| A PUBLICATION FOR IASA MEMBERS • ISSUE 8 • WINTER 2016 |

IN THIS ISSUEThe Fifth Annual IASA Spine Workshop PAGE 4

A Visit to our Mission Partner, Health & Care Foundation PAGE 6

A Fellowship Experience PAGE 7

MIS Focused Fellowship PAGE 8

Opening the Door to New Opportunities

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Dear Members,

February 2017 will mark the end of our 5th year as an organization. Much has been accomplished in that short time, with new programs being added and many of our original programs firmly established and accessed by numerous surgeons.

This year also marks the passing of the baton as it were, in keeping with our charter, for two more of our founding board members; Dr. Sajan Hegde and Dr. Dilip Sengupta. Words are simply not enough to document the tremendous amount that each of these gentleman has contributed to the organization as we know it today. Nor can we express adequately the debt of gratitude to them for selflessly serving and helping to bring this organization from a simple idea to what it has become. At our reception during NASS this year in Boston, we honored them for their service and have presented them with a plaque recognizing their years of service. It was through the efforts of Dr. Hegde and Dr. Sengupta that we established our signature bio-skills educational workshop in Bangalore, a program that has become a major point of identity in India for our organization. It is with great pride that we have had the opportunity to work with these two leaders in their field, and I know we will be able to count on them for continued support of our programs and mission as we move forward. That mission is achievable only through the kind donation of time, energy, and ideas of our seated board members and those members that help support our numerous programs.

With their departure we would like to announce and recognize our two new board members. IASA is pleased to welcome Dr. Praveen Mummaneni from the University of California in San Francisco and Dr. Alok Ranjan from the Apollo Health City Campus Hyderabad, India. Both are neurosurgical surgeons and their addition has our board equally comprised of ortho and neuro surgeons. Each of these gentlemen is well known and respected in their countries. You can learn more about them on the next page. We welcome them to this new position and look forward to their guiding influences for the next three years.

Briefly, we enter 2017 with two new programs fully under way. Our first six-month Traveling Fellowship has been granted to the Park Clinic in Kolkata for 2017 where we will be supporting a fellow for six full months with one month at an IASA Member clinic outside of India. Second, we will be conducting our first IASA Humanitarian Mission in conjunction with the Health and Care Foundation in Ahmedabad. This will be the first program that will be entirely coordinated through IASA, allowing more of our interested members to participate.

We start our 6th year with much anticipation, and we hope you will continue to participate as members. IASA is all about its membership and serving your needs in helping patients in India with spinal disease.

Best Personal Regards,

M. Kevin Carouge Chairman, IASA

Thoughts from the Chairman

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Dr. Alok Ranjan is senior consultant Neurosurgeon and Chief of Neurosurgery at the Institute of Neurosciences, Apollo Health City Jubilee Hills, Hyderabad. He attended Christian Medical College and Hospital in Vallore where he received his MBBS, and later his M.CH in Neurosurgery. He has previously practiced as a Consultant Neurosurgeon at Morriston Hospital at Swansea, Wales.

Dr. Ranjan’s areas of interest include: complicated brain and spine procedures in pediatric and adult patients, neurosurgical emergencies, MIS, tumors, micro-neurosurgery for brain and spine, skull based surgery, pediatric spinal cord deformity surgery, and aneurysm surgery. He regularly conducts instructional courses in minimally invasive disc surgery, minimally invasive spinal fusion, disc arthroplasty, and balloon kyphoplasty.

Dr. Praveen Mummaneni is Professor and Vice Chair, Department of Neurological Surgery at UCSF School of Medicine, Director of Minimally Invasive and Cervical Spine Program, Director of the Minimally Invasive and Complex Spine Fellowship Program, and Co-Director of the UCSF Spine Center. He received his medical degree from Boston University, and completed his neurosurgery training at different campuses of University of California, followed by a fellowship in

complex spine surgery at Emory University under Dr. Regis Haid.

Dr. Mummaneni is active in numerous national and international societies, having served as Director at Large at the Scoliosis Research Society, Chairman of the AANS-CNS Joint Section on Disorders of the Spine and Peripheral Nerves, and President Elect of the California Association of Neurological Surgeons, to list a few. He is routinely an invited guest speaker at conferences across the country and around the world.

