| a publication for iasa members • issue 4 • spring 2014 |

In thIs Issue

IASA at ASSICON 2014 page 3

Spine Fellowship in New York City page 4

A VSP Opportunity in Kerala page 5

Mission Trip to Ahmedabad page 6

CelebrATINgOur ThIrd YeAr

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Dear Members,

It is with great pride that I announce the start of IASA’s third year of existence! As with many things in life, it seems longer than two years, but also shorter since time goes by quickly when there are many things to do!

We have accomplished many of the objectives we identified early on, and have increased the number of surgeons involved in our programs. We currently have 370 members in India and more than 140 outside of India for a total of 510. After recently attending and exhibiting at the 27th Annual Conference of The Association of Spine Surgeons of India (ASSICON) in Kolkata, we enrolled over 60 new members and met personally with many who had participated in IASA programs over the past two years. The reception for members was well attended by more than 100 surgeons and featured a presentation by Dr. Damandeep Makkar, a past recipient of an IASA Spine Fellowship. He gave an overview of his experience with Dr. Kern Singh at Rush Medical Center in Chicago. This type of surgeon to surgeon exchange is the heart of our mission and as such we have increased the number of spine fellowships we will support in 2014 from three to six. We have added opportunities in New York, San Francisco, and Los Angeles, in addition to sites previously used in Chicago and Cardiff, UK. We have also supported three visiting surgeons from India who each spent a few days at different U.S. teaching institutions. In 2014, we will be reciprocating by sending surgeons from the U.S to India for short, educational exchanges.

So far, IASA has supported two humanitarian mission trips to India and facilitated the treatment of over 20 needy patients with spinal diseases, who otherwise may not have been helped. With the support of our members both within and outside of India, we hope to continue to expand this part of our organization's mission. We extend our sincere gratitude to members Dr. Jeff McConnell and Dr. Sashin Ahuja, who have led the mission trips we have supported to date.

We have published four newsletters reporting on many of the programs we have supported in the past two years, and continue to update our website (www.indo-americanspine.org), which I encourage you to visit regularly. A great deal of thanks goes to Ms. Nazie Dana, Director of IASA, for her tireless efforts in working with all of you to implement our programs. I would also like to thank our Board of Directors, Drs. Singh, Hegde, Patel, Sengupta, Rajasekaran and Jayaswal, for their guidance and commitment in getting our organization off the ground and growing. Thank you, gentlemen!

Our challenge as an organization is to continue to grow and provide meaningful opportunities for our members to exchange ideas and mutually educate each other for the benefit of treatment of patients with spinal pathology in India. To properly affect this mission, we need your participation through your suggestions, leadership, and guidance.

As we embark on our third year, I am proud of what we have accomplished, but look forward to doing more with your help. Please do not hesitate to reach out to Nazie or myself with your input.

Sincerely,

M. Kevin Carouge Chairman IASA

Celebrating Our Third Year

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In January, IASA participated at 2014 ASSICON in Kolkata, India. The annual gathering attracted more than 100 members and prospects. Over 60 surgeons joined as new members.

Additionally, an announcement was made at a general session inviting ASSI members to submit their deformity research proposals for the 2014 "IASA Research Grant at ASSICON". Six proposals were received and Dr. Kiran Kumar of Kolkata, principal investigator, was selected as the recipient of the grant for the following project: Correlation of MRI tactography with neurological status in patients with deformity due to spine Tuberculosis and its usefulness in predicting neurological recovery.

Congratulations, Dr. Kumar! v

IASA at ASSICON 2014

I A S A N e w S l e T T e r | S p r I N g 2 0 1 4

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Since its inception, IASA has granted one month Fellowships to five young spine surgeons from India. They have been placed at leading academic institutions in the U.S. and U.K., with prominent spine surgeons as their mentors. In 2014 alone, we have awarded six such Fellowships. Starting in June, we will accept applications for the 2015 calendar year.

