Trailblazing neurosurgery gives hope to sniper victim

A war veteran, paralysed waist-down following a spinal injury in the line of duty, gets a new lease of life after a spinal fixation with stem cell therapy, a first in spinal surgery here.
Kumudini Hettiarachchi reports

Doubled up in excruciating pain and paralysed from waist-down was his plight for two long years, since he fell victim to a sniper when pushing forward the defence line as part of the 'Humanitarian Operation' in the last phase of the war, against all odds with a few men in the jungles of Mullaitivu.

"It was a rapid attack," says Captain Suranga C. Wickramaarachchi from Anuradhapura, recalling that day - February 17, 2009 clearly. He and his band of men secured an earth-bank in Otiyamalai. It was calm and quiet after the intense battle and he got out into the open to inform his Commanding Officer on the field phone of their breakthrough.

No more pain: Captain Suranga C. Wickramaarachchi is all smiles. Pix by M.A. Pushpa Kumara

Seconds later, Suranga was down, shot through his spine by a lone sniper. Bleeding heavily and unable to move his body from waist-down, he held on till he was airlifted by helicopter to Anuradhapura Hospital, losing consciousness only as he was taken through the gates.

Brave on the battlefield and well-known for leading his unit from 4th Delta Company of the Sinha Regiment from the front, today he has become a trailblazer in Sri Lanka's medical field.

A first not only in spinal surgery but also in stem cell procedure has been performed on this 33-year-old war veteran and he is all smiles when the Sunday Times visits him on Friday. "Yes," he feels the touch of the doctors on his thigh, says Suranga, having undergone pioneering surgery just two days before while making a valiant attempt to lift his right leg. But most of all there is no pain, he smiles, putting down the latest book he has been reading before our arrival at the Intensive Care Unit of the Neuro-Trauma Unit of the National Hospital in Colombo.

Suranga's spine was damaged and it was heart-rending to see him in such agonizing pain, explains Consultant Neurosurgeon Dr. Himashi Kularatane, conceding that it was one of the main reasons for him to venture into unchartered territory in the country's medical history.

The pain was unbearable, chips in Suranga, taking on different forms at different times.……..gini jaalawak meda innawa wage, gal rolak anga udin yanawa wage, viduliya veduna wage or kaduwakin himin kapanawa wage (as if he was amidst a ball of fire, a steam-roller going over him, as if he was electrocuted or being slashed by a sword).

Having contacted Dr. Himashi about a year ago on the urging of a friend, the first surgery on Suranga’s spine had been done then to correct spinal angulation and deformity. But Suranga wouldn't let up, pleading with this Neurosurgeon for a respite from the pain. But there was no procedure available in Sri Lanka, or wasn't there?

Intense discussions followed, with Dr. Himashi not only mobilizing his juniors in neurosurgery but also harnessing the wealth of knowledge of his colleagues in other specialities at the NHSL including Anaesthesia, Transfusion Medicine and Haematology.

The crucial decision came after many searches on the internet and through available literature.
Spinal fixation with stem-cell therapy was the answer, pointed out Dr. Himashi which would entail the repair of the spinal cord. But how do you do it? Although stem-cell therapy was an option, this procedure had not been tried out in Sri Lanka.

Dr. Himashi Kularatane Dr. Manjula Kularatne Dr. Bhaddika Jayaratne Dr. Geetha Jeganathan

It was then that Consultant Haematologist Dr. Bhaddika Jayaratne and Consultant Transfusion Physician Dr. Geetha Jeganathan decided they would go off the beaten path and fulfil the request of Dr. Himashi to give him a stem-cell yield from Suranga. Then he could graft the stem-cells to Suranga's spine.

"We mobilized the stem cells from the bone marrow to the peripheral blood using GCSF (Granulocytic Colony Stimulating Factor), separated stem cells using the stem-cell separator kit and counted the cell number by Flow-cytometry," says Dr. Bhaddika who has been "fascinated" by the wonder of stem cells.
Tuesday, March 22, was V-Day for Suranga. Wheeled into the operating theatre early morning around 6, it was the Transfusion Team and the Haematology team which went in first along with the Anaesthesia team. Next it was time for the Neurosurgical team to don their green gowns and scrub up, being handed over 80ml of purified stem-cell concentrate. Making a foot-long incision along Suranga's damaged spinal area, Dr. Himashi and his team began the surgery at around 10 a.m. closing up only around 6 in the evening.

Meticulously Dr. Himashi opened the covering layers of the spinal cord and cleared the entangled nerve roots and spinal cord as much as possible. The "nerves of the spine were not only bundled up but also oozing". After that the segment of damaged spinal cord was excised and stem cells instilled into that area. Finally, the covering layers of the spinal cord were re-sutured back, the Sunday Times understands.

The harvesting of stem cells

The Neurosurgical team headed by Dr. Himashi comprised Senior Registrars Dr. Nirukshan Jayaweera and Dr. Saman Pushpakumara and the Anaesthesia team headed by Consultant Dr. Manjula Kularatne included Dr. Amila Gunawardena, Dr. Sineetha de Silva and Dr. Deepa Chandrakumari. Meanwhile the Transfusion Medicine team headed by Dr. Geetha comprised Registrars Dr. Anoja Herath, Dr. Shiranie Veerasingam, Dr. Hansa Ramanayaka and Medical Officers Dr. U.L.M. Wijesekara and Dr. S.P. Rupasinghe while the Haematology team led by Dr. Bhaddika included Senior Registrars Dr. H.D.H.S Gunasekera, Dr. I. Punchihewa, Dr. A. Amarasena and Dr. G.D.S Gamage.

We were assisted by skilful nurses and other staff, stressed Dr. Himashi while both the Director of the National Hospital, Dr. Hector Weerasinghe and the Director of the Accident Service Dr. Prasad Ariyawanse congratulated the teams for their groundbreaking achievements.

Emphasizing the importance of team work, Dr. Weerasinghe explained that NHSL had gone from strength to strength becoming "centres of excellence" in many fields. He cited the neurosurgery procedure on March 22 along with liver transplants performed last year as proof.

Neurosurgery is very important, he said, in the light of trauma being the leading cause of hospitalization in Sri Lanka. Head and spinal injuries are the main cause (80%) of death in such trauma.

As they see a smiling Suranga vowing to go back to the army and uplift the mental wellbeing of others who have suffered grievous injury, Dr. Bhaddika's wish is to develop a protocol not only for stem-cell therapy but also for training and expertise for her juniors in the development of stem-cell cultures in-vitro. "We need to get into multi-potent propagation of stem cells."

This is while Dr. Himashi hopes to continue such operations and introduce stem cells not only to the spine but also directly to the brain to revolutionize the treatment of stroke victims and those with brain tumours.

Stem cells

What are stem cells? They are "mother cells" that have two defining properties - the ability to differentiate (develop) into other cells and the ability to self-regenerate (to divide and produce more stem cells). Stem-cell therapy is widely used all over the world including India and China for spinal grafts.

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