Project summary: Establishing a charitable mission project to provide spinal disease and deformity treatment for the poor and under-served in India.
Featured Spine-health.com Member: Dr. Jeffrey R. McConnell
Establishing a charitable mission project to provide spinal disease and deformity treatment for the poor and under-served in India was a dream shared by two orthopaedic spine surgeons:
- Jeffrey R. McConnell, MD, an orthopaedic surgeon working at the Pennsylvania Spine & Scoliosis Institute, OAA Orthopaedic Specialists, Allentown, PA, with over twenty years surgical experience, fourteen of those years as a specialist spine surgeon.
- Dr. Ujjwal K. Debnath, FRCS, MS (Ortho) an orthopaedic surgeon working in Cardiff, UK and former colleague of Dr. McConnell's. Dr. Debnath has eleven years experience as a surgeon, with a special interest in spinal surgery.
In the U.S., Dr. McConnell established the Spine Education and Research Foundation to help fund the project, solicited donors, recruited skilled team members, and arranged for donated supplies and equipment.
While based in the UK, Dr. Debnath, native to India and Kolkata, navigated cultural, political and institutional barriers and tirelessly organized local support for the project through the Ramakrishna Mission Seva Pratisthan (RMSP), where years earlier he had completed some of his orthopaedic training.
In November 2006, after four years of hard work and careful planning, the dream shared by Dr. McConnell and Dr. Debnath became a reality when the "Operation Straight Spine" team landed in India.
"Operation Straight Spine" was successfully completed as a pilot charitable project during November 12 - 24, 2006. "Operation Straight Spine" is the first-ever charitable project of its kind in India and consists of outpatient clinics, major spine surgery interventions, ward rounds and teaching seminars for local support staff and physicians.
While in India, the "Operation Straight Spine" team successfully managed eight patients requiring major spinal surgery, inclusive of a 15 year old boy with a thoracic scoliosis deformity and a 63 year old woman who underwent a hi-tech laminaplasty procedure for cervical spinal stenosis with myelopathy. All equipment, consumable supplies, surgical instruments and implants necessary to perform these modern spine surgical procedures was provided by the international operating team and their generous sponsors. Medtronic Sofamor-Danek (Memphis, TN, USA) our primary sponsor, provided an inventory of 4.5 million USD worth of implants and equipment, as well as travel related expenses. Draeger International graciously provided the team with a much needed modern anesthesia machine delivered to RMSP after a 10 day journey by truck from Mumbai. Spinal Monitoring Associates (Bala Cynwyd, PA, USA) donated 50K USD of sophisticated equipment and a highly-skilled neurophysiologist to monitor patient's spinal cord and nerve function during surgery. Lehigh Valley Hospital and Health Network (Allentown, PA) supported the project with consumable operating room supplies and medications.
Notable Highlights of Operation Straight Spine
- First ever charitable project to provide spine surgery services to poor and underserved in India
- Performed eight major spine surgical procedures
- Performed first scoliosis correction surgery with pedicle screw instrumentation at RMSP hospital
- Used Bone Morphogenic Protein (BMP2) for spinal fusion for the first time in India
- State-of-the-art SSEP, MEP and EMG neurophysiological spinal monitoring techniques used for first time in India
- Featured on national DDNews TV program and "The Telegraph" newspaper
- Conducted SPINAL SURGICAL SERVICES FOR SPINAL PATHOLOGIES conference
- Trained RMSP Orthopaedic residents and nursing staff in spine surgery and perioperative care techniques.
India Trip Summary
The team of six specialists from the USA and Dr. Debnath from the UK arrived in New Delhi on the 11th of November. They attended the 51st annual Indian Orthopaedic Association (IOA) meeting where Drs. McConnell and Debnath gave lectures to the delegates on scoliosis surgery, disc replacement, spondylolysis repair, and minimally invasive spine surgery techniques. Acting as diplomats for "Operation Straight Spine", the team received important and overwhelming official support from the president and other key members of the IOA ensuring future success and sustainability for the charitable project. The team also had the opportunity to do some sight-seeing highlighted by our visit to the Red Fort and the Taj Mahal in Agra.
The team flew to Kolkata (Calcutta) on the 15th of November and set out to work relentlessly for the next eight days to assure all planned surgeries were safe and successful. Boxes of supplies were unpacked, instruments sorted, a nitrogen tank and regulator to operate a high speed burr was procured, and the anesthesia machine (arriving by truck at the last possible moment after a 10 day trip from Mumbai) was finally installed. Patients were screened and prepared for operative procedures during clinic sessions on the 16th and 17th of November. Following a morning clinic on the 17th, the team attended a symposium held in the hospital auditorium entitled SPINAL SURGICAL SERVICES FOR SPINAL PATHOLOGIES which was part of the educational component of out mission to help train staff, residents and nurses at RMSP. Each team member gave a didactic lecture presentation in their respective areas of expertise pertaining to spinal surgery. The seminar was addressed by the Head of the Institute, Sri Sarvalokanandaji Maharaj and attended by local surgeons and members of the West Bengal Orthopaedic Association including its president Prof. T.K Moitra.