Please visit our website for more information: http://indo-americanspine.org/fellowships/

Below is a report from Dr. Om Gupta of Bhadohi, Uttar Pradesh, who spent a month with Dr. Sheeraz Qureshi at Mt. Sinai Hospital in New York City.

My Journey as an Iasa Fellow

First, I would like to thank ASSI and IASA for giving me this wonderful opportunity to spend a month in New York as an IASA Spine Fellow. I was delighted to find out I was selected. The whole process, from receiving the invitation letter to travel and lodging arrangements were meticulously handled so that I would not encounter any hurdles.

My journey started in Delhi in the early hours of Feb 1, 2014. I reached the Newark airport in the evening. I was picked up from the airport and dropped off at a beautiful apartment on the Upper East Side in Manhattan where I stayed for the month.

On my first day at Mount Sinai Hospital I went through orientation. The next day I met my mentor, Dr. Sheeraz Qureshi. He welcomed me warmly and introduced me to Drs. Branco and Motasem, his neuro and orthopedic spine fellows, along with the rest of his team. He informed me about his work schedule; surgery on Mondays, Wednesdays, and Fridays, Manhattan clinic on Thursdays, and his New Jersey office on Tuesdays.

The next morning I was at the spine research meeting where fellows and faculty discussed their projects. There were quite a few interesting cases and the views of some of the stalwarts in the field of spine surgery were enlightening.

My experience in the operating room with Dr. Qureshi was exhilarating. He is a minimally invasive spine surgeon. You would see the whole spectrum of spine surgeries from XLIF,

to TLIF, to MIS discectomies and laminectomies. He did them all through a tubular retractor. The best part was how Dr. Qureshi explained his techniques and procedures during surgery; he gave tips and tricks while everything was being projected from microscope to the LCD screens. He was very open to questions and enjoyed answering them, making it all sound so simple and easy. I also met Dr. Heht and Dr. Newirth, who practiced open spine surgery.

In addition, I spent time with Dr. Qureshi in the clinic (OPD) were he would discuss management and outcomes of his various cases. He would keep his fellows and residents on their toes by always asking them questions.

I also got a wonderful opportunity to attend the 7th CSRS Hands-on Cervical Spine Cadaver Course for three days at St. Louis University Medical School, thanks to IASA. I learned a lot from this course, which had a strong faculty including Dr. Dan Riew and Dr. Qureshi. The 3D demonstration of the procedure was fabulous where you could see it from all angles.

The duration for the IASA fellowship is only a month. It will be helpful for the young budding surgeons if it could be extended. Also it would be beneficial if the program includes attendance at a workshop such as the CSRS hands-on cadaver course.

All arrangements made by IASA including travel, health insurance, lodging, transportation, etc. were excellent. I thank Nazie Dana, program director at IASA, who guided me through the process, and Dr. Qureshi for accepting me for the fellowship despite his busy schedule, and sharing his vast knowledge and experience in minimally invasive spine surgery. – Dr. Om Prakash Gupta

Spine Fellowship in New York City

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When a call for volunteers to join a humanitarian mission or a visiting surgeon program in India went out to the membership, Dr. Ripul Panchal, DO, of San Diego, CA, jumped at the opportunity and contacted IASA immediately. He first connected with Dr. McConnell’s mission team Operation Straight Spine in Kolkata for a week, and then joined Dr. KrishnaKumar, a past VSP himself, at Amrita Institute of Medical Sciences in Kochi, Kerala, for a few days. Below is his report.

a VsP oPPortunIty In Kerala

IASA had arranged for me to visit Dr. Krishna Kumar, an orthopedic spine surgeon, and my gracious host for three days. I arrived in Kochi, Kerala, Saturday evening, and felt as if I had landed in a new country with a different culture and language. Although I was born in India and had visited the country since immigrating to the United States, the culture and language was very different than what I had been accustomed to. I had Sunday to explore the town, and with a hotel driver visited local tourist attractions such as the St. Francis church (Vasco da Gama’s Tomb), Chinese fishing nets, the Jewish Synagogue, the Dutch Palace and the newest addition, the Kerala Folklore Theatre & Museum.

