Complex Spinal Deformity Correction in Port-of-Spain, Trinidad
A Global Outreach Program from SRS and FOCOS
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
Dr. David Toby provides expert orthopaedic care to patients in Trinidad and Tobago, with a population of 1.3 million. He operates an average of 50 spinal deformities every year at the Princess Elizabeth Center. I have been fortunate to know Dr Toby and help him doing surgery on complex cases requiring 2 spine surgeons.
In 2006 I approached Dr Boachie to know if he would help me setup a new chapter in Trinidad. Dr Boachie whose FOCOS outreach programs already included Ghana and Barbados was enthusiastic and helped me to organize such a new chapter in Trinidad.
Since that time the program has continuously expanded and has now 4 rotations a year.
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 was provided by Impulse monitoring. Total intravenous anesthesia (TIVA) techniques were started under the leadership of Prof Pajewski from the University of Virginia.
Surgical Implants were generously donated by Synthes ( AOUSS deformity system) 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...
Over the course of 3/4 Clinical Rotations a year, 35 complex spinal deformity cases have been operated. An example is shown below:
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, FOCOS, 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.