Neurosurgery Program. International Spine Surgery Course and Mission

Transcription

1 Neurosurgery Program International Spine Surgery Course and Mission Cochabamba, Bolivia March 25 April 1, 2017

2 Surgical treatment of the spinal column is a highly-demanded area of medicine that requires precise case analysis, careful judgment, manual dexterity, close mitigation of risks and expert technical skills of medical personnel throughout the continuum of care. At the request of neurosurgeons in Bolivia, Solidarity Bridge and Puente de Solidaridad (PdS) led a three-day course in Cochabamba that focused on surgical treatment of the degenerative spine and of conditions resulting from trauma. The Cochabamba chapter of the Bolivian Society of Neurosurgeons and the Viedma Hospital, which co-organized and hosted the course, achieved the participation of 33 attendees from Bolivia and Nicaragua. The theoretical-practical course was made possible through the financial support of Globus Inc., which also provided state-of-the-art spinal instrumentation through its distributor, Atlas Medical. Instrumentation and supplies valued at $128,133 were donated by these companies and by missioners, and used in mentored surgeries during the course and in the subsequent week of mission in Sucre and Santa Cruz. I. COURSE GOALS The course focused on two principal goals: 1) Provide training and equipping resources to neurosurgeons and residents, and 2) Assist participants in improving knowledge, skills and techniques in traditional and minimally invasive surgeries. As is the case of all Solidarity Bridge missions, this course sought to ensure access to urgent and complex surgery for patients with limited economic means. II. MEETING OUR GOALS Course faculty Dr. Fanor Saavedra (right) discusses a case with colleagues: Dr. Luciana Rasguido, Dr. Rene Garcia, Dr. John Weaver, interpreter Francisco Lazaro, Dr. Barbara Lazio and Dr. Gustavo Jemio. a. Provide training and equipping resources to neurosurgeons and residents As an academic program, this course offered daily lectures by faculty from the University of Massachusetts Medical School, University of Puerto Rico, Providence Hospital Group and the Viedma Hospital, on the following topics:

3 Professionalism and Ethics in Neurosurgery The Degenerative Spine (spondylosis, spinal balance, pain generators, non-surgical treatment) Degenerative Instability (spondylolysis, spondylolisthesis, scoliosis) Surgical Treatment of Lumbar Spinal Instability (fusion and bracing, instrumentation, and TLIF, PLIP and ALIF techniques) Post-operative Spinal Instability (junctional instability, kyphosis, failure to achieve spinal balance) Spinal Cord Injury (surgical treatment, non-surgical treatment) Surgical Treatment of Trauma at the Cranial Vertebral Junction Surgical Treatment of Spine Trauma (cervical, thoracic, lumbar, open, minimally invasive) Surgical Management of Osteoporosis Fractures Minimally Invasive Spine Surgery: Indications and Techniques Surgical Treatment of Spinal Tumors Three months prior to this course, faculty at the Viedma Hospital led by hospital director Dr. Daysi Rocabado and neurosurgeons Dr. Gustavo Jemio and Dr. Rene Garcia, worked diligently to identify surgical cases that would provide robust learning experiences as well meet the socioeconomic criteria of Solidarity Bridge and PdS. The response was highly positive, with more candidates for surgery than could be provided within the mission s time limitations. Faculty and staff at the Viedma Hospital gathered on March 29 to analyze each case, resulting in a dynamic exchange of medical knowledge and experience. Cases for surgery were selected and scheduled. Globus spinal instrumentation was made available through the donation by Atlas Medical. b. Assist participants in improving knowledge, skills and techniques in traditional and minimally invasive surgeries Three surgical operations were the vehicle for the transmission of knowledge and techniques during the course, with an additional surgery performed following the course. The first patient, a 63-year-old woman with rheumatoid arthritis, had suffered the dislocation of two vertebrae and spinal cord compression, resulting in chronic pain and numbness in her limbs. She is on the road to recovery after successful spinal fusion using Globus instrumentation. A 50-year-old woman with Dr. John Weaver operates with colleague Dr. Miguel Saenz in a post-course surgery. 3

