Mission Updates

Monday was the day this mission really began: our first operation of the trip at St. Nicholas Hospital. The case went well, and our patient is recovering.

Getting the baselines right

Before the correction begins, Meghan records baseline neuromonitoring signals from the patient’s spinal cord and nerves. Every signal later in the operation is compared against these, so they are the foundation of a safe correction. Watching her work, you can see her expression as she spots something that isn’t quite right, works out what it is, and then gives a subtle nod to herself once it’s resolved.

Old friends

Some of the best moments of every mission are the follow-up visits. Today we saw patients we operated on last year and two years ago: a former prom queen who now works as a Ukrainian–English translator, an architect who is restoring Ukraine’s architectural heritage, and one of our most complex cases, who is doing very well. Seeing them living full lives is why we keep coming back.

New consultations

We also saw new patients, including a girl whose X-ray shows a 150-degree curve, and several teenagers with adolescent idiopathic scoliosis (AIS), the most common type of scoliosis, which usually appears around puberty.

Made to fit

Pre-operative planning continued, and we machined vertebral spacers to custom-fit our patients.

A ride to the OR

☀️ Sunday was a rare free morning. Dr. Orach spent it where any good dad should be, at his children’s soccer games, and the rest of us took the chance to explore the city.

Lviv, a city worth seeing

Lviv is truly one of the most beautiful cities in Europe. Its historic center, a UNESCO World Heritage Site, is a maze of cobblestone streets, Renaissance and Baroque churches, pastel façades and old tram lines, with centuries of history layered into every block. From the hills above the old town the rooftops and spires stretch out to the horizon, and in early November the parks are still glowing gold. The city is also famous for its café culture, and we did our part.

It’s a city that carries its history with dignity, too. Among the churches and parks are memorials to those who gave their lives for Ukraine, including the Heavenly Hundred, the protesters killed during the 2014 Revolution of Dignity. Walking these streets, it’s impossible not to feel how much this place means to the people who live here, and why caring for its children matters so much.

City photos courtesy of Meghan Mullaney.

Back to work

In the afternoon we headed back to St. Nicholas Hospital for final preparations: reviewing images, measuring curves and walking through each step of the surgical plan so that nothing is left to chance.

Our first operation of this mission is tomorrow. Please keep our patients and their families in your thoughts. 🇺🇦💙💛

🛠️ After a full day of consultations, we went straight to the operating room to prepare for our upcoming cases. Every piece of equipment gets set up, checked and tested before the first patient arrives, so that on surgery day the only thing we need to focus on is the child on the table.

Thank you, VB Spine 💙

Spinal implants are one of the biggest barriers to surgery in Ukraine. They’re expensive, often in short supply, and without them a child with a severe curve simply can’t be operated on. Thanks to VB Spine‘s generous donation, the implants and instruments for these operations are unpacked, sorted and ready to go.

The operating room is set, the implants are ready, and the team is rested (almost). Surgery starts soon. 🇺🇦💙💛

🩺 Today was clinic day at St. Nicholas Hospital, and we saw more than 50 patients. The printed schedule alone had 35 consultations booked in ten-minute slots from 11:00 until 4:40 in the afternoon, and that was only about two-thirds of the families who came to see us. Our patients ranged from toddlers under two to young adults of 21, with idiopathic and congenital scoliosis, Scheuermann’s kyphosis, spinal deformity related to cerebral palsy and spina bifida, and curves that have kept progressing despite bracing.

Each visit starts with the films. We review X-rays, CT and MRI with the family, examine the child from head to toe, check strength, sensation and reflexes, and talk through what the curve means and what the options are. For some children that means observation or bracing; for others it means planning surgery, either on this mission or the next.

Thank you to every family who trusted us with their child’s care today, and to our colleagues at St. Nicholas who made a day this busy run smoothly. Surgery planning continues tomorrow. 🇺🇦💙💛

🏥 After 22 hours of travel, we arrived at St. Nicholas Hospital in Lviv at 10pm and went straight to see three of our pediatric patients.

One of them is a young girl in halo traction for a severe, 180° scoliosis that has impaired her lung function. She’ll have a two-stage operation, and Brian, our neurophysiologist, is already preparing her for it by practicing the Stagnara wake-up test with her.

What is a Stagnara wake-up test?

Straightening a severely curved spine stretches and moves the spinal cord, so the most important job in the operating room is making sure the cord keeps working. Throughout surgery, our neurophysiologists monitor the nerve signals running between her brain, spinal cord and limbs. The Stagnara wake-up test, named after the French spine surgeon Pierre Stagnara who introduced it, is the direct check: once the spine has been corrected, the anesthesiologist lightens her anesthesia just enough for her to respond, and we ask her to squeeze our hands and then move her feet. If she can move her feet on command, her spinal cord is working, and she is put back to sleep to finish the operation. She stays comfortable throughout, and most patients don’t remember it afterwards.

Rehearsing it with her now means she’ll know exactly what we’ll ask of her and can respond quickly and calmly in the operating room.

Now resting at the hotel ahead of a full day tomorrow. 🇺🇦💙💛

🛬 We’ve landed in Rzeszów, Poland, with all our bags and supplies in one piece. Next stop: crossing the border into Ukraine and on to Lviv.

More from the other side of the border soon. 🇺🇦💙💛

✈️ Tonight Brian, Meghan and I depart JFK for Warsaw, then on to Rzeszów and across the border to Lviv. Over the next two weeks at St. Nicholas Children’s Hospital, we’ll be performing follow-up surgeries for 15 children and seeing up to 50 new patients in clinic.

Follow along here for daily updates from the ground. 🇺🇦💙💛