Barbados
State Of The Art Scoliosis & Complex Spine Surgery Performed At The Queen Elizabeth Hospital In Barbados
![Queen Elizabeth Hospital]() Congenital spine deformity results from anomalous vertebra development and can result in scoliosis, kyphosis, or lordosis. These deformities develop during the early period of spinal development in the embryo, when the skeletal system is formed. Therefore there is a high incidence of associated anomalies averaging 60%. Family history is very rare, and isolated anomalies have no genetic risk. However, complex anomalies may carry 5-10% risk. Anatomical classification can be divided into defects of formation, defects of segmentation, and mixed anomalies. Defects of formation could be related to hemi-vertebra, single, or double. Natural history of the deformity depends on the type of local deformity, levels involved, and the site. A unilateral unsegmented bar with contralateral hemi-vertebra poses the greatest risk of progressive deformity. Lower thoracic and thoracolumbar deformities are also at greater risk of progression. Overall, 25% of curves do not progress, twenty-five percent will progress slowly, and 50% are very progressive. Bracing can be used for long flexible curves over many segments. Surgery is the mainstay of treatment for most of the deformities and can include:1) posterior spinal fusion in situ; 2) posterior spinal fusion with cast correction;3) anterior and posterior spinal fusions via a growth arrest procedure, i.e. anterior and posterior hemi-epiphysiodesis, and 4) hemi-arthrodesis and hemi-vertebra or wedge resection. Posterior spinal fusion is the gold standard. Fusion of the entire index curve is required. Postoperative cast or bracing may be needed, and internal fixation is reserved for large patients. Growth arrest procedures are indicated in patients younger than five years of age with between 50 to 70ยบ scoliosis and is contraindicated if kyphosis is present. Anterior and posterior spinal fusions are performed in immature patients to avoid crankshaft and in large, rigid deformities to reduce pseudarthrosis and curve bending.
FOCOS Surgeons And Staff Volunteers Engages In A Program Of Training And Education In Barbados
Complex spinal reconstruction entails the collaboration of multi-specialists, including orthopedic surgeons, anesthesiologists, nursing, operating room technicians, internists, pediatricians, physical and occupational therapists, nutritionists, neurologists, general and vascular surgeons, neurosurgeons, psychologists and social workers, to name a few. This multidisciplinary team approach was immediately put into place at the Queen Elizabeth Hospital in Barbados. Grand Rounds and in service programs with the different teams at the hospital were accomplished during the 2 days preceding the week of surgical procedures. QEH Staff Anesthesiologists assembled for a pre-surgical spinal update with FOCOS surgeons and resident orthopedic surgeon Dr. Jones.
Carson Knight is a 15 year old resident of Barbados who initially presented to Dr Jones with scoliosis. Even though less common in boys, idiopathic scoliosis affects boys who usually present with curves larger than their counterparts in girls. The natural history of untreated scoliosis follows the same pattern as in girls with the potential for cardiopulmonary compromise in severe cases. CK underwent a successful 3 hour Spine fusion and instrumentation by FOCOS surgeons Gupta and Boachie.
Dr. Gupta is joined by Mr. Perez, RN, and Ms. Mastrandrea,ST, during a training session. The FOCOS international program includes educational components including Grand Rounds, Seminars, in-service programs, workshops and patient education. During these sessions patients and preoperative protocols are reviewed, and implants and instrumentation are assembled and sterilized for the different procedures to be performed.
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