A deformation of the spine characterized by abnormal curvature associated with rotation, scoliosis affects approximately 3% of the population. As it progresses, the torsion causes compression of the thorax, then the lungs. "Surgery is necessary when the angle of curvature reaches 40° or more.", explains Dr. Jacques Samani, orthopedic surgeon at the Providence Hospital in Neuchâtel. This specialist in the spine (vertebral column), and more specifically in deformations in children and adults caused by scoliosis, explains that this condition is systematically screened by pediatricians. If scoliosis is detected, it can be corrected by an operation at the end of adolescence, once growth is complete. When it is very pronounced, the child is prescribed a corset to limit the deformation while he or she continues to grow.
Compressed lungs
However, in less fortunate regions of the world, scoliosis is not necessarily detected or treated, which is why Dr. Samani has been involved in humanitarian medicine missions for thirty years (see box). This commitment is at the origin of the surgical intervention of Phat, a little 6-year-old Vietnamese boy, carried out free of charge at the Providence hospital last month. A first in the private Neuchâtel establishment.
Phat suffered from a severe spinal distortion caused by fulgurant scoliosis. The pathology manifested itself when he was just one year old and progressed very quickly. The doctor's examinations of the child revealed a deformation of the vertebrae at an angle of 110°, which is impossible to correct in Vietnam. "The extent was such that it had caused a deformation of the rib cage causing compression of the lungs. His life prognosis was at stake, because his breathing capacity was reduced. If he was not operated on, his life expectancy was limited."
5 hour operation
Correcting such a significant deformity, however, requires a delicate surgical procedure, which is rarely performed on a 6-year-old child. Firstly, because in the event of respiratory failure, as in this case, the anaesthesia is somewhat complex. Secondly, because it is very complicated due to the risk of spinal cord injury – that is, paralysis. The operation involves making an incision in the back from top to bottom, inserting screws into the vertebrae and then connecting them to sliding rods. Thanks to their mobility, these will be able to adapt to the child's growth. "It is a very specific material, the development of which is quite recent, which is found in Europe and the United States but not in Asia", the surgeon said.
Phat's operation was performed on January 24 by Dr. Samani, assisted by his colleagues Dr. Vincent Villa, orthopedic surgeon, and Dr. Ali Sarraj, anesthesiologist. The procedure was long, five hours during which the surgeons inserted eleven screws and sliding rods throughout the spine, a thorny task carried out on a millimeter scale.
"Because of the small size of the vertebrae - especially those of a child - scoliosis surgery is quite complicated.", comments Dr. Villa. At the end of the operation, all those involved waited impatiently for Phat to wake up, just to make sure it had been a perfect success. They were completely reassured: the child came to without complications and after two days, he was already taking his first steps.
The scoliosis was reduced and its progression was permanently blocked. "The team took great pride in it," testifies Dr. Samani. "From the doctors to the nursing staff, everyone showed great enthusiasm at every stage of the boy's care.".
After more than a week in hospital, Phat and his father who had accompanied him were welcomed by the Dich family that Dr. Samani had found when organizing the operation. They stayed there for two weeks, waiting for the child to recover enough to be able to make the return trip.
Also of Vietnamese origin, this family was very involved in the adventure, often coming to the hospital to act as translators, because father and son speak neither French nor English.
On February 17, they were able to return home. But Phat will continue to receive follow-up from Dr. Samani, who plans to see him again when
of two humanitarian medical missions that he carries out each year in Vietnam.