Scoliosis Mission in Siem Reap

In August and September, we had the opportunity to participate in and assist with scoliosis surgeries at Kantha Bopha Hospital in Siem Reap on various occasions. Scoliosis refers to a pathological curvature of the spine that typically occurs in all three dimensions. A distinction is made between the more common idiopathic scoliosis and the rarer secondary scoliosis. Idiopathic scoliosis most commonly occurs in adolescents: during puberty, the spine becomes deformed for reasons that are still unknown. If this happens early in puberty and the deformity is severe, surgical treatment may be necessary.

It was precisely this surgery that I, Anaëlle, was initially able to observe under the guidance of the neurosurgery and orthopedics staff at Kantha Bopha Hospital. This is the first procedure of its kind in Siem Reap to be performed under an all-Cambodian medical team, so the nervousness leading up to the surgery was palpable. The patient undergoing surgery today is 14 years old and has a severely deformed spine. This not only affects her appearance but also causes severe back pain and impaired lung function.

While she is being put under anesthesia, an orthopedic senior resident connects the patient to the intraoperative neuromonitoring system—more on that later. He explains to me that he has completed extensive training for this and is fully proficient in all the device’s functions. As the surgery begins, the neurosurgeons and the orthopedic surgeon work hand in hand. Together, they carefully expose the spine and then position screws and rods—all under the constant supervision of the neuromonitoring system. Everyone appears experienced, focused, and yet relaxed. The surgery is a success. When I ask where they gained this experience, they explain that a French medical mission has been performing these procedures every six months for several years and passing on their knowledge to their Cambodian colleagues. This mission will pay another visit to Jayavarman VII Hospital in Siem Reap a week later.

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To this end, three doctors from Toulouse (FR)—Professor Jérôme Sales de Gauzy (surgery), Dr. Jean-François Trinchero (anesthesiology), and Dr. Patrice Henry (neurology)—traveled to Siem Reap for a week. During this mission, they not only performed ten surgeries together with the doctors from Kantha Bopha Hospital but also examined a total of 76 children with scoliosis to determine whether surgery was necessary. What makes this special is that, thanks to the active support and training from France, the orthopedic team here at the hospital is now able to independently perform surgery on uncomplicated scoliosis cases.

On the last day of the mission, I, Sina, had the opportunity to accompany the team during two surgeries. I watched with great admiration as all three doctors provided targeted supervision to the Cambodian team, since not only is the coordination between the surgeons and the anesthesia team of the utmost importance, but so is the continuous neurological monitoring of the patient throughout the entire surgery. Dr. Trinchero told me that every time they’re here on a mission, it’s like a big reunion among friends, since they’ve known the entire team for years. Although it always involves a lot of work and a tight schedule, they’re always very happy to come back. This mission showed me once again what makes medicine so special: it brings people together with the shared goal of working for the health and well-being of others. It was a truly wonderful experience for me to be able to spend a day with the team, and it will remain in my memory for a long time to come.

About two weeks later, following the visit by their French colleagues, the local doctors performed their first scoliosis correction—now the second surgery of this kind carried out entirely under Cambodian leadership. I, Bénédicte, was once again able to observe the procedure. The young patient who underwent surgery suffered from lumbar scoliosis, which, in severe cases, can even impair the digestive system due to lack of space and increased pressure in the abdominal cavity. It was particularly fascinating to observe the neuromonitoring process mentioned earlier. Before, during, and after the surgery, electrodes are used to monitor the function of important motor and sensory nerve pathways: The motor signal is measured at the muscle after the corresponding region of the brain has been electrically stimulated. The sensory response, in turn, is recorded in the brain after a peripheral nerve has been stimulated. This allows for the early detection of injuries to the spinal cord or nerve roots caused by the insertion of screws into the spine, and their position can be adjusted if necessary to prevent irreversible damage.

While orthopedic surgeons and neurosurgeons perform the operation, a neurologist is responsible for monitoring and regularly updates the team on the signals from the nervous system. Step by step, the neuromonitoring system was explained to me before the surgeons operated on the patient’s spine with confident, precise movements. After the successful completion of the procedure, the team appeared visibly relieved and proud of the result, as well as the improved quality of life they had made possible for the patient. This is a wonderful example of how knowledge transfer is put into practice here—one of the central pillars of the Kantha Bopha Hospital’s philosophy.

Warm regards from Siem Reap

Anaëlle, Sina, and Bénédicte