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| a publication for iasa members • issue 5 • fall 2014 |

In thIs Issue

Thoughts From the Chairman page 2

IASA Members Gathering in San Francisco page 3

Six Fellows, Five Institutions page 4

Cervical 360 - Third Annual BioSkills Workshop page 6

Mission to Kolkata page 9

GROWTH& TRAnSITIOn

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I A S A n e w S l e t t e r | f A l l 2 0 1 4

Dear Members,

I am pleased to introduce the 5th issue of the IASA Newsletter and I trust that you will find the accounts of the organization’s activities over the past 6 months informative and stimulating. This also marks the completion of our third full year, as the interest in our organization, along with our membership, continues to grow. None of this would have been possible without the guidance and direction of our volunteer surgeon board members.

Pursuant to our bylaws, two board positions will come up for replacement this year. This begins a period of important change for the organization as we begin to ask our membership to commit to IASA at a significant level by filling these two open positions. Therefore, as we approach our third anniversary, it is with deep gratitude and a sense of reluctance that we accept the departure of two of our founding board members; Prof. S. Rajasekaran and Dr. Alpesh Patel will officially step down effective January 1st, 2015. We thank them for their insight, fortitude and contributions over the last three years, without which the organization would not be as robust as it is today. We recognized their participation and contributions with the presentation of a plaque during the 2014 IASA Reception at NASS in San Francisco.

Though disappointed that we lose their guidance, it is with strong anticipation that we welcome two new members to the board; Dr. HS Chhabra, Medical Director of the Indian Spinal Injuries Centre and Secretary and Treasurer of the Association of Spine Surgeons of India (ASSI) in New Delhi, and Dr. Alok Sharan, Chief of the Orthopedic Spine Service at the Montefiore Medical Center, Albert Einstein College of Medicine in New York. We officially welcome you both to the board, and thank you in advance for your contributions.

As we enter our fourth year, we are pleased to report that interest in the IASA Spine Fellowship is at an all time high and we are planning a 25% increase in the number of Fellowships offered in 2015. This is important as it provides not only greater opportunities for the Fellows, but more opportunities for the membership to serve as mentors to these young surgeons. To that end, we invite you to volunteer to host future Fellows.

In closing, I wish each of you and your families a healthy and happy start to the new year.

Sincerely,

M. Kevin Carouge Chairman IASA

Growth and Transition: Thoughts from the Chairman

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The Bistro Boudin in San Francisco’s popular Fisherman’s Wharf neighborhood was the setting for the 2014 IASA Reception at NASS. Over 30 members from across the US and India joined to network and to hear about our recent achievements.

Board of Directors Chair Kevin Carouge gave a summary of our accomplishments to date, and spoke of the upcoming transition in the Board.

Following Mr. Carouge’s remarks, IASA member Dr. Ripul Panchal, DO, of UC Davis Health System shared his experience as a volunteer surgeon with Operation Straight Spine in Kolkata, and as a visiting surgeon with Dr. KrishnaKumar in Cochin earlier in the year. v

IASA Members Gathering in San Francisco

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Dr. Ripul Panchal

I A S A n e w S l e T T e r | F A l l 2 0 1 4

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Our most sought after program is our Traveling Spine Fellowships. To date we have sponsored 10 Fellows, and have budgeted for 8 more in 2015. The application procedure is simple, but it’s a highly competitive process, as often there are eight or more applications for the two spots available in each cycle. For more detail, please visit our Fellowship tab on our website: www.indo-americanspine.org

This past year we utilized three more sites, each with an exceptional mentor: Dr. Praveen Mummaneni at UCSF in San Francisco, CA, is the Co-Director of Spinal Surgery at UCSF Spine Center. Dr. Devanand Degulmadi of Hyderabad spent the month of June at UCSF with Dr. Mummaneni as his mentor.

Dr. Sheeraz Qureshi, is Associate Professor of Orthopaedics at Mount Sinai in Manhattan, NY. He was advisor to Dr. Om Gupta of Bhadohi in February, and Dr. Shashidhar B.K of Bangalore in May.

Another site we added this year was Cedars-Sinai Hospital in Beverly Hills, CA, where Dr. Neel Anand, Director of Spine Trauma, was mentor to Dr. Ashok Thomas of Trivandrum.

In addition, two other Fellows were sent to Chicago, under the tutelage of Dr. Kern Singh, Associate Professor and Co-Director of Minimally Invasive Spine Institute at Rush University Medical Center, and Dr. Alpesh Patel, Director of Orthopaedic Spine Surgery at Northwestern Memorial Hospital. Dr. Feroze Ali of Cuttak spent his Fellowship in Chicago in June, and Dr. Ankit Gupta of New Delhi, spent the month of September with the two experts. Dr. Gupta was awarded IASA Fellowship as the winner of Best Paper at 2013 WENMISS.

Below is Dr. Ashok Thomas' fellowship report.

