| a publication for iasa members • issue 3 • fall 2013 |
IN THIS ISSUE
| first Humanitarian mission PagE 2
| bioskills Workshop: back by popular Demand! PagE 4
| Visiting surgeon program PagE 5
| spine fellowships Grow PagE 6
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Operation Straight Spine (OSS) was established in 2002, with a vision of establishing a medical aid project for children and adults with spinal disorders. OSS’s approach is both medical and developmental, combining surgical intervention with rehabilitation and outpatient clinics to follow up and accelerate recovery.
Headed by founder and IASA member Dr. Jeffrey McConnell of Allentown, PA, OSS made its sixth mission trip to India in February 2013. Two teams of spine professionals from the US and the UK met for 10 days in Ramakrishna Mission Hospital in Kolkata. The team consisted of spine surgeons, anesthesiologists, pediatric nurse specialists, neuroscience nurse specialists, and neuromonitoring specialists. IASA member Dr. Bobby Bhatti of Conyers, GA, volunteered to join the group as well.
They operated on 14 patients from ages 3 to 70. There were cases of herniated discs, tuberculosis of the spine, thoracic scoliosis and kyphosis, congenital and early onset scoliosis, spinal stenosis, and corrections to previous surgeries.
IASA is presently reviewing applications for mission trips to other parts of India and will be bringing you updates in future issues of the newsletter and on our website. We welcome your interest in this program.
Sponsored by IASA, Operation Straight Spine returns to Kolkata
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Dr. bHatti's report
My Experience in Kolkata
I arrived in Kolkata on Sunday, February 10. The team had been there for one week already operating for 7 days. During that time they had performed 10 pediatric scoliosis cases ranging from growing rods to long construct corrections. We made rounds on the most recent inpatients with the residents of The Ramakrishna Hospital early Monday morning. It was quite obvious as we visited the communal pediatric wards that the patients and families were full of appreciation for Dr. McConnell's work. The team performed dressing changes and educated the patients and families about their postoperative care.
Dr. Debnath had set up an L1 Tuberculosis case. The patient received a pacemaker early that morning. We started with the patient in a lateral position, with the anesthesia residents learning on the go TEVO. We performed a corpectomy and decompressed the TB and restored normal sagittal alignment. We implanted an expandable titanium cage containing both the 12th rib autograft and allograft. The patient was then re-positioned for the open posterior fixation. This was an "early" day ending around 6pm as we were able to leave the hospital and clean up in time for a traditional Bengali dinner.
The next day started the same as the first with rounds. Our first case was a lumbar spondylosis with significant central canal stenosis. Our instrumentation was open, with an OR table that did not adjust in height or rotation, so we performed an open decompression and TLIF, with posterior instrumentation. Moreover, we had very limited flouroscopic capabilities so the traditional open techniques which I rely on less seldom but Dr. McConnell has perfected during his many trips to Kolkata came in handy. My learning curve was steep and very beneficial!
Our next case was an L5-S1 discitis 6 weeks post op from a discectomy. We performed an L5-S1 ALIF with PLIF cages anteriorly for our only option, and then posteriorly decompressed and instrumented. This was a "normal" day and we returned back to the hotel around 11pm. Exhausted, but fulfilled. The team that had already been there for 10 days left, while I remained in Kolkata and rounded on the inpatients.
My first participation with the Operation Straight Spine Team was significant. It satisfied both my goals of giving back to a community less fortunate than ours, and the less altruistic goal of cleansing my soul. Dr. McConnell is a wonderful mentor and his leadership and humble approach to the patients at Ramakrishna Hospital are truly an inspiration. I hope to return next year to continue to learn and help in any way I can.
– Dr. Bobby Bhatti ¡
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above: Dr. McConnell (right) and Dr. Bhatti (left) in the operating room
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Back by Popular Demand, Bioskills workshop returns to Bangalore!
In September 2012, IASA held its first bioskills workshop in Bangalore at the prestigious and well equipped MS Ramaiah Advanced Learning Center.
MSRALC is a state of the art facility comprising of a Cadaver Lab, Drug Testing Lab, Tissue Bank, and Clinical Research Center for educating both medical students and professionals alike.
