Dubai: Rare spine corrective surgery performed for the first time in the Middle East

A 13-year-old Jordanian girl was treated for scoliosis with a corrective surgery which was performed successfully for the first time in the GCC and North African region.

Salma Naser Nawayseh was diagnosed with adolescent idiopathic scoliosis in April, after her parents noted the curve in her spine.

They consulted many doctors in the UAE before approaching Dr Firas M Husban, consultant orthopedic surgeon, at Burjeel Hospital. When Salma consulted Dr Husban, she had a thoracolumbar curve of 65 degrees and suffered deformity of the back with shortening of the trunk, lower back hump, un-levelled pelvis, and back pain.

Scoliosis can develop in infancy or early childhood, but it most commonly occurs in children aged 10-15 years.

“Adolescent idiopathic scoliosis is the most common type and is usually diagnosed during puberty. The three treatment options for such patients are observation, bracing, or surgery,” said Dr Husban. While bracing is an option in patients with mild forms of scoliosis, “in Salma’s case, she required surgery to correct the deformity,” he added.

Minimally Invasive Procedure

The traditional method to correct scoliosis is spinal fusion surgery, where two or more vertebrae are permanently joined into one structure using screws and rods. While spinal fusion is the most common method to treat scoliosis, it limits spinal mobility and subsequent growth.

In 2019, the US FDA approved a new treatment called Vertebral Body Tethering (VBT), a minimally invasive technique that allows for continued growth without fusion, while preserving motion and flexibility.

The new treatment enables fusion-less spine correction, allowing the patient to experience the full range of motion and further growth. Its other advantages include discreet incisions, minimal trauma, fewer complications, and faster healing. As Salma had not reached full skeletal maturity yet, she was the perfect candidate for this procedure.

Dr Husban explained, “As opposed to spinal surgeries that involve cutting into the back and manipulating the spinal cord and nerve roots, in this surgery, we make discreet incisions in the abdomen through the endoscope.”

He further said that a flexible cord, called the tether, is attached to the spine on the outside of the curve through bone screws and tension is applied to the tether to straighten the spine. “The tether puts pressure on the outside, allowing the inside of the spinal curve to grow. Because VBT is minimally invasive, there is little trauma to the delicate tissues of your back.”

In this method there is less blood loss, less postoperative pain and a speedier recovery time compared to spinal fusion surgery.

VBT is performed only in a few countries and UAE is now one of them. The first instance of the surgery in the Middle East, a unique and rare medical accomplishment, was performed at the Burjeel Hospital in Dubai.

“Right after surgery, Salma’s spinal curve showed improvement,” said Dr Husban, also pointing out that the curve will continue to improve, and the tether will guide the growth of the spine as the body grows.

Salma is recovering well after the surgery and will be able to go back to school after two weeks. “Four weeks later she can return to full activity with no restrictions and can start playing sports,” the surgeon added.

Salma’s parents are thrilled at the outcome and were excited to see her walking the second day after surgery. “We are happy that our daughter was eligible for this surgery. We look forward to our daughter holding the racket again and resuming tennis,” said Salma’s parents.

“We thank the staff at Burjeel Hospital, Dubai, for taking good care of us. We are grateful to Dr Husban for making this surgery available in the region,” they said.

While scoliosis affects 2-3 per cent of the population, most cases are mild and do not require invasive treatment. If left untreated, however, moderate to severe scoliosis can lead to pain, increasing deformity, and potential heart and lung problems. Corrective surgery is essential in cases like Salma’s, where the patients have large curves.

First Time in the Region

Not every patient with adolescent idiopathic scoliosis is a candidate for VBT. It would ideally be performed in children and teens in the age group of 9 years and above who are still growing. Moreover, the procedure is most effective in patients with a curve of 45 to 65 degrees.

Despite being a newer treatment, the cost of VBT is similar to other treatments for scoliosis.

Dr Shajir Gaffar, CEO, VPS Healthcare (Dubai and Northern Emirates), said the surgery is a testament to advanced medical capabilities in the UAE.

“It is a great privilege to conduct the first VBT surgery in the MENA region at Burjeel Hospital, Dubai. It took months to get the approval and instruments ready for the procedure. We plan to further expand our scoliosis treatment facilities to help affected patients enjoy a better quality of life. We are hopeful that the success of the surgery will inspire people from all over the Middle East to come to the UAE for the procedure,” said Dr Gaffar.

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