IASA trAvelIng fellowShIp report

I was indeed very excited when I was informed in January 2014 of my selection for the IASA Spine Fellowship. I reached Los Angeles on 1st September 2014, after a 23 hour journey from Kochi. I was picked up from the airport and dropped off at my accommodation in Beverly Hills. It was a cozy studio apartment at a walkable distance from the Cedars-Sinai Spine Centre. Next day, I went through health examination and orientation which are mandatory as per Cedars-Sinai Hospital regulations.

On 3rd September, I met Dr. Neel Anand at his office at the hospital. Dr. Anand is one of the leading spine surgeons in the US and is a pioneer in the field of MISS. I learned that he

has extensive experience with MISS and has played a major role in the current status of MISS in the field of spine surgery. In the next four weeks I participated in the routine work of his unit. Dr. Anand’s weekly schedule consists of outpatient clinics on two days and surgeries on three days.

In the operating room I observed around twenty-five surgeries in all. It was indeed a great learning experience as majority were MIS procedures, involving the use of percutaneous screws, MIS-TLIF, DLIF and ALIF. Majority of the cases were of degenerative type. I attended surgeries like multi-level lumbar lateral fusions (DLIF), ALIFs, MIS TLIFs, C1- C2 O-Arm navigation assisted fusions, lumbar micro decompressions, cervical microdiscectomies and cervical laminoforaminotomies. He religiously involves himself in every aspect of the surgery including shifting the patient on to the operating table, positioning, draping, etc., taking time to teach me and his other fellows why he does a particular step and how to avoid pitfalls. His enthusiasm to teach is matched by his surgical skills as he explained each and every step of the surgery using operating microscope and

Six Fellows, Five Institutions

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arthroscopic camera to demonstrate the steps. His techniques of thoroughly planning the intra-op strategy based on meticulous analysis of pre-op imaging were very impressive.

I got the opportunity to be with Dr. Anand in his outpatient clinics as well. It was indeed a fantastic learning experience as I got to actually see short-term and long- term outcome of his patients. He happily introduced me to every patient. His techniques of history taking, thorough examination and discussion of treatment options with the patients were all unique and very informative for me. It stressed the importance of each of these steps in successful outcome for every patient. I must say, I gained as much from the outpatient clinics as I did from the operating rooms.

Dr. Anand is a fantastic surgeon and a great human being. He made sure that I was comfortable throughout my one-month stay in the US, in whichever way he could. He was very cordial and invited me and his fellows to a dinner at his home where we got to enjoy some great Indian food made by his mother. It was indeed an enjoyable evening.

This report cannot be complete without a note for my deep appreciation and gratitude for Ms. Nazie Dana, the Program Director at IASA. From the time of me applying for the fellowship in September 2013 to my completion of my fellowship in October 2014, she was constantly in touch with me through emails and guiding me through the entire process. Whether it was helping me through the visa process, booking my flights, airport pick-up, securing a very comfortable accommodation and even the minutest details of my stay in Los Angeles, she was always there, making sure I had no trouble at any point.

I would like to thank IASA, Ms. Nazie Dana, and Dr. Neel Anand for this great learning experience bestowed on me.

– Dr. Ashok Thomas

Far left: Linda sheriden, Rn, Dr. Feroze Ali (Fellow), and Dr. Alpesh Patel. Center: Dr. neel Anand and Dr. Ashok thomas (Fellow). Right: Dr. Devanand Degulmadi and his mentor Dr. Praveen Mummaneni.

“Dr. Thomas was very sharp; perhaps one of the best Fellows I've ever had!” - Dr. Anand

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For the third year in a row, IASA held its two-day workshop on Essentials in Spine in Bangalore, India. More than 30 surgeons from across India and Mauritius attended the program. This year, the emphasis was on posterior and anterior cervical spine. The co-chairs, Dr. Sajan Hegde of Apollo Hospitals in Chennai, and Dr. Dilip Sengupta of Dartmouth-Hitchcock Medical Center in New Hampshire invited a faculty of notable spine surgeons from India and the US:

Dr. Shankar Acharya – Sir Ganga Ram Hospital, New DelhiDr. Sarat Chandra – AIIMS, New DelhiDr. h. S. Chhabra – Indian Spinal Surgery Center, New DelhiDr. tapan Daftari – Resurgens Orthopaedics, AtlantaDr. Arvind Kulkarni – Bombay Hospital, MumbaiDr. vedantam rajshekhar – Christian Medical College, VelloreDr. Alok ranjan – Apollo Hospital, Hyderabad

Day 1 consisted of didactic presentations on surgical techniques, complications, and disc arthroplasty. Subjects such as myelo-radiculopathy, OPLL, posterior stabilization, osteotomy correction, adjacent segment degeneration, ACDF, arthroplasty, and cervical TDR were presented and discussed during case presentations. Following the lectures, the attendees and faculty had a chance to network with each other over a group dinner.