Monday morning, I arrived at the Amrita Institute of Medical Sciences, a 1500-bed private hospital. Dr. Kumar, who I met for the first time that morning, gave me a brief office tour and we attended morning grand round conference. I met the

orthopedic chair, Dr. Chandrababu, and the rest of the faculty. One of the residents had prepared a talk on congenital scoliosis.

Next, Dr. Kumar gave me a tour of the hospital and rounded on his inpatients. I found this to be a much newer institution and equipped with the same type of furniture as American hospitals, made up of private beds and wards. Dr. Kumar introduced me to Dr. Sajesh K. Menon, neurosurgery chair. I accompanied him into the OR (referred to as OT in India). He had a neuro-oncology and spine fellow. Similar to our practice, he also ran two rooms. The OR section was divided into the Neuro/Ortho section. I found the OR set up and flow similar to set up in United States. The staff was very welcoming. That evening Drs. Kumar and Menon invited me to have traditional Kerala dinner with them, and we had a wonderful time sharing our experiences in the field of spine, research interests, career goals and personal life.

Next day, I observed Dr. Kumar perform a lumbar decompression case very meticulously, with a traumatic deformity to follow. On my last day, I was asked to present a lecture on cervical deformity at the morning Grand rounds that was well received. Dr. Kumar shared his experience from his recent visit to the US and his strong interest in research.

The visit was an invaluable experience. I hope to continue collaborating with the physicians I met to further research and treatment of the underserved. IASA allowed me to meet new surgeons in India, and created an opportunity to not only see what other surgeons do, but also a chance to continue to work together, share ideas and conduct research at a much higher level to help spine patients. v

VSp Opportunity in Kerala

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Dr. Sashin Ahuja, an IASA member in Cardiff, Wales, organized a humanitarian mission to Ahmedabad this past February, in partnership with the Polio Foundation. With a team of experts headed by Dr. Ahuja and Dr. Bharat Bhagat, Polio Foundation Chairman, ten scoliosis patients between the ages of 5 to 26 were selected and successfully operated on. Below is a report.

MIssIon trIP to ahMedabad

IASA sponsored a mission trip in Ahmedabad spearheaded by IASA member Dr. Sashin Ahuja of University Hospital of Wales, Cardiff. His team of ortho and neuro surgeons, anesthesiologists, and neuro-monitoring specialists, along with a team of India based spine surgeons spent a week operating on ten scoliosis patients at the Polio Foundation’s hospital, and the BJ Medical College & Civil Hospital. Patients, from 5 to 26 years of age, were carefully examined and selected by all five surgeons, and scheduled for each day of the week. Each surgery took between six to nine hours to complete, with an overall consumption of only six units of blood, thanks to the efficient use of anesthesia and skillful surgery.

The team consisted of:dr. sashin ahuja, Spine Surgeon, University Hospital of Wales, Cardiff, UK dr. am rai, Spine Surgeon, Norfolk and Norwich University Hospital, Norwich, UK dr. shaishav bhagat, Spine Surgeon, Ipswich Hospital, Suffolk, UK dr. Vinay Jasani, Spine Surgeon, University Hospital of North Saffordshire, Stoke-on-Trent, UK dr. Iqroop Chopra, Neurosurgeon, University Hospital of Wales, Cardiff, UK dr. steven Pugh, Anaesthesiologist, University Hospital of Wales, Cardiff, UK Mr. Mushtaq sheikh, Neurophysiologist, Bespike Healthcare, Preston, UK dr. Kalpan desai, Consultant Orthopedic surgeon, Smruti Fracture Orthopedic Hospital, Ahmedabad, India dr. J.P. Modi, Spine Surgeon, B.J. Medical College & Civil Hospital, Ahmedabad, India dr. M.M. Prabhakar, Chair, Dept. of Orthopedics, B.J. Medical College & Civil Hospital, Ahmedabad, India dr. bharat bhagat, Chairman, Polio Foundation, Ahmedabad, Indiadr. Prakash bhatt, CEO, Polio Foundation, Ahmedabad, India Mr. banerjee, Administrative officer, Polio Foundation, Ahmedabad, India

The team was split between the two locations; two male and two female patients were operated on at the Polio Foundation, and the other six at BJMC.

