2022 Winter NSF Newsletter (View PDF)
Dear Donors and Supporters
Thank you again for your most generous contributions and support of the Nepal Spine Foundation’s efforts to provide neurosurgical education and support to Tribuhvan University Teaching Hospital.
November Spine Week 2022 was yet another successful trip with neurosurgical and orthopedic spine education, training, collaboration, fellowship and friendship. This year’s theme was lateral and anterior approaches to the lumbar spine.
The team arrived in early November then Spine Week began with a Welcome/Felicitation Ceremony with our colleagues at Tribhuvan University Teaching Hospital (“Teaching Hospital”), followed by a Pre-Operative Spine Conference to review the potential surgical cases. The bulk of the week included three OR days completing 5 surgical cases, and an academic day of engaging lectures from both the US team as well as the Teaching Hospital Team. Our week concluded on November 11th, after which several members of the team stayed on to trek in the Himalayas.
In addition to our core Nepal Spine Foundation neurosurgeons, Richard Wohns, Farrokh Farrokhi and Rick Chua, two additional spine surgeons, Dr. Matt Neal, neurosurgeon from the Mayo Clinic – Scottsdale, and Dr. Todd Alamin, orthopedic surgeon from Stanford University, joined us and provided their expertise. Our team also included physician assistants from Virginia Mason Franciscan Health, Catherine Jackson, PA-C, and Hannah Boudreaux, PA-C. In addition, Logan McKnight, CEO of Northwest Neuromonitoring, LLC, provided additional intra-operative experience and technology for the week of surgeries. We were accompanied by Judd Hunter and Joe Triano from Medtronic Spine, who joined us again to provide support and donated spinal implants, equipment, and supplies. Jeremy Logan from Isto Biologics, Inc. joined us with supplies of donated bone graft products and technology for acquiring autologous stem cells and natural bone morphogenic proteins. Our experienced and native Nepali surgical technologist from Virginia Mason, Kumar Shrestha, again joined us to provide OR support and training for the Teaching Hospital OR staff.
Of note is that the donated medical equipment and implants in 2022 were greater than $1,000,000 in value, which is a nearly 100% greater than the value of our donations in 2021.
Our academic and didactic day included the following lectures:
- Dr. Rick Chua – “Spinal Fusion: Which Technique Should I Choose?”
- Dr. Farrokh Farrokhi – “Lateral Lumbar Interbody Fusion Techniques and Patient Selection”
- Dr. Matt Neal – “Patient Selection for ALIF Surgery”
- Prof. Mohan Sharma – “Industrial Revolution and Neurosurgery: How Can We Adapt to the Change”
- Dr. Richard Wohns – “Surgeons and Industry – Handling Conflicts of Interest”
- Dr. Todd Alamin – “Tricks and Tips on Anterior and Anterolateral/Anterior to the Psoas Approaches” and
“Anterior Retroperitoneal Approach to L4-S1” - Dr. Ram Shrestha – “How I Climbed Mount Everest – Mission Stand Up”
- Logan McKnight – “Neuromonitoring”
- Ms. Kalpana Thapa – “Instrument Handling for Spine Surgery”
- Asst. Prof. Amit Pradhanang – “Our Experience with MIS Technique
- Catherine Jackson, PA-C and Hannah Boudreaux, PA-C – “The Role of Physician Assistants in Spine Surgery”
- Asst. Prof. Dipendra Shrestha – “1-Year Audit of Spine Surgery at TUTH”
In addition to our own didactic series, the team was hosted by the Nepal Society of Neurosurgeons (NESON) one evening for a CME-sponsored lecture, including Rich Wohns speaking on “Neuronavigation in Spine Surgery” and “Neurosurgery Malpractice Update.”
Our surgical week included the following:
1. L5-S1 anterior lumbar interbody fusion (ALIF) with mini-open posterior instrumented fusion
The patient is a 45-year old construction worker injured on the job while working in Hong Kong. He was unable to continue working and had failed to improve with substantial non-surgical treatments in Hong Kong and Kathmandu. He had been unable to return to any work. He had developed severe and incapacitating low back pain going down the right leg. The x-rays, CT, and MRI showed a lytic grade I L5-S1 spondylolisthesis.
2. Minimally invasive L4-5 discectomy
The patient is a 40-year old man with nearly 2 year history of back pain radiating down the right leg, associated with leg and foot numbness and leg weakness. The MRI showed a herniated disc at L4-5.
3. Minimally invasive L4-5 transforaminal lumbar interbody fusion (MIS-TLIF)
The patient is a 42-year old woman with a 8-9 year history of low back pain going down both legs. She had a standing and walking tolerance of only about 15 minutes, and had to leave her job. She was also having trouble with household duties and caring for her 11-year old son. Her CT and MRI showed a grade I degenerative L4-5 spondylolisthesis.
4. L5-S1 anterior lumbar interbody fusion (ALIF) with integrated instrumented cage and plate
The patient is a 50-year old post-menopausal woman with greater than 10 year history of predominantly low back pain with some leg pain. She was unable to continue to work as a shop keeper and was having difficulties as a homemaker. Her imaging studies showed a grade I spondylolisthesis of L5-S1.
5. L3-L5 lateral lumbar interbody fusion (trans-psoas approach) with posterior instrumentation
The patient is a 56-year old woman with complaints of low back pain, leg pain and leg weakness worsening over 5 years. She had to leave her job as a librarian due to the pain. Her CT and MRI showed multi-level degenerative disc disease with associated adult degenerative scoliosis centered at L3-4 and L4-5.
Another exciting event was announcement of the Nepal Spine Foundation’s first fellowship for continuing spine surgery education which was awarded to Dr. Dipendra Shrestha, a junior faculty member of the neurosurgery department at Tribhuvan University Teaching Hospital. With our donors’ support, it is now possible for the Nepal Spine Foundation to fully fund a one month visit for a member of the Teaching Hospital staff to join Dr. Rick Chua in Tucson, and Dr. Farrokh Farrokhi and myself in the Puget Sound Region, for an intensive educational spine experience. We are all very excited about the fellowship which will begin this year, 2022, and continue annually for other faculty and residents thereafter.
In summary, overall it was our most successful Spine Week – thanks to the efforts of our team of spine surgeons from Tribhuvan University Teaching Hospital and the Nepal Spine Foundation, and your generous and meaningful donations that support our educational activities in Kathmandu.
Thank you and namaste,
Richard Wohns, M.D., JD, MBA
Founder and President of Nepal Spine Foundation