Le Bonheur Surgeons Successfully Separate Rare Conjoined Twins

Most complex surgery in hospital history

Doctors at Le Bonheur Children’s Hospital successfully separated conjoined twins, Joshua and Jacob Spates, on Monday, Aug. 29. The Spates family is from Memphis. Conjoined twins are identical twins whose bodies do not fully separate in utero. A rare phenomenon, conjoined twins occurs in approximately one in 100,000 births.

Joshua and Jacob are pygopagus twins, which is a rare form of twins joined back to back at the pelvis and lower spine, each with separate hearts, heads and limbs. This type represents only 15 percent of conjoined twins.

Born joined at the lumbar sacral spine and sharing a rectum, muscle and nerves, the twins are one of only six documented cases in Memphis history. The Spates boys were diagnosed prenatally via ultrasound at 25 weeks gestation and then referred to Le Bonheur’s Fetal Center. Dr. Giancarlo Mari, medical director of the Fetal Center, developed a plan of care and delivered the boys at 34 weeks gestation on Jan. 24 via Caesarean section at The Regional Medical Center. Seven hours later, Pedi-Flite transferred the boys to Le Bonheur’s Neonatal Intensive Care Unit. Two days later, pediatric surgeons performed a colostomy and inserted a gastrostomy tube to assist with nutrition and waste elimination.

For the following seven months, Le Bonheur specialists cared for and prepared to separate the boys. Born with multiple congenital anomalies, Joshua (Baby A) was diagnosed with complications of situs inversus totalis, calcifications in the spleen, a single kidney and a heart defect. Jacob (Baby B) was diagnosed with Dandy-Walker syndrome, hydrocephalus, two-vessel umbilical cord and a heart defect. Their care team included pediatric experts from multiple specialties including anesthesia, child life, critical care, general surgery, neonatology, neurosurgery, orthopaedics, nursing, plastic surgery, rehabilitation therapy and social work.

During the 13-hour separation surgery, surgeons separated the spinal column, spinal cord and muscles and completed gastrointestinal repairs.

“This collaboration of physicians and specialists is the absolute proof of success from years of national recruitment of the best,” said Meri Armour, Le Bonheur president and CEO. “For our team to have successfully separated a case of this complexity and do it flawlessly is a major milestone in health care for the city of Memphis and the region.”

Joshua and Jacob remain in the Pediatric Intensive Care Unit (PICU) at Le Bonheur where they will continue to receive critical care and rehabilitation therapy.

Downloadable Information Sheets (PDF)

A trust has been established in honor of Joshua and Jacob. Donations may be made at any First Tennessee Branch or mailed to the following address:

First Tennessee Bank
Attn: Mary Alice Ruleman
165 Madison Ave, 1st FL
Memphis, TN 38103