Dr Dukhi restores paralysed patients

— in first-of-its- kind surgery in South America

GUYANA has become the first country in South America to perform a Vault C Anterior Cervical Discectomy and Fusion System (ACDF) implant surgery, restoring motor functions to two patients who were partially paralysed.

The procedure was performed at two separate private institutions here by Guyana’s only neurosurgeon, Dr Amarnauth Dukhi, on two male patients, ages 51 and 65.

Carlo Koren, President of Innovation Medical Technologies Inc., the South American distributor of the titanium plate used in the surgery, confirmed that Guyana is the only country on this continent to perform the procedure.

According to Precision Spine, the U.S.-based company that manufactures titanium plates, Vault C Anterior Cervical Discectomy and Fusion System (ACDF) is a zero profile, modular system featuring a titanium anterior cervical plate with an integrated, one-step locking mechanism and a snap fir PEEK-OPTIMA spacer.

The system is designed to restore sagittal profile, while providing anterior column support to enhance the fusion process.

To get a better understanding of what the procedure entailed, the Guyana Chronicle sat down for an exclusive interview with Dr Dukhi.

He explained that both patients suffered from spinal injuries due to separate motor vehicle accidents, which rendered them bedridden and paralysed.

He explained the surgical procedure.

“A small incision is done on the neck, where you have to go from the anterior approach through the skin, then you separate the trachea , the esophagus to one side and then all the vessels and the nerves to the other side. You go through all those structures through the neck to the spine. When you get to the spine then you have to prepare it, after preparation – the traumatic disc that has migrated and compressing the cord will be removed. So you decompress the cord by removing that disc and now [in] that space that is left empty, the implants are placed. It is fixated into that spacing so you reconstruct and realign the spine using implants, then it is fixed by utilising the screws.”

The surgery is very technical and without due care and precision can be fatal to the patient or in some cases, render them fully paralysed.

GREAT ACCOMPLISHMENT

Dr Dukhi was able to successfully accomplish this very complex task in a timely manner.

“This type of surgery depends on how quickly you get the patient. This surgery will not change the prognosis in patients who are paralysed for a prolonged period and surgeries delayed for long periods. If there is hope, the correct thing to do is immediate surgery. If the spinal cord is damaged, there is also no point for surgery. Timing is critical,” he noted.

Speaking to the Guyana Chronicle, one of the patients who requested anonymity, a 51-year-old businessman and a father of four of Foulis, East Coast Demerara, said he is thankful to regain full control of his body.

“I had  about three accidents with the last one in the U.S. in December last year and I used to feel numbness in various parts of my body, coupled with severe pain which caused me to walk with a limp and due to the pain I went to get local massage which made it worse. When I went to the doctor, I was told to get an MRI. I was later told my case was rare, but there was hope. After agreeing to have it done locally, I realised it was the best thing I ever done because I can now walk and do all the things that were not possible before surgery. I still have physical therapy, but I am very thankful to Dr Dukhi.”

Dr. Dukhi explained that in the case of the 51-year-old male, a double implant was performed. Prior to the surgery, the patient experienced severe weakness in the upper and lower limbs, difficulty walking and limited or no function of the arms.

In the case of the 61-year-old male, the patient suffered a motor vehicular accident in December 2017 in the interior region, rendering him completely paralysed.

However, through the post-ACDF implant, he was able to recover movement of the upper limbs and is currently under rehabilitation to recover movement in the lower limbs. His surgery was done five days after the incident.

Dr Dukhi, who has been performing neurosurgical procedures in Guyana since 2015, has successfully completed over 450 surgical procedures, giving patients a new lease on their lives.

LONG WAY TO GO

Additionally, he believes that based on the progress made thus far, Guyana still has a long way to go, but with the support of government and private institutions, Guyana can be the premier State for medical treatment in the future.

“Prior to 2015, there was nothing neurosurgical in Guyana. Neurosurgical capacity was nil. I think we would have gone a long way to where we are now in building a Department of Neurosurgery at the Georgetown Public Hospital Corporation, where we are now able to offer surgeries for brain tumours among others, where persons previously would have had to go overseas.”

He continued, that Guyanese will have a lot to look forward to in terms of avoiding costly trips overseas to have these procedures done.

“Vascular neurosurgical procedures is the peak of neurosurgery, it takes a lot of technology, instruments, human resource capacity to develop that and that by itself is very costly, so we would have to have the political willpower, build our own human resource capacity in terms of training more doctors in neurosurgery, so we can facilitate these type of surgery in the future and I have no doubt we would get there. We are working towards that, we are now almost into minimally invasive neurosurgical procedure. We were able to source through the government a neuroendoscope and tower, where sooner or later we would be able to start up procedures so that babies do not have to have open shunting surgeries for hydrocephalus.”

Four doctors are currently being trained in the field of neurosurgery at the GPHC.

“In terms of formal training, we are presently drafting a post-graduate programme, myself and Professor Ivor Crandon from Jamaica, where we are working to create in the local health system a programme where we are able to train local doctors to a post-graduate level that will be a University of Guyana/University of the West Indies programme. Hopefully, everything in this should be available in less than a year,” the enterprising doctor said.