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.