Day 2 was a hands-on workshop held at the MS Ramaiah Advanced Learning Center, an educational, research, and training center with state of the art BioSkills lab. The faculty demonstrated each technique first, and then the registrants practiced in groups of 2-3 per cadaver. Techniques such as anterior discectomy and locking plate fixation, anterior stabilization, disc arthroplasty, screw fixation, posterior fusion techniques, and trans-articular screws were demonstrated and practiced.

Evaluations from attendees were very positive and encouraging. Plans for a 4th such workshop are in the works for September 2015 in Bangalore. Stay tuned for details! v

Cervical 360 - Third Annual Bangalore BioSkills workshop

”Great course with expert speakers; keep up the good work!

...Informative & inspiring!“

speaker Dr. tapan Daftari (left) and Co-Chair sajan hedge (right) with attendees.

Co-Chair Dr. Dilip sengupta in discussion with two attendees.

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“This was a wonderful learning experience. It will definitely improve my practice!”

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surgeons gathered for a Bioskills demostration at the Ms Ramaiah Advanced Learning Center.

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The following report is by IASA member Dr. Panchal from UC Davis who joined Operation Straight Spine in Kolkata for a week:

KolKAtA MISSIon trIp

I would like to thank the Indo-American Spine Alliance (IASA) for giving me the opportunity to participate in Operation Straight Spine’s annual mission trip to India led by Dr. Jeffrey McConnell (Pennsylvania, USA) and Dr. Ujjwal Debnath (Kolkata, India). I learned about Operation Straight Spine—a non-profit created by two colleagues and good friends from two different countries with a common mission to help the poor and underserved patients with spinal disorder—when I visited the main office of Globus Medical in Audubon, Pennsylvania, through which OSS secures donated implants and instrumentation. This visit sparked my latent interest to help others in the underserved area, something I’ve been doing in various capacities since I was 14 years old.

Sunday evening, I arrived in Kolkata, India. Although I was born in India and had visited the country since immigrating to the US, I quickly realized that East India is a foreign place to me with a completely different culture and language than what I had been accustomed to. Upon arrival in Kolkata, I met the OSS team for the first time over dinner. The team consisted of Dr. Priya Cuomo (anesthesiologist) from the UK, and a team from the US with Denise Lawyer (nurse), Johanna Ziegler (scrub technician), Chelsea Naddeo (neuromonitor) and Daniel Welsh (Globus instrumentation representative). Everyone was very welcoming and made me feel right at home.

Our days began with a hospital shuttle taking us to the Ramakrishna Mission Seva Pratisthan, a teaching hospital established in 1932 to help those in need. Dr. Debnath had spent the entire year identifying patients and organizing surgical schedules for the OSS team. On my first day, Dr. McConnell and I rounded with the team on the patients he had operated on the week before. I found the hospital to be very well organized, efficiently run and a welcoming place for outsiders. [Continued on Page 10] è

Mission Trip to Kolkata

Operation straight spine team

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On day one, we operated on a young female with large lumbosacral abscess requiring anterior and posterior approach with L5 corpectomy. When I initially walked into the operating theater (OT) and Dr. McConnell shared the details of the case and surgical plan with me, I was not sure how this would be possible with the conditions I observed: an operating table that was held up by two posts, IV pole made from a wooden post, a pile of instrumentation, old spinal instrumentation system that I’d never seen, a Boviecautery that required a gel on the patient with a metal paddle for grounding and tape holding the wire in the socket. I felt a rush of anxiety and started running through different “what if” scenarios in my head, but was reassured by Dr. McConnell’s and the entire team’s calm demeanor and friendly attitude as I scrubbed for my first international case. I’ve never seen such a large fountain of purulent drainage rush out of someone’s abdomen, but the patient did just fine.

On subsequent days, our cases included congenital scoliosis, traumatic kyphotic deformity and a traumatic fracture on an elderly with multiple comorbidities. Unfortunately, we had to turn away two patients due to not having the proper instrumentation, and still the parents were very thankful for trying.

During this one week, I got to know every team member. We shared our personal stories and how we ended up there. On one of our last evenings, we had dinner with the local orthopedic and anesthesia residents who had been a tremendous help in accomplishing our goals.

I found this experience to be eye opening and humbling. I came to realize and appreciate the changes a small group of people with proper resources can bring to those in need. The local staff was very helpful and patients were very appreciative. I hope to be going back to India on a similar mission. v

Mission Trip to Kolkata (cont'd)

Dr. Panchal and Dr. McConnell with a patient.

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IASA newsletter is printed twice a year. Editor: nazie Dana.Cover Photo: IASA BioSkills Workshop in Bangalore.

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]


Don't miss the IASA reception at ASSICOn

Thursday, January 22nd • 18.00–19.30

Jw Marriott Hotel Pune Please RSVP by January 16th [email protected]

SAVE THE DATE ASSICON 2015

SEE YOU IN PUNE!

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