What Dr. Ben Carson and a Baby Girl with 4 Legs and 2 Spines Have In Common

By Jamie Wells, M.D. — Mar 24, 2017
Dr. Carson, the secretary of Housing and Urban Development, was a pioneer in the field of pediatric neurosurgery. He catapulted to world-renowned status in that arena as the principal surgeon in a 22-hour operation separating conjoined twins, who were attached at the head.
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A ten month-old baby girl – called Dominique – born with two spines and four legs traveled from the Ivory Coast to Chicago to cross paths with a team of care givers who would successfully operate on her in a six-hour surgery. The coordinated effort required five surgeons and fifty clinicians.

Concerned over lack of intervention leading to undesirable complications like paralysis, the medical crew reportedly removed the accessory appendages without event and the patient is thriving by all accounts. In this case, the anomaly is the consequence of a parasitic twin. "A parasitic twin is an identical twin that fails to fully separate in development," said John R. Ruge, a pediatric neurosurgeon at the hospital. "In other words, not another independent twin, but a twin that was dependent on her body system, such that Dominique's heart and lungs provided the nourishment."

To learn more about the varying types of conjoined twins and birth anomalies, review The Science Behind When Two Fetuses Become One. Also, Ovarian Tumors With Brain Tissue, Teeth Or Hair (Not Unheard Of) can shed further light on the occurrence of malformations. 

In these scenarios, the vanishing twin virtually gets absorbed into the host twin in a fashion that typically leaves the corresponding duplications lacking in normal functioning. Information released by the hospital to news outlets claims the second spine was left in place while muscle tissue from the parasitic twin was used to fashion the closure for the operative wound site. 

Our current Secretary of Housing and Urban Development (HUD), Dr. Ben Carson was a pioneer in the field of pediatric neurosurgery catapulting his world-renowned status in that arena when he was the principal surgeon in a 22-hour operation separating conjoined twins who were attached at the head. This one case alone requires the ability to captain a ship and thrive under the most intense and highly stressful of circumstances. The patient is put in hypothermic and circulatory arrest which have time limits or points of no return. Another such case took him 28 hours where the twins were attached at the top of the head instead of the back and the outcome successfully allowed them to remain neurologically intact. These types of cases do not have road maps from a textbook and were groundbreaking for Dr. Carson, the field of neurosurgery and Johns Hopkins School of Medicine. 

To learn more about the complexities of such a surgical subspecialty that comprises the brain, spine and peripheral nerves, read It's Not Brain Surgery, But Do You Know What Is? Brain Surgery!

From a medical and surgical perspective, these operations are complex and challenging to say the least as each is vastly different from the other depending upon the location and connections involved. Let's not forget how tiny these structures are in a baby as opposed to an adult, along with the need to measure all fluids and medications based on kilogram (weight) dosing. 5 surgeons --multiple ones neurosurgeons-- along with 50 clinicians worked tirelessly to free Dominique from the challenges of her condition while balancing retention of all of her neurologic and other bodily functions. Working in and around the spine is among the highest real estate in the body. The procedure was an apparent success and the descriptions published proclaim there is no reason not to expect a normal life and development.

Vital structures of nerves and arteries encompass the peri-spinal areas composing an elaborate neurovascular system that requires tedious and careful navigation and surgical precision in this type of case. Thankfully, this is seemingly a wonderful story and outcome. Access to such comprehensive care and diversity of medical staff was essential in yielding this positive result.