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City of Banjul
Wednesday, October 28, 2020

Let the dream of youth continue The first case of upper cervical spine surgery in The Gambia

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By Dr Guang Zhao

If life is colourful, then youth must be one of the most beautiful parts; if life is dynamic and static blend, then the youth of 14 years old must be one of the most dynamic. Saloum Jarjue, a 14-year-old Gambian boy, would have been the young wind runner who was happily playing football on the beach if he hadn’t been injured in the accident.

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The accident injured his head and neck. After the injury, he was aware of it and spoke normally, but his limbs lost his ability to move. The right limb can only move slightly (muscle strength 2), but the left limb could not move at all (muscle strength 0). In the hospitals we were assisted with, only simple radiography was performed, and the results showed atlantoaxial fractures and dislocations. Clinical diagnosis: atlantoaxial fracture and dislocation, spinal cord injury, paraplegia.

This is a great disaster for the 14-year-old and his family. The family found the Director of Neurosurgery, Dr John Jabang, hoping to be treated. The Gambian has never had such a difficult spinal surgery before. So two options lay before him: 1. Go abroad to be treated in developed countries; 2. Go home with no possibility of recovery and need the care of others for years. The child is only 14-years-old, the family is unwilling to discuss with the director again.

Director Dr John Jabang found me, hoping to help give surgical treatment. After I saw the film, I didn’t immediately answer them. This kind of surgery can only be carried out in top hospitals in China. Moreover, there is no three-dimensional CT examination, no angiography, and the related safeguard measures are not perfect. And, the important nerve and large blood vessels are not in the normal position. The operation would be fraught with danger. But seeing the helpless look of the poor child and the expectation of the worried family, after consulting with Director Jabang, I decided to take the risk and give the child a chance to be treated.

The operation was arranged one week after the injury, and the surgery was carefully operated every step. The movement range was calculated in millimetres . The distance between the pedicle screw point and the vertebral artery was only 1.38 mm,2. The error of a millimeter may lead to the injury of vertebral artery and massive bleeding, and the patient may die on the operating table. He is also very careful in the process of dislocation reduction. If the central nervous system is damaged again, the child could be paralysed in bed all his life. In this way, after nearly five hours of thin ice, thrilling operation process, the operation was finally successfully completed, with the doctor’s surgical clothes soaked with sweat.

The untiring efforts led to a return. The second day after the operation, I was pleasantly surprised to find that the patient recovered very well, the right limb had been able to resist the resistance activity at random (muscle strength 4+), and the left limb was also free to move (muscle strength 3). In the next step, we will give the child a rehabilitation training to be able to recover further, hoping that he will return to health at an early date, and return to being the big boy who is positive and full of sunshine!

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