Memphis operation successfully separates twins joined at the spine

By Dr. Ananya Mandal, MDSep 15 2011

Joshua and Jacob Spates, all of seven months old spent their initial months outside the womb as conjoined twins. Now they are recovering in the pediatric intensive care unit of a Memphis hospital after a successful 13-hour surgery to separate them.

Dr. Max Langham, team leader for the separation, said that all involved are enjoying a “celebratory mood of how well Joshua and Jacob are doing.” The twins, who were joined at the spine, were separated on August 29th. Two weeks later, not only are the boys healthy, “both of them are using their legs and getting ready to try to crawl out of bed,” Langham said. “Most conjoined twins don't ever get a chance to get to separation because they die from complications at delivery,” said Langham, chief of pediatric surgery at Le Bonheur Children's Hospital.

Conjoined twins occur in one out of 100,000 births. These boys were born pygopagus twins, joined back-to-back at the pelvis and lower spine, but with separate hearts, heads and limbs. This condition occurs in just 15 percent of the cases of conjoined twins, according to Le Bonheur.

That the two boys were conjoined was detected during mother Adrienne Spates' 25-week fetal ultrasound last November, according to the hospital. After being monitored for eight weeks, the babies -- who had a shared rectum, muscles and nerves - were delivered via Caesarean on January 24. Two days later, surgeons performed a colostomy and inserted a gastrostomy tube to assist with nutrition and waste elimination, according to the hospital press office.

Doctors had to deal with a number of other conditions in the following months. Joshua had a single kidney, a heart defect and calcifications in the spleen and Jacob had a two-vessel umbilical cord and a heart defect.

Langham said members of the medical team “spent over a month” planning and rehearsing the operation. It took a 34-member pediatric surgical team 13 hours to separate the Memphis brothers' spinal column bone, nerves and muscles and to complete gastrointestinal repairs. The doctor said the trickiest part of the surgery involved dealing with the part of the spine shared by the boys.

The boys are only the sixth documented case of conjoined twins in Memphis history, and the hospital reports that the last case in which such a surgery was attempted was in the 1970s. All previous Memphis surgeries resulted in the death of at least one of the twins.

Bill Warner, an orthopedic surgeon in the hospital's spine clinic, said the boys have health problems that will require ongoing treatment, but he expects Joshua will be able to walk with braces and hopes that Jacob will do the same. “The outlook is bright as far as them being functional in the community,” Warner said.

The Joshua and Jacob Spates Trust Fund has been set up to provide financial help to the boys.