20 February 2019
Helping Helen - An impossible position
Helen, 64, has Ankylosing Spondylitis (AS), a long term chronic condition in which the spine and other parts of the body become severely inflamed.
Helen’s condition had deteriorated significantly and, a few years ago, her neck collapsed so that her chin became permanently rested on her chest. It left here with severe life-limiting problems.
Hip replacements and revised hip replacements had been necessary and slowly, over time, eating has become less. As her mobility and balance reduced, Helen became wheel-chair bound, had constant chronic back pain and poor chest expansion. There is no cure.
We knew any corrective spine surgery procedure to help Helen would involve many hours of time in the operating theatre. Due to the shape and position of her spine, neck and head and her weight, this was a significant challenge. A bespoke operating table was required if any operation was to be carried out and even then, this would be extremely high risk.
The positioning of the patient on the operating table was a major challenge. Other surgeons had decided not to tackle this due to Helen’s overall health, the length of the procedure and the process of developing an operating table solution.
At Salford Royal:
- We have a large tertiary spinal and neurosurgical unit
- We have 18 spinal surgeons, 12 spinal anaesthetists and 60 critical care beds
- We have access to a 3D printing laboratory at Salford’s Media City - Salford Eagle Lab @The Landing https://labs.uk.barclays/locations/salford
- We are on a journey to become an NHS Global Digital Exemplar and we are the most digitally mature NHS organisation in England.
- We had tackled one similar procedure already, although the same technique could not be used for Helen, due to the added difficulties such as nutritional status, weight, height and bone and skin condition
We knew that we needed to look at a different approach. A bespoke solution would cost tens of thousands of pounds, so we looked at alternatives.
So we looked at 3D systems and engaged with 3D technology groups as we were keen to come up with an in-house solution. We involved radiology and medical physics and went to the Salford Eagle Lab at The Landing in Salford, to work with their team.
Helen had a number of CT scans carried out and then we were able to create a 3D mould of her body. From this mould, we were able to build a special silicon support which our in-house medical physics team then made into a special operating table.
The advantages of the 3D solution were:
- We would use in house expertise
- This could be done easily, quickly and cheaply
- We had the support of NHS Litigation Authority so all the medical-legal aspect was covered
- The first operation of its kind in the UK, using 3D digital printing techniques.
- It took five hours to safely anaesthetise and position Helen
- The surgeon explains that only way of restoring her alignment is to carry out an osteotomy of the spine (breaking of the spine) and to straighten it. However, the apex of the problem lies in the thoracic part of the spine, which is the riskiest part.
- Helen’s surgery lasted over 15 hours
- After surgery, Helen spent 6 days in critical care
- She was able to return home around three weeks after surgery.