As 16-year-old Meshari Fahim on his feet with a “straighter backbone” hopes to get back to his studies soon and contact sports in about a year, his “hero” has only a simple explanation to offer.
The need is not only to know “what to do” but “when to stop” without pushing it a little more, says eminent ‘Brain and Spine’ Surgeon, Dr. K. Sridhar from India in all humility.
|An unseen bond: Patient and doctor. Pic by M.A. Pushpa Kumara
For, if you don’t stop, the consequences could be disastrous, he says, with patients such as Meshari who have gone in for complicated scoliosis correction surgery becoming paralysed on the operating table due to the spinal cord being damaged. That would be irreversible.
The knowledge of when to stop, comes with years of expertise and experience, the Sunday Times understands, complemented by cutting-edge technology and a well-trained multi-disciplinary team.
“Skill, expertise and experience,” is what Dr. Sridhar, the Director of the Institute of Neurosciences and Spinal Disorders at Global Health City has aplenty, what with 100 neuro-surgeries a month in a career spanning 25 years.
It was with concern that Mohamed Fahim and his wife saw the condition that had their only and youngest son, Meshari, in its grip since birth, getting worse. They had gone through similar pangs of anxiety and worry over their eldest daughter, Naflaa, now 21. Their second daughter, 18-year-old Eman was fine.
In 2000, the Fahims managed to take Naflaa who was then 11 years old to Los Angeles, America, after uncles and cousins extended a helping hand, to undergo spine “stabilization” for scoliosis which is the abnormal curving of the spine or backbone. “The procedure stabilized the spine by fixing metal implants and prevented aggravation of the bend,” explains Mr. Fahim.
During a follow-up visit the next year (2001), they also showed six-year-old Meshari and were told that at that point surgical intervention was not needed.
Back home, life went on for the family, with Meshari not only immersed in his studies at the Royal Institute but also engaging in sports such as soccer.
Gradually, however, Meshari’s curvature of the spine became more visible and debilitating, with a hump coming out as well, says Mr. Fahim while Meshari adds that not only pain but also exhaustion dogged his days.
Seeking pain-relief through acupuncture, the family was looking for options, as affordability also played a major part, when a relative, M.F.A. Riyas who is Chairman and CEO of Forte International, pointed them in the direction of Global Hospitals in India.
Being the information and facilitation centre for Global Hospitals which has secured “a niche in multi-super-speciality and multi-organ transplantation” and has hospitals in Chennai, Bangalore and Hyderabad, with the next being opened in Mumbai in April, another soon in Kolkatta and “when the time is right” in Sri Lanka as well, Mr. Riyas had sent Meshari’s reports to Chennai.
Having been strongly advised by Dr. Sridhar after a series of tests including scans in January this year that the surgery on Meshari’s spine should be hastened without delay, the decision had been taken to go ahead.
It was deemed more important than the London Ordinary Level that Meshari was to sit in May-June, says Mr. Fahim, adding that he would now take the exam in November.
Time is of essence, according to Dr. Sridhar, with the ideal time for the surgery being the early teens, when the spine is still growing. “Even if the curve is bad, we can straighten it out to whatever extent possible and growth will take care of the rest,” he says.
In the case of Meshari with a very bad curve, however, the growth of the spine was almost over as he is 16. The urgency was great and unlike his sister who had it “fixed” but not corrected, Dr. Sridhar was bent on correcting Meshari’s spine, having discussed the pros and cons with his multidisciplinary team which included doctors of neurosurgery, anaesthesia and critical care and ortho and spinal, the Sunday Times learns.
Letting the family know what the doctors could offer as opposed to the family’s expectations, the two-stage operation was fixed for February 2 and 8.
When asked about pain, Meshari who was “on my back” after a vertebra was removed and until the second surgery, in his soft-spoken voice is quick to point out that extreme pain cannot be managed, one can only go through it and tolerate it. It was with a lot of faith in Allah that the family went through this medical ordeal, says Mr. Fahim.........faith, blessings and good doctoring seeing Meshari back on his feet on February 18 and returning home to Sri Lanka from Chennai on March 3.
Pointing out that fixing a bend in the spine is simple but straightening the bend out is where expertise comes into play, Dr. Sridhar who is also an expert in other fields such as brain and spine tumours, vascular neurosurgery, spine fixation surgery to name a few, says this is the gold standard. Correction of scoliosis is important as patients could die at a young age of lung failure due to a decrease in lung volume. While correction also brings relief from severe pain and cosmetic changes are a bonus, the person’s lifespan along with his quality of life improves.
Giving a glimpse of the meticulous skill at work in the operating theatre, Dr. Sridhar says that in the 10-hour first surgery, they went through the left chest wall (thoracotomy) to resection (remove) a wedge of the spine (wedge osteotomy) and also release tissue which was holding the spine-bend. “This was critical surgery done under the microscope using high speed drills,” he says.
When asked whether such long 10-12 hour surgeries are not tiring, he smiles and says that though it is not easy, when a job has to be done, it has to be done.
The second stage involved opening up Meshari from the back and putting titanium rods and screws into place on the spine while closing the wedge-gap. There was a three-dimensional bend in the spine like a spiral, he explains, adding that de-rotation of the spine was also needed. The whole procedure took upto 12 hours.
Knowing from childhood that he wanted to be a doctor, then a surgeon and then a neurosurgeon, work which he finds “fascinating” and would take up even in his next birth, under Dr. Sridhar’s gifted hands patients who undergo general spine surgery face a risk less than 1%, for spinal tumours less than 3% and for scoliosis less than 10%.
“Unexpected” were the results, says this Neurosurgeon who has followed his pioneer uncle, Prof. B. Ramamurthi, into this intricate and complex field. “Our expectations for Meshari were a 20-25% correction of the spine but we achieved almost 60-65%.”
For Dr. Sridhar gratification comes from seeing patients like Meshari go home with a smile.
Prevention the best
Prevention of scoliosis is the best, says Dr. Sridhar, pointing out that a simple measure of vital importance is for women to start taking folic acid when planning a pregnancy.
Take folic acid before you become pregnant, he says, advising couples to avoid consanguineous (between relatives) marriages and also to have babies when the mother is young. If the first baby comes after the mother is over 30 there could be problems.
Research indicates that globally the prevalence of scoliosis is between 0.5-4.5%, says Dr. Sridhar, although there are no figures for the Indian subcontinent.
He urges people not to be fearful of spinal surgery if they are in the hands of the “right” experts with experience, as the benefits outweigh the risks.