Born in Europe and raised in the US, Dr. Mummaneni’s parents came from the state of Andrha Pradesh, from whom he learned to speak Telugu.

Meet Our New Board Members!

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The Fifth Annual IASA Spine Workshop in BangaloreAnterior Approach to Cervical and Thoracolumbar Spine

The fifth annual IASA workshop was once again held at the MS Ramaiah Advance Learning Center, a full service research and training center in Bangalore. Twenty eight surgeons from across India joined other colleagues to hone their skills and learn new techniques through didactic presentations, demonstrations, and hands-on training in the bio-skills lab. Dr. Dilip Sengupta and Dr. Arvind Jayaswal, both IASA Board Members and co-chairs of the program, formed the content and selected an impressive faculty from the US and India to support it:

Dr. Upendra B., Bangalore, India Dr. Praveen Mummaneni, San Francisco, CA Dr. Mahesh Bijjawara, Bangalore, India Dr. Srinivas Prasad, Philadelphia, PA

Dr. Sajan Hegde, Chennai, India Dr. Alok Sharan, Yonkers, NY Dr. Umesh Srikanta, Bangalore, India Dr. Vamsi Krishna Varma, Chennai, India

A new addition to the program was the case discussions where attendees were encouraged to bring along a challenging case they have had to manage in their practices. It was a chance for the surgeons to offer their input, and discuss alternative approaches to complex cases their colleagues presented to the group.

More information will be shared on the 2017 workshop in March. Stay tuned!

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‘Very informative and well-organized course’

‘The case discussions were a welcome addition to a

perfect workshop’

‘The workshop helped me learn new

techniques I can now add to my practice’

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A Visit to Our Mission Partner, Health & Care Foundation in Ahmedabad, India

Through a grant from IASA in each of the past three years, the Health & Care Foundation (formerly the Polio Foundation) in Ahmedabad has been hosting a team of UK surgeons who travel to India for a week of corrective spine surgeries on children, adolescents, and young adults.

Last fall while in India for the IASA Bangalore workshop, I took the opportunity to travel to Ahmedabad to see the clinic and meet with its leadership to discuss partnering and supporting an annual humanitarian mission program.

At the clinic I was given a tour of the facilities by Dr. Bharat Bhagat, the chairman of the board. The clinic is a three story building with several units staffed with physicians and other health care professionals attending to packed waiting rooms with patients and their diverse health issues – cleft lips, club feet, eye problems, dental issues, cerebral palsy, etc. The clinic is essentially a day clinic, with a few beds on the top floor for the individuals who are being monitored over night following on-site surgeries in their well-equipped operating theaters.

The highlight of my trip was meeting the children who had been operated on, along with their families. After an introduction by Dr. Bhagat followed by a warm welcome by one of the parents, I had a chance to thank everyone on behalf of IASA, and express our gratitude for Heath & Care Foundation that makes these surgeries possible. I then went around and talked to the children and their families through the help of Dr. Bhatt. It was extremely heartwarming and humbling to see the thankful look in the parents’ eyes and the shy smile on the children’s faces.

Beginning in 2017, IASA will assemble its own mission to the Health & Care Foundation from interested members around the world. This program will be honed and repeated on an annual basis, each year with a new group of member surgeons involved. We are looking forward to continuing our collaboration with the Foundation.

Nazie Dana IASA Program Director

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A FELLOWSHIP EXPERIENCEat Riley Hospital for Children, Indianapolis, IN

My journey to the US for IASA fellowship started on 30 April, 2016. It took me 24 hours to reach Indianapolis where I started working with my mentor, Dr. Shyam Kishan at Riley Hospital for Children for the month of May. My accommodation was a comfortable apartment in the heart of the city, not far from the hospital. It was fully furnished and had everything to make me feel at home for the duration of my stay. There were near by eating joints and grocery stores, which eased me to meet my daily quota of calories.