All forty four surgeons in attendance gave very positive feedback, therefore the IASA board elected to return to Bangalore this September. Dr. Sajan Hegde, of Apollo Hospitals in Chennai, and Dr. Dilip Sengupta, of Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire remained as co-chairs.
For this year's program we instituted a ratio of one faculty member per each registrant. The faculty was comprised of a new team of notable spine surgeons from the US, Switzerland, and India, covering cervical and lumbar issues through presentations and bioskills labs. For two days, the faculty enthusiastically shared their insights, skills, and techniques with a very eager and receptive audience.
Some of the subjects covered were myolopathy, arthroplasty, adult deformity, degenerative spondylolisthesis, OPLL, dynamic stabilization, and fusion instrumentation.
Our faculty
Dr. Upendra B.N.Dr. Saumyajit Basu
Dr. Mahesh BijjawaraDr. Tapan K. Daftari
Dr. Roy DanielDr. Harsha K. Hegde
Prof. Arvind JayaswalDr. K. Appaji Krishnan
Dr. Ram MudiyamDr. Surya Prakash-Rao V.
Dr. Umesh SrikanthaDr. Vamsi Krishna Varma
above: Workshop attendees and Co-Chairs Dr. Hegde and Dr. Sengupta strategizing in the bioskills lab.
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Visiting Surgeon Program Continues to Support Short Visits
The Visiting Surgeon Program (VSP) was established to accommodate spine surgeons for short, 2-4 day observorships with other surgeons, each with a specific goal in mind. To that effect, IASA has sponsored three surgeons:
1. In August 2012 Dr. Krishna Kumar of Cochin, Kerala, spent a week in Chicago with Dr. Singh of Rush University Medical Center and Dr. Patel of Loyola University, before attending the SRS Annual Meeting.
2. In February 2013, Dr. Appaji Krishnan of Chennai, Tamil Nadu, visited Dr. Suken Shah at Nemours/Alfred I. DuPont Hospital for Children for three days, following a visit with Dr. Lawrence Lenke at St. Louis Children’s Hospital.
3. In September 2013, Dr. Shah Alam of Dhaka, Bangladesh, attended the SRS Annual Meeting in Lyon, prior to his visit with Dr. Alok Sharan at Montefiore Medical Center in New York, and Dr. Dilip Sengupta at Dartmouth-Hitchcock Medical Center in Lebanon, NH.
We welcome your interest and inquiries about the program. Applications can be downloaded from the VSP page on our website: indo-americanspine.org/visiting-surgeon-program
at Right: Dr. Krishna Kumar (left) with his mentor, Dr. Alpesh Patel
Since the Spring of 2012 when IASA first announced opportunities for Spine Fellowships, 16 applications have been received. So far, five spine surgeons have been accepted into the program, and another five applications are pending review.
Dr. Palani Vel Raaja was the recipient of our first Fellowship program, spending his one-month Fellowship at Rush University Medical Center in Chicago under the mentorship of Dr. Kern Singh, Assistant Professor of Orthopaedic Surgery, and Co-Director of the Minimally Invasive Spine Institute at Rush.
Our second Spine Fellow was Dr. Vijay Sekharappa, who spent a month in Chicago dividing his time between Dr. Kern Singh at Rush Medical, and Dr. Alpesh Patel at Northwestern Memorial. Dr. Patel is Associate Professor in the Department of Orthopaedics at Northwestern Memorial. Dr. Patel and Dr. Singh are co-founders of IASA, and staunch supporters of our Fellowship and Visiting Surgeon Program.
In August, Dr. Damandeep Makkar completed his Fellowship in minimally invasive surgery with Dr. Singh at Rush Medical in Chicago. Dr. Agnivesh Tikoo spent the month of September with Dr. Sashin Ahuja at the University Hospital of Wales & University Hospital Llandough, both in Cardiff, Wales.
For more information or to download an application for the IASA Spine Fellowship program, please visit us at indo-americanspine.org/fellowships
felloWsHip report by Dr. makkar
My Experience as an Indo-American Spine Alliance Fellow
I was delighted to receive word that I had been selected as a Spine Fellow of the Indo-American Spine Alliance (IASA) at Rush University Medical Centre, Chicago, under the mentorship of Dr. Kern Singh. The whole process, from the invitation letter to travel and lodging arrangements, was meticulously handled so that I encountered no hurdles in acquiring a US visa or in my move to Chicago.
