not recur. Arannya’s surgery consisted of removal of the T11 hemivertebra, correction of the local kyphosis and scoliosis, and limited fusion from T10 to T12.  To stabilize the spine and help fuse where the hemivertebra was removed, two small screws and a single 3.5mm diameter rod was placed from T10 to T12 on the right side.

Arannya did amazingly well after surgery, a testament to his young age, and by the 4th postoperative day was going on walks in the courtyard, smiling, carried in his mother’s arms.

scoliosis deformity xray

Pre-operative MRI of the thoracic spine showing the T11 hemivertebra and acutely angled scoliosis deformity.

scoliosis postop xray

Post-operative X-ray after removal of the T11 hemivertebra and placement of spinal screws and rod.

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Four days after surgery on walk with his mother.

Case Study: Severe Scoliosis in an 11-Year Old Girl with Rare Syndrome

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Shruti Sharma during her pre-operative evaluation with the OSS 2017 team.

Kolkata, India,  January 25, 2017

During their annual mission trip to Kolkata, India, Dr McConnell and the other members of the Operation Straight Spine (OSS) team were faced with a very challenging case of severe scoliosis in an 11 year-old girl.

Shruti Sharma was diagnosed with Prader-Willi syndrome (PWS) at a young age.  PWS is a complex genetic disorder affecting approximately one in 15,000-30,000 individuals. The disorder results in short stature, disorders of metabolism, cognitive disabilities and behavioral problems. One of the hallmarks of the disorder is insatiable appetite and obesity which often leads to childhood diabetes mellitus (Type 2 diabetes).  Due to low muscle tone, patients will often develop spinal deformities such as scoliosis. Shruti was certainly the most challenging case the OSS team faced this year, not only from a medical management standpoint, but also by the severity of her spinal deformity.

Shruti originally presented to the OSS team in 2016 for consideration of corrective surgery for her thoracic scoliosis, however her diabetes was newly diagnosed and poorly controlled. The team thought it best to delay her surgery until their return trip in 2017 so that her diabetes could be brought under better control. By 2017 her left thoracic scoliosis curvature had progressed to 92 degrees.

Pre-operative X-ray showing severe, 92 degree thoracic scoliosis

Shruti’s scoliosis surgery

After Shruti was placed under anaesthesia, blood started collecting in her right lung for unknown reasons. This delayed her surgery for several hours. The bleeding eventually stopped and she was stable enough to complete the procedure, which lasted about 6 hours. It consisted of a posterior correction of the scoliosis and the placement of spinal rods and fusion from the 2nd thoracic vertebra to the 3rd lumbar vertebra. Due to her relatively small size, small 4.5mm rods and implants were used. Then, special bands resembling zip ties, known as  “Jazz Bands”, were attached to several vertebra. By slowly tightening the Jazz Bands the severe curvature of Shruti’s spine was gradually straightened and anchored to the spinal rods.

Shruti’s postop and recovery

Shruti’s postoperative course was somewhat stormy.  She remained intubated in the ICU for the first 24 hours. as her blood pressure was unstable and she ran a high temperature. On post-op day #1 the breathing tube was removed, but her right lung had filled with fluid and she required aggressive manual pulmonary therapy to help clear the lung. Ultimately, Shruti did very well and by the 4th post-op day she was smiling, walking, and coloring pictures.

About 3-4 weeks after her scoliosis surgery, Shruti had a slight setback when part of her spinal incision came open and developed an infection.  Luckily, Dr Ujjwal Debnath, based in India, was able to re-operate on Shruti’s back, wash out the wound and clear the infection. She required additional hospitalization and antibiotic therapy but ultimately recovered.

Post-operative X-ray showing excellent correction of the scoliosis deformity.

Shruti walking on 4th post-op day with OSS team member Bethan Salmon, RN

Case Study: Congenital Spinal Deformity

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During Dr. McConnell’s  yearly mission trip to Kolkata, India to support Operation Straight Spine he will often see cases of congenital spinal deformities.  This past year was no exception.  Congenital spinal deformity is caused by an abnormality in the growth of one or more spinal vertebra and occurs before birth.  After the child is born and during their most rapid periods of growth the spinal deformity can become quite severe and produce significant disability if not corrected early.

This is a case of a 22-year old man with severe congenital kyphoscoliosis who came to us complaining of back pain and progressive weakness in his legs.  The 3D CT scan of the spine pictured here shows just how severe his congenital deformity had become over the years.  The deformity was causing pressure on his spinal cord resulting in the weakness of his legs.

Lateral 3D CT image

Lateral 3D CT image

AP 3D CT image

AP 3D CT image

AP Post-op X-ray

AP Post-op X-ray

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Surgery was performed to straighten his spine and relieve pressure on the spinal cord.  The procedure involved removing two of the deformed vertebrae and inserting a cage to replace them. Spinal rods and screws were inserted to stabilize and keep the spine straight while the area fused together with bone graft.
Lateral Post-op X-ray

Lateral Post-op X-ray

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The patient had complete recovery of his leg weakness and was very pleased with his post-operative condition.

To learn more about Operation Straight Spine please visit our website at www.healingspines.org