Riley Hospital for Children is a tertiary center, which is more than 90 years old and caters to all complex and challenging spine and orthopaedic problems. On my first day Dr. Kishan introduced me to his staff, including his secretary Amy who later helped me and guided me for all small things. Riley’s is one of the very few centers in the US where I could scrub and stand as observer next to Dr. Kishan to observe from close by all spine surgeries.

Dr. Kishan is a pediatric orthopedic surgeon at Riley’s and his work involves lots of pediatric spine, which was of the most interest to me. I found Dr. Kishan to be a real humble, hard working person with unfathomable knowledge. He is an encyclopedia with whom you can discuss any subject on any given day. Dr. Kishan made me very comfortable from the beginning. I scrubbed with him in all of his spine surgeries. He had OR on two days and clinic on the other three days. During my fellowship period I had an opportunity to observe neuromuscular deformity surgeries, adolescent idiopathic scoliosis deformity surgeries,

casting for infantile scoliosis, and MAGEC rods lengthening, to name a few. His technique of vertebral derotation with asymmetric rod contouring, hook applications in deformity, and Rail systems for deformity correction were also new to me. The preoperative counseling, management and effort Dr. Kishan takes to explain even minor details of surgery to the patient and their parents particularly impressed me.

Dr. Kishan took me out frequently for lunch and dinner. I had the opportunity to meet his family on several occasions while I was in Indianapolis. They are nice people and I had a great time with them. Indianapolis 500’s 100th anniversary race was scheduled on May 29th and I was lucky to get tickets for it and watch it before leaving to come back home.

I would like to thank Dr. Kishan and hope I will be able to implement his teachings in my practice. I would also like to thank IASA and especially Nazie Dana who took care of every single thing that I required from the start of my journey till I reached back home. Big thanks again to IASA, Dr. Kishan and Nazie for this memorable educational experience.

Dr. Rajat Mahajan Indian Spinal Injuries Centre

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On 3 December 2015, I received an email from IASA that I had been selected for the prestigious IASA spine fellowship in 2016. I knew that this was going to be a huge opportunity in my professional life. At the outset, I would like to give special thanks to Nazie Dana, who helped me in every small aspects of my fellowship starting from selection of fellowship center to coordinating with the host so that I would not encounter any difficulty. She was very cordial and responded to my queries without any delay.

As my preference was Minimally Invasive Spine Surgery, Nazie carefully chose Addenbrookes Hospital, in Cambridge, UK, under the able mentorship of Dr. Rikin Trivedi. I was forwarded a detailed travel plan well ahead of schedule. I landed at Heathrow airport, in London on 5 June where a prepaid taxi was arranged to

transfer me to Cambridge, where I had a furnished room in a nice house owned by an Indian couple waiting for me.

On the first day, mandatory paperwork at hospital was done speedily by Lousie Biggs who made sure that I would have access to most of the Hospital through an ID card. She then introduced me to Dr. Trivedi in his clinic. Dr. Trivedi gave me a warm welcome. We discussed how to plan my fellowship for the month so it could be utilised in the most effective manner. Dr. Trivedi, who performed the first Keyhole Lumbar surgery in the region, has a very busy practice consisting of degenerative spinal care, spine trauma, infections and tumors. He uses MIS techniques in most of these conditions very proficiently. Dr. Trivedi also invited me to visit Spire Lea Cambridge hospital where he handles his private cases.

Dr. Trivedi is an extremely well read person who welcomed all my question. We had daily academic discussions on all topics ranging from degenerative spine to tumour surgeries. On clinic days, I saw a wide variety of cases including his follow-up patients. We had a lot of deliberation on how to make decisions on spine pathologies. During our discussions, he also shared challenging cases including a lot of revision surgeries performed successfully by him in the past. His special interest was in navigation guided spine surgeries. We discussed surgical steps and instrumentation in MIS surgeries.

On OR days, I was fortunate to observe around 20 lumbar decompression surgeries, 4 degenerative cervical myelopathy cases (cervical discectomy with anterior cage reconstruction), 6 recurrent lumbar disc surgeries, and Instrumented fusion (navigation guided MIS TLIF). I also got the opportunity to observe cervical disc arthroplasty as well. One case that needs particular mention was calcified thorasic disc herniation causing impending paraplegia in a young software engineer. Dr. Trivedi approached the disc trans-thorasically with an operative microscope. He has a special 3D attachment to the operative microscope so observers have a 3D display of surgery on a large LCD monitor which can be watched with special 3D glasses! Contrary to our expectation, herniation was of intra-dural variety and needed careful dissection of disc material from dura. It was a treat to watch such a well-performed surgery as the patient regained his ambulatory status.

