Spinal Frame for Resource Limited Settings
A Resourceful Solution to an Immeasurable Problem
Specialized operating room tables used for spinal surgery in the United States cost upwards of one hundred thousand dollars. These tables are needed for many types of spinal surgeries in order to promote a normal alignment of the spine and keep the patient steady during surgeries that require stability and precision. Performing these surgeries in developing nations presents a real challenge; resources are limited and many locations do not have the doctors to perform the complex surgeries. In Haiti, many patients who have experienced a spinal injury remain in bed for many months in the absence of the appropriate equipment or personnel to perform the necessary surgical interventions.
Jonathan Riley, MD and Nicholas Boulis, MD, PhD, respectively a resident and attending neurosurgeon at Emory University, saw this need grow tremendously following the devastating earthquake in Haiti in the fall of 2010. Buildings collapsed throughout the capital city, Port-au-Prince, leaving many injured, displaced from their homes, or deceased. Riley and Boulis developed a relationship with the organization Partners in Health, which has a fully functional hospital in Mirebalais, Haiti, providing a location to perform neurosurgeries, but the hospital was not equipped with the highly specialized spinal operating tables necessary for surgery. Even prior to earthquake, Haiti had suffered from a paucity of neurosurgeons; the whole country, at any given time, has at best a few neurosurgeons, which is well below the recommendations of the World Health Organization. Riley then began reaching out to various companies that produce spinal operating tables seeking donations, but found limited success. As his departure for a clinical rotation to Haiti came closer, he took matters into his own hands, quite literally. With permission, Riley and his team used the Emory Physics Department workshop and constructed a spinal frame from items purchased at a local hardware store for a fraction of the cost of a traditional operating table. Riley described the process, “the goal was not to create an invention, we simply wanted a strategy to help patients.”
The device, a platform that adapts a normal surgical table into an effective spinal operating table, has all the critical features: it allows the abdominal contents to hang freely which decreases bleeding, it permits proper spinal alignment during surgery, it locks onto the operating table for stability, and it is free of metal in critical areas to allow for accurate intra-operative x-rays. Additionally, the frame is adjustable to accommodate a wide range of patient widths and heights and can collapse to fit into a suitcase-size container for easy transport. Although this device was developed specifically for Haiti, this low-cost solution could be highly useful in other resource-limited settings or areas that do not require a permanent, high-cost spinal operating table. Cliff Michaels of Emory’s Office of Technology Transfer, commented, “The device is ingenious in that it enables a normal surgical table to be adapted for spinal surgeries, and does so in a straightforward and relatively simple manner. We often think about the big advances; the next generation implantable device, a new biologic or drug, stem cell therapies, but there are many practical considerations, like the one that this platform addresses which can have a real impact on the lives of patients worldwide.”
Riley has already used the spinal frame on numerous patients in Haiti with great success. Individuals who may have remained permanently immobilized or suffered neurological damage from spinal cord injuries have been treated. These patients are now able to have the surgeries necessary to stabilize fractured spines, leading to an improved chance for neurologic recovery and increased quality of life. The spinal frame is only one component in an ongoing initiative to develop sustainable neurosurgical capacities in Haiti thereby providing this underserved and very deserving patient population access to specialty healthcare. For further information on the Haiti Neurosurgery Initiative, please feel free to visit the website at: www.haitineurosurgery.org.
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