4 degenerative spondylolisthesis (sometimes termed a "slipped vertebral body") also required spinal instrumentation. The joints and ligaments in her spine had become weak and were no longer able to hold her spinal column in alignment. A third case of an adolescent boy is described on p. 4. It should be noted that young local doctors and medical students took on important tasks in several fundamental aspects of the course: case organization, case presentations, contact with patients, translation, interpretation and accompaniment of the medical team. Each of these individuals advanced his or her own knowledge, provided the valuable services mentioned and brought intergenerational energy to the mission. (See list of collaborators, page 5). Participants assessed the exchange of experience and best practices in a positive light. On a scale of one to five, participants consistently ranked the methodology and content of the course as very good (4) to excellent (5), with special recognition to faculty for their commentary on surgical processes. Participants predicted they will apply knowledge acquired through the course in their practice (4.5 average). The experience and professional skills of faculty was most highly rated (4.8.) In identifying course weaknesses, participants expressed the need for better technology for audiovisual transmission. Solidarity Bridge, Puente de Solidaridad and missioners were awarded a special recognition by the Bolivian Congressional Commission on Health, Recreation and Sports for the organization s longstanding commitment and best practices in serving patients without economic means. Dr. Diego Antezana (first row, second from left) was also honored for his long-term work with indigenous people. The Viedma Hospital was recognized for its work, represented by neurosurgeons Dr. Rene Garcia and Dr. Marcelo Wilcarani (first row, right). 4

5 III. A PROFILE IN COURAGE One of the most touching aspects of the course was the medical journey of young Diego, a 14-year-old boy who had lived with severe pain for months and experienced mobility difficulties. Diego s family attributed his condition to a prior accident, a typical tumble in the life of an active boy. PdS social worker, Maria Ines Uriona (pictured at right with Dr. Rene Garcia, Dr. Gustavo Jemio and intern Dennis Vedia), worked with the family to facilitate Diego s transfer from the Children s Hospital. In this way, Diego was able to benefit from the experience of the missioner team and valued Globus instrumentation. Course faculty carefully analyzed the case and its history. Diagnostic imaging revealed spinal tumors that had dislocated the third vertebrae. Although his surgeons predicted a lengthy day in surgery, the case was even more difficult than anticipated, requiring a full day surgery on Tuesday, and a second surgery on Friday. As part of this complex treatment, the neurosurgeons carefully removed hardware installed in Diego s prior surgery. They successfully repaired Diego s spinal column after removing spinal tumors that included an additional tumor discovered during the operation. Diego will require continued treatment by his attending surgeon. PdS is working to achieve radiation services that will respond to this case pathology. What impressed each of us on this mission was the courage of Diego, his mother (above with Dr. Barbara Lazio) and other members of his family. Diego s thumbs up after surgery and the heartwarming smile behind his restrictive brace reminded us of the resilience of the human spirit as well as the regenerative capacities of our bodies when we receive the medical care we need. For Diego, this meant access to safe spinal surgery, musculoskeletal implant instrumentation, and sound medical advice for post-operative treatment. 5

6 Solidarity Bridge thanks the many persons who made this mission possible: donors, medical professionals, patients and staff. Among others, we acknowledge: Globus Medical Inc. and Atlas Medical Inc. Zachary Kaufman Bolivian Society of Neurosurgeons, Cochabamba Chapter Dr. Sandra Campero, president Viedma Hospital and its Staff Viedma Hospital, Cochabamba Dr. Daysi Rocabado, Director Dr. Gustavo Jemio, Dr. Rene Garcia and the entire team of neurosurgeons at the Viedma Hospital Collaborating Hospitals Los Olivos Clinic (one surgery) Mission Participants Dr. Richard Moser, University of Massachusetts Medical Center and School Dr. John Weaver, University of Massachusetts Medical Center and School Dr. Barbara Lazio, Providence Medical Group Dr. Fanor Saavedra, University of Puerto Rico Medical School Mary McCann Sanchez, MA, MS, Senior Director of Programs, Solidarity Bridge Mission Facilitators Patricia Vargas Rojas, Executive Director of Puente de Solidaridad Maria Ines Uriona, Coordinator of Health Programs, Puente de Solidaridad Marcela Canedo and Fr. Dae Kim, Chaplains Jose Choque, Coordinator of Medical Supplies, Puente de Solidaridad and the entire team of Puente de Solidaridad for dedicated support work Ariel Montano, Communications, Puente de Solidaridad, Santa Cruz Sofi Porter-Castro, Operations Manager at Solidarity Bridge Mission Collaborators Dr. Luciana Rasguido, Viedma medical support staff Dr. Victor Lanza, interpreter Dr. Alejandra Blanco, interpreter Octavio Lazaro, medical student and interpreter Francisco Lazaro, medical student and interpreter 6