On the evening of 31st of July I arrived in Chicago – the windy city. I was picked up from the airport and dropped off at a beautiful apartment right next to the famed “Magnificent Mile,” where I could see the tall Chicago architectural delights.
On my first day at Rush, I met Susan Dvojack, the fellowship director at Midwest Orthopaedics, who took me around the premises and introduced me to Dr. Kern Singh. Much to my surprise Dr. Singh remembered me from the IASA spine workshop in Bengaluru last year. I was informed of Dr. Singh’s schedule, and about all the various activities I could get involved in his absence. I was introduced to his personal staff, Kristin and Priya, who briefed me on the operating room schedule. I also met Dr. Sreeharsha Nandyala and Dr. Alejandro Lara, Dr. Singh’s research Fellows. They shared with me the various research projects underway, and invited me to collaborate with them. I ended up reviewing a few chapters in a book Dr. Singh is editing on Minimally Invasive Surgery, to be published soon.
The next morning I was at the Spine Clinical meeting where Fellows presented various cases to the faculty and discussed their pre-operative plans. There were quite a few interesting cases and the views of some of the stalwarts in the field of spine surgery were enlightening. This academic endeavor happened every Wednesday and Friday and I found them very informative.
The operating room experience with Dr. Singh was exhilarating. One has to be there to feel it; he runs two operating rooms simultaneously on every Tuesday and Friday, with every case planned to the finest detail. His timings are so consistent that he knows when he will be moving to the next operating room and before you know it you have seen 7 major spine cases done in a day by a single surgeon.
More Surgeons Joining the IASA Spine fellowship Program
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You would see the whole spectrum of spine surgeries from ACDF, to ALIF, to XLIF, to TLIF, to MIS discectomies and laminectomies. The best part of it all is the way Dr. Singh explains his techniques and procedures during surgery; he gives you tips and tricks while everything is being projected from his head camera to the LCD screens. He is very open to questions and enjoys answering them, making it all sound so simple and easy.
At the end of my month- long visit, I had seen 44 surgeries, among which were some excellent cases of XLIF corpectomies, and revision spine surgeries done with minimally invasive techniques.
I also spent time with him in the clinic (OPD) were he would discuss management and outcomes of his various cases. He would keep everyone on their toes by asking questions from the fellows and students.
In addition, Dr. Singh got me permission to go to the operating rooms of other surgeons such as Dr. Howard An, Dr. E. Goldberg and Dr. C. DeWald where I saw a wide array of open case spine surgeries from primary TLIF to scoliosis revision.
The weekends were reserved for exploring the city. The location of my apartment was so convenient that I could walk to all the major attractions. I enjoyed Chicago thoroughly, the Magnificent Mile; the various museums, Navy Pier, Architectural Boat tours, City bus tours, Chicago Cubs game, not to mention the delicious food.
One month flew by, having learned so many things; I have come back to India more enriched with knowledge and more procedures in my armamentarium and a bag full of tips to help me become a better spine surgeon. Thanks to the Board of IASA, Dr. Kern Singh, Nazie Dana and everybody at Rush for making it all possible.
– Dr. Damandeep Makkar ¡
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IASA Newsletter is printed twice a year. Editor: Nazie Dana.Cover Photo: Operation Straight Spine patient Juli, 10 months post op
If you are interested in becoming involved with the group and its activities, please log on to our website (indo-americanspine.org) and join, or contact Nazie Dana, IASA Program Director at 866.835.5306, or via email at [email protected]
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Planning to be in new Orleans for the nASS Annual Meeting?
J O I N U S A N N U A L I A S A R E C E P T I O N AT N A S SIndo-American Spine Alliance (IASA) Board of Directors
invites you to join us at the Annual IASA Reception at NASSThursday, October 10, 2013 | 5:30 PM – 7:00 PMHilton New Orleans Riverside Belle Chasse, Third Floor 2 Poydras Street, New Orleans, LARSVP by October 7, 2013 | [email protected]
