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SRS: Scoliosis Research Society

Scoliosis Research Society

Dedicated to the optimal care of patients with spinal deformity

Trinidad - Port-of-Spain

Doctors

Complex Spinal Deformity Correction in Port-of-Spain, Trinidad

David Toby, MD
Princess Elizabeth Centre for Physically Handicapped Children, Trinidad, West Indies

Vincent Arlet, MD
UVA Health System, Department of Orthopaedic Surgery, Division of Spine Surgery

 

Background

In 2006 Dr. David Toby, Medical Director of the Princess Elizabeth Center in Trinidad & Tobago, approached Dr. Vincent Arlet about setting up a new SRS chapter in Trinidad & Tobago. Since that time the program has continuously expanded.

Dr. David Toby in partnership with Dr. Vincent Arlet provides expert orthopaedic care to patients in Trinidad & Tobago, with a population of 1.8 million. Dr. Toby operates an average of 50 spinal deformities every year at the Princess Elizabeth Center. Dr. Arlet joins Dr. Toby twice a year to perform 8 to 10 cases of complex spinal deformities requiring extensive release, posterior or three column osteotomies. Over the last ten years Dr. Toby and Dr. Arlet have corrected a total of 90 cases of complex spinal deformities. No neurologic complications were encountered.

Last year Dr. Arlet asked Duncan Tree Foundation (DTF) to help Dr. Toby and the Princess Elizabeth Centre to expand their program to increase awareness and sustainability of the Trinidad Program.

Since March 2012, DTF has been primarily focused on corrective spine surgeries for patients under 20 years old. Over the course of 3/4 Clinical Rotations a year, 35 complex spinal deformity cases have been operated. The average pre-op Cobb angle has been 95 degrees corrected down to 50 degrees in average.

Orthopedic surgeons from North America, Europe, Asia and Africa are joining DTF's cause and supporting DTF's Complex Spinal Deformity Correction in Port-of-Spain, Trinidad. Volunteers are teaching, giving lectures, helping with capacity building, and lending support.

Roughly 2-3% Trinidadians suffer from scoliosis. Currently, there are hundreds of adolescents on a surgical waiting list who cannot afford the expenses of corrective spine surgery. Approximately 54,000 Trinidadians live with moderate to severe scoliosis, and approximately 1% of these patients are in need of corrective spine surgery.

DTF Trinidad will provide training opportunities for healthcare professionals in Trinidad through capacity-building initiatives. The DTF visiting surgical team provides "gold standard" educational opportunities through lecture series for the local medical community.

Methods

Additionally, surgical theatre equipment upgrades were provided by funds from the Trinidad Health Department and private donors. These funds were used to add a Jackson table.

Spinal cord monitoring is a standard of care for these complex spinal deformities cases. Specialty Care provides neuromonitoring support.

Surgical Implants were generously donated by Depuy Synthes. Additional equipment included intermittent pneumatic compression devices for thromboembolic prophylaxis, a cell saver machine, a Midas-Rex burr, a bone mill system, and modern surgical tool upgrades.

The mission trips currently take place twice a year in late spring and fall, for up to 7 days. Volunteers pay for their own travel. Lodging accommodations and food are provided through a Community Chest, which is a local charity in Port of Spain. Passports and volunteer registration are required to enter the country. No vaccinations or visas are necessary for this mission trip.

Old OR table
Old OR table
New Jackson Table
New Jackson Table
Dr. David Toby and his team in Trinidad.
Dr. David Toby and his team in
Trinidad.

Patients

Over the course of 3/4 Clinical Rotations a year, 35 complex spinal deformity cases have been operated. An example is shown below:

Pre-op
Pre-op
Intra-Op
Intraop: Concave rib osteotomies
Pos-Op
Post op

Results

The average pre-op Cobb angle has been 95 degrees corrected down to 50 degrees in average.

We had 6 complications: One superficial wound infection. One case of postoperative respiratory depression from narcotics that was reversed with Naloxone. One CSF leak that required a lumbar drain. Three loss of evoked potentials during the surgery all reversible with adequate steps. No patient had any post op neurologic deficit.

Dr Toby and I would like to thank the SRS GOP, the staff from the Princess Elizabeth Hospital and the people from Trinidad and Tobago to help build up such an outreach program that helped us treat these complex spinal deformities.