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Jordanian teen has a ‘spine made of rope’ in first-of-its kind surgery in Dubai

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A teenage girl from Jordan has had a new spine made of rope in a pioneering operation in Dubai; making her the first recipient of the surgery in the MENA region.

Salma Naser Nawayseh, aged 13, underwent the pioneering operation called vertebral body tethering (VBT), where a piece of rope is run down the full length of the spine.

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Screws are then inserted into each section of the spine to help produce the correct tension on the rope and correct the curve.

After the operation at Burjeel Hospital, Dubai, last week, the teenager is already making a remarkable recovery and is now not only back walking – but plans to soon return to the tennis courts to resume one of her favorite hobbies.

Salma’s parents first noticed the curve in her spine in April 2022.

X-ray image of the spine before and after the surgery. (Supplied)
X-ray image of the spine before and after the surgery. (Supplied)

They were stunned when doctors diagnosed her with scoliosis, a condition in which there is an abnormal lateral curve of the spine.

Scoliosis can develop in infancy or early childhood. However, the primary age of onset for scoliosis is 10-15 years.

While scoliosis affects about two percent of the population, most cases are mild and do not require invasive treatment. If left untreated, moderate to severe scoliosis can lead to pain, increasing deformity, and potential heart and lung problems.

According to Dr Firas M. Husban, a consultant orthopedic surgeon at Burjeel Hospital, when Salma, a grade 9 student, came to him, she had a thoracolumbar curve of 65 degrees.

Due to her condition, she suffered deformity of the back with shortening of the trunk, lower back hump, unlevelled pelvis, and back pain.

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

The traditional option to correct scoliosis is spinal fusion surgery, where two or more vertebrae are permanently joined into one structure using screws and rods.

Dr. Firas M. Husban performing the VBT surgery at Burjeeel Hospital, Dubai. (Supplied)
Dr. Firas M. Husban performing the VBT surgery at Burjeeel Hospital, Dubai. (Supplied)

While spinal fusion is the most common surgery to treat scoliosis, it limits spinal mobility and subsequent growth. In 2019, the USFDA approved Vertebral Body Tethering; a minimally invasive technique that allows for continued growth without fusion while preserving motion and flexibility.

The new treatment enables fusionless 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, doctors said she was the “perfect candidate” for the procedure.

“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,” said Dr Husban. “A flexible cord, called the tether, is attached to the spine on the outside of the curve through bone screws.

“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. As a result, there is less blood loss, less postoperative pain and speedier recovery time compared to the spinal fusion surgery.”

Right after surgery, Salma’s spinal curve showed improvement. According to Dr Husban, the curve will continue to improve, and the tether will guide the growth of the spine as the body grows.

“The patient is recovering well after the surgery. After two weeks, Salma can go back to school. Four weeks later she can return to full activity with no restrictions and can start playing sports,” he adds.

Salma’s parents are thrilled at the outcome.

“She started walking the second day after surgery,” they said in a statement, released by the hospital. “We are happy that our daughter was eligible for this surgery. We look forward to our daughter holding the racket again and resuming tennis.”

First time in the region

VBT is currently performed in very few countries, including the US, France, and Germany. This is the first instance of the surgery being performed in the GCC and North Africa.

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 nine 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.

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