Operating theatre sessions took place on the 18th, 20th, 22nd, 23rd and 27th of November. All patients during the first four sessions were operated on by Dr. McConnell assisted by Dr. Debnath and Dr. Chakraburtty or Dr. Paul. Dr Debnath performed a Buck's repair during the last operative session on the 27th for a symptomatic L5 spondylolysis. There were no surgical complications and all surgical goals of deformity correction, back or leg pain relief, were achieved. All patients did exceedingly well postoperatively and were satisfied and grateful with their surgical procedures.
Sophisticated, computerized neural monitoring equipment (utilizing Somatosensory-Evoked-Potential, Motor-Evoked-Potential and EMG monitoring) provided by Surgical Monitoring Associates was used for the first time in India. Spinal monitoring was conducted by Vijay Tambi, neurophysiologist, whose expertise in neural monitoring helped minimize risk to the spinal cord and spinal nerves ensuring an extra measure of safety for our patients during surgery.
The majority of the instrumentation and implants supplied by Medtronic were used for the first time in Eastern India, most notably BMP-2 (bone morphogenic protein). BMP-2 and PEEK (Poly-ethyl-ethyl-ketone) plastic cages placed in the intervertebral space were used to enhance fusion in five of the surgeries performed. These products are very expensive and are most commonly used in highly developed countries like the USA, Europe and Japan. These specialized products and all instruments and consumables were provided totally free of cost to the patients for all surgeries performed.
Despite the difficulties and obstacles presented during the two week mission of "Operation Straight Spine" the level of spine surgical care provided to the patients treated was comparable to the care provided in the USA and the UK. Patients, nurses, doctors, hospital administration and the people of Kolkata were very appreciative of the premier care provided to the under-privileged in this part of the world by the "Operation Straight Spine" project. The local and national media took interest in the project and the story was carried on DDNews TV and in the "Telegraph" newspaper. Overall, the project was a very great success and the first of its' kind in India. Each member of the "Operation Straight Spine" team was deeply moved by their experience in Kolkata and felt privileged for the opportunity to selflessly share their time and expertise for a small group of underprivileged patients in need of spinal surgery. The lives of the patients treated were positively and profoundly changed by correcting deformity, eliminating pain and improving daily physical functions, independence and productivity. Although the numbers treated relative to the need was small, the impact of this pilot project was large.
One of the primary goals of this project was to prove the feasibility of providing modern spine care services to indigent patients in Kolkata and other underserved areas in India. The future goal of "Operation Straight Spine" and the Spine Education and Research Foundation is to continue our work started in India. The need for modern spine care in this developing region of the world is tremendous. We hope to raise enough funds and procure equipment to develop a permanent spinal unit that will provide free clinics staffed by local physicians and program administrators. We will improve the service capabilities through a virtual spine clinic where digital photos and x-rays sent via email to consulting surgeons in the US and UK will allow appropriate patient screening and surgical planning. Complex spine surgeries, outpatient spine clinics and education of local surgeons and residents will then be provided by international spine care providers who will visit three to four times per year. Discussions are now in progress with the Indian minister of health and the minister of finance to ensure continued support for our project at the governmental level. Plans are also under consideration for building a free-standing orthopaedic specialty hospital funded through private and corporate donations, the Indian government and low interest government loans. This hospital will not only provide free spinal care services to the underprivileged in eastern India, but comprehensive general and specialty orthopaedic services as well.
A special, heartfelt thanks goes out to all of the people who helped to make this Operation Straight Spine trip a success, including:
Team Membersfrom USA:
- Sharon Monahan, CRNA (Nurse Anesthetist, Lehigh Valley Hospital)
- Andrea McAloose, RN (Operating Room Nurse, Lehigh Valley Hospital)
- Holly Tavianini, RN (Neuroscience Unit Head Nurse, Lehigh Valley Hospital)
- Vijay Tambi (Neurophysiologist, Spinal Monitoring Associates)
- David Kelley (Spinal Consultant, MedAlliance Inc., Distributor for Medtronic - Sofamor Danek)
Operation Straight Spine Sponsors:
- Medtronic Sofamor Danek
- Draeger International
- Lehigh Valley Hospital and Health Network
- B Braun
- Spinal Monitoring Associates
- DePuy Spine
- MTF Musculoskeletal Transplant Foundation
- Synthes Spine
- MAP International
- 3M Medical Division
- Cardinal Health
- Molnlycke Healthcare
- Bard Medical
- King Pharmaceuticals