Case of SC6385
On one of our earlier spine and scoliosis clinics in the Dominican Republic December 2010, we were presented with a very nice 11 year old girl who presented with a painful scoliosis, and upper leg pain. She had no neurological issues or gate disturbance on examination and was otherwise functional except for pain.
ISF began the process of obtaining diagnostic studies in preparation for surgical intervention on behalf of our patient as it was clear she would continue to progress. Part of the work included pulmonary function studies, and it revealed she had a restrictive lung condition secondary to the thoracic portion of her scoliosis (FEV1= 60%). Many of the patients in this country are forced to live with their progressive condition to the point that they become inoperable due to other medical comorbidities. She was also treated and struggled with chronic urinary tract infections which were difficult to control and prolonged her conservative treatment, and by Sept 2012, her curve had increased to 125 degrees.
Surgery was performed in September 2012 via a anterior thoracic release and posterior scoliosis partial correction and instrumented stabilization with neuromonitoring utilizing the facilities of HOMS Hospital Metropolitano de Santiago. The surgical team consisted of 9 highly trained professionals who provided intra-operative care for just under 10 hours. The team included one spine surgeon, cardiothoracic surgeon, general medical physician, anesthesiology, certified surgical first assistant, surgical scrub technician, neuromonitoring technician, and two equipment vendors. Without the help of Foundation HOMS and the hospital staff, her surgery would not have been successful. Her postoperatve treatment included 4 days in the very well staffed and equiped intensive care unit, and was discharged from the hospital after 8 days.
She was discharged from the hospital with a residual 76 degree curve, and continued to improve and recover at home. She is currently doing well and her function has showed gradual and steady improvements and has returned to most of her activities of daily living. Her preoperative leg and back pain has resolved. We will continue to monitor her progress over the next 3 years.
Urgent Need: This is a 21 yr old girl who have been suffering with painful upper chest scoliosis and has a documented slow decline in her pulmonary function. Her current pulmonary function values are still high enough to safely perform her surgery but this will not endure. Due to the extreme poverty of her family, they have been unable to afford the needed diagnostic studies required to safely perform her surgery. She was first evaluated 14 Dec 2010 and has struggled to save the money to afford serial scoliosis x-rays along with CT scans and MRI.
Her examination shows no evidence of a neurologic deficit currently.
Her last Pulmonary Function Studies shows a FEV1 = 61.6%
Surgery was performed without complication with only a few days in the hospital. She is currently pain free and happy with her results. Surgery was performed September 2014. Her surgical time was 6 hours and 28 min. We lost 800 ml of blood and were able to return to her during the operation 460 ml of her own blood via cell saver processing. Her recovery was remarkable and only needed two days in the hospital.
Her family has expressed their deepest thanks and appreciation of all the volunteers and philanthropist that supported her surgery.
HISTORY: Mariel is a 15-year-old female who has suffered with significant mid back pain and progression of her spine deformity (scoliosis) over a 2 year span. Surgical time was 6 hours and 27 minutes, 900 cc of blood loss, and we were able to return to her, via Cell Saver, 225 cc of blood of her own blood. Postoperatively her wound drain stopped working and she developed a hematoma, that required a return to surgery for wound related complications.
Her second surgery was successful and she now remains asymptomatic. She has no evidence of drainage, the wound is stable and healed, and she is happy with her results.
Scoliosis Reconstruction, T4 to L4 for Idiopathic Scoliosis.
HISTORY: Orley is a 15-year-old female with idiopathic scoliosis of the right thoracic and lumbar spine. She underwent T4 to L4 surgery for her idiopathic scoliosis on September 7th, with 1200 cc of blood loss and 227 cc of blood returned. Her length of stay was 5 days. She did very well postoperatively and has been anxious to return back to all of her activities of daily living. She has not been cleared due to the need to revise her hardware.
The surgery was performed on December 6th 2014 by a 6 man surgical team comprising part of our AZ team and with the help of our Dominican partners. Her surgery was very successful and has returned her to improved function.