A short synopsis of the ten cases can be seen at right.

aCKnowledgeMents

• IASA: Financial support of the mission • Globus Medical: Provider of implants and instrumentation• Medtronics India: Provider of neuromonitoring equipment• Dr. Kalpan Desai and Dr. Amit Zala: Local arrangements at

Polio Foundation• Dr. M.M. Prabhakar and Dr. J.P. Modi: Coordination at B.J.

Medical College and Civil Hospital • Dr. Sashin Ahuja: Coordinating the UK team, consisting of Dr. Am

Rai, Dr. Vinai Jasani, Dr. Iqroop Chopra and Dr. Shaishav Bhagat, Dr. Stephen Pugh, Mr. Mushtaq Shaikh and Mr. Ian Weighell

• Mr. Biren Shah: Organizing accommodation for the UK team

In addition, a number of other doctors including anesthesiologists, radiologists, pediatricians, physiotherapists, neurologists, junior surgeons in training at both institutes and non-medical staff have contributed their time and skills to the success of this mission.

goIng Forward

Scoliosis is a grotesque spinal deformity associated with a huge social stigma, enduring physical disablement which would require some challenging treatments to a young child with far reaching socio-economic consequences. There is need for joint action to help children and families with such condition.

The entire team from UK and India has expressed their wish to repeat this charity mission every year, with hopes of continued support from all organizers. – Dr. Shaishav Bhagat

Mission Trip to Ahmedabad

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SYNOpSIS OF THe TeN CASeSPatient 1 (26 year old male) - Severe deformity spanning thoracolumbar junction, corrected with pedicle screws and osteotomies.

Patient 2 (17 year old male) - A large curve with significant disfigurement and disability which would have worsened if left untreated. The curve was corrected from nearly 85 degrees pre-operatively to about 20 degrees. [Fig. A]

Patient 3 (14 year old female) - Severe kyphotic and scoliotic condition was corrected with osteotomies and re-aligning.

Patient 4 - Previous tuberculosis of spine, operated elsewhere with subsequent deformity of the spine. We performed 1st stage posterior correction and now local team has performed second stage anterior correction. She will also undergo anti-tuberculosis treatment for 9-12 months.

Patient 5 - A 5 year old boy with severe, rapidly progressive congenital scoliosis. He underwent correction of deformity with growing rods which will be extended every 6-12 month until he reaches maturity. He will need another 6-8 operations. [Fig. B]

Patient 6 - Adolescent idiopathic scoliosis correction.

Patient 7 - The most complicated case of the mission!!! Here is a 5 year old girl with severe congenital scoliosis and Diastomatomyelia (splitting of spinal cord). She has underdeveloped lungs due to fusion of the ribs which does not allow the lungs to expand. She has undergone spinal cord surgery for removal of bony bar as first stage. Second stage would require excision of ribs and expandable device to keep the spine corrected and growing till maturity. She will need a number of further operations. [Fig. C]

Patient 8 - 11 year old female with congenital scoliosis that underwent posterior hemi-vertebrae excision and correction.

Patient 9 - Correction of slip at lumbar sacral junction. This patient was unable to walk for more than 20 steps due to narrowing of spinal canal.

Patient 10 - Severe curve corrected by 80% as can be seen in the x-rays. [Fig. D]

Fig. a

Fig. C

Fig. B

Fig. D

IASA Newsletter is printed twice a year. editor: Nazie dana.Cover Photo: Victoria Memorial in Kolkata

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 ndana@indo-americanspine.org

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