FOCUSED FELLOWSHIPMIS

at Addenbrooke’s Hospital, Cambridge, UK

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Dr. Trivedi does meticulous preoperative planning. He taught me how to dock MIS tube, use burr over lamina, and base of spinous process to do over the top decompression on opposite side. We discussed indications, approach, and bone grafting options. One feature that stood out in contrast to my native institute, was scarce use of autogenous iliac crest bone graft. Dr. Trivedi emphasized regarding postoperative morbidity caused by iliac crest bone grafting affecting postoperative recovery of patient. He preferred to use local bone graft with cage in cervical spine cases.

Addenbrookes Hospital has state of the art support staff in neuromonitoring and anaesthesia. I also got an opportunity to observe Dr. Crawford who does deformity corrections. I managed to see around 4 scoliosis surgeries. Addenbrookes has a very good digital database repository. On similar ground, I am planning to convert my record database to digital format and keep it updated from time to time.

Dr. Trivedi has keen interest in research and has multiple research projects undergoing in the department under his supervision. After observing detailed record keeping and analysis of data, I am sure it will help me to initiate research in conditions like tuberculosis, and critically analyse my clinical work.

Addenbrookes has a dedicated spinal meeting on every Thursday where spine consultants present various difficult cases and take opinions of house, which includes senior radiologist as well. I was able to actively participate in those discussions. Just like everyone else’s, my opinion was also discussed and deliberated in the meeting. I strongly feel such multispecialty meetings need to be implemented in my teaching hospital and I will take effort in same direction.

Dr. Trivedi made sure that I didn’t miss local food so he took me to dine out in company of other colleagues from the hospital. On weekends, I got to see beautiful landmarks in Cambridge like Cam River and surrounding world famous Cambridge University colleges. I also travelled to London for local sightseeing. It was overall a wonderful experience in my life and will be long cherished.

I sincerely express my gratitude toward IASA, Dr. Rikin Trivedi, Dr. Crawford, Dr. Richard Malian and Nazie Dana for providing me such learning experience, which will help in improving my spine practice rendered at our public hospital in Mumbai.

Dr. Tushar Rathod Assistant Professor, Department of Orthopaedics, Seth G S Medical College & KEM Hospital, Mumbai, India

‘It was overall a wonderful experience in my life and will be long cherished’

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Our First Combined Six-Month Travelling Fellowship Awarded!Park Clinic in Kolkata is the first recipient of the new IASA program, the Combined Six-Month Travelling Fellowship. The Fellow (selection by the hosting clinic) will spend the first four months at the clinic in India, leave for the US or the UK for a one month observer experience in his 5th month, and return to the host clinic to share his new sought knowledge with his peers.

Applications for the second half of 2017 will be accepted through February 28th. Any questions? Please visit our website under the ‘Opportunities’ tab, or email Nazie Dana at ndana@indo-americanspine.org

MEMBER NEWSDid you receive an award recently? Have you switched hospitals? Did your article get published in a peer-reviewed periodical? Were you invited to speak at a conference? Did you complete a Fellowship?Let us know and we will publish it in the next issue of our newsletter! Email your news to Nazie Dana, Program Director at IASA: ndana@indo-americanspine.org

Save the DateIASA RECEPTION AT ASSICON!

Join us at the 30th ASSICON in Hyderabad

Thursday, January 26, 18.30 – 20.00Novotel Hyderabad Convention Center

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IASA Newsletter is printed twice a year. Editor: Nazie Dana.Cover Photo: Ornate door in Jaipur, India.

If you are interested in becoming involved with the group and its activities, please log on to our website (indo-americanspine.org) and join, or contact Nazie Dana, IASA Program Director at 866.835.5306, or via email at ndana@indo-americanspine.org