Adrienne Spates holds son Joshua as he catches his first glimpse of his twin brother Jacob after they were separated last month at a Memphis hospital. They’re healthy and starting to crawl. | Mike Brown~Scripps Howard News Service
Updated: November 24, 2011 12:25AM
MEMPHIS, Tenn. — Her two wide-eyed and wondrously whole 8-month-old babies wiggled and stared up at her, so Adrienne Spates bent down to kiss one on the cheek while gently nudging the other with her index finger.
“Hey, Jacob, you see your brother?” she asked during a visit last week.
Until this day, in fact, he hadn’t. Neither boy had laid eyes on the other even though they’re identical twins. Jacob and Joshua Spates were born conjoined, fused together back-to-back at the pelvis and lower spine.
On Aug. 29, the twins were separated in a 13-hour operation at Le Bonheur Children’s Hospital in Memphis. The surgery was so complex it required 34 doctors, nurses and technicians who conducted weeks of planning and even staged rehearsals using two sewn-together Cabbage Patch Kids.
Despite the daunting odds facing conjoined twins — the long-term survival rate generally is no more than about 25 percent — the outlook for the Spates boys is bright, doctors say.
They will require ongoing care for numerous congenital anomalies — particularly for Jacob, who needs surgery to fix a heart defect — and it’s uncertain at this point how well either boy will be able to walk.
But the surgery succeeded in avoiding the kind of neurological damage that would have left them quadriplegic or paraplegic.
“Not only are they healthy, but both of them are using their legs and beginning to crawl,” said Dr. Max Langham, the team leader and lead general surgeon on the case.
At a hospital news conference last week, an emotional Adrienne Spates hugged nurses and others from the neo-natal and pediatric intensive care units. Her twins have spent nearly all their lives there. They got separate rooms after the surgery.
“You just have to be strong. I was chosen for this, so if I was chosen, it means I can do it,” Spates said. “Like any mother, I want them to be normal, have normal lives.”
Spates, a 28-year-old single mother from Memphis, has two other children. She learned she was carrying conjoined twins from an ultrasound last November, two months before they were born by Caesarean section at the Regional Medical Center at Memphis.
Conjoined twins occur about once every 200,000 live births or once every 100,000 pregnancies, according to various estimates. Between 40 percent and 60 percent of the babies are stillborn. Many others die shortly after birth.
About 15 percent of conjoined twins are pygopagus — like Jacob and Joshua, they’re joined back-to-back at the pelvis and lower spine with separate heads, hearts and limbs.
A search of medical literature indicates the only other successful separation of pygopagus twins since 2000 occurred in Riyadh, Saudi Arabia, said Dr. Giancarlo Mari, director of maternal and fetal care at the University of Tennessee Health Science Center and Le Bonheur. Spates’ decision was to “do anything we could” for her twins, Mari said.
After the ultrasound revealed the conjoined twins, Spates had frequent appointments with doctors. There were many meetings among members of the Le Bonheur Fetal Center, a wide-ranging group of specialists who monitor and deal with high-risk pregnancies.
The first decision was determining when the boys should be delivered. They chose a C-section at 34 weeks, figuring it was safer to have planned premature births than to wait and risk having to take emergency measures if one or both of the boys experienced distress, Mari said.
Last month, the operation to separate the twins involved four pediatric surgical teams — orthopedics, neurological, plastic surgery and general surgery.
Surgeons separated the spinal column, spinal cord and muscles and completed gastrointestinal repairs.
A major challenge for doctors was figuring out how to safely “flip” the boys over during surgery without entangling or unhooking any of the tubes and wires monitoring, anesthetizing and sustaining them.
The connections, color-coded with red going to one baby and blue to the other, “looked like spaghetti,” said Dr. Joel Saltzman, the anesthesiologist during the operation.
Saltzman said his wife sewed two dolls together to represent the conjoined twins during rehearsals. That preparation helped make for a smooth operation, he said.
As for the future, the boys’ mother says, “I visualize all good things.”
Scripps Howard News Service