MEMPHIS, Tenn. -- Her two wide-eyed and wondrously whole 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 Wednesday morning.
Until this day, in fact, he hadn't. Neither boy had laid eyes on the other even though they're identical twins.
Now 8 months old, 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 that 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.
Although it was the sixth documented case of conjoined twins in Memphis history, the operation was the first in the city in which both survived separation, doctors said Wednesday.
Despite the daunting odds facing conjoined twins -- for whom the long-term survival rate generally is no more than about 25 percent -- the outlook for the Spates boys is bright, doctors say.
There will be 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.
Wednesday was something of a coming-out day for Joshua and Jacob, whose story was featured on the "Today" show and "Good Morning America," as well as networks that included CNN and the BBC. A morning news conference at Le Bonheur provided details beyond the brief announcement the hospital had released the day before.
As the event got under way, an emotional Adrienne Spates hugged nurses and others from the neo-natal and pediatric intensive care units, where the twins have spent nearly all their lives, staying in separate rooms after the surgery.
The 28-year-old single mother from Memphis, who has two other children, learned she was carrying conjoined twins from an ultrasound in November -- some two months before they were born via cesarean 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, with many others dying shortly after birth.
About 15 percent of conjoined twins are pygopagus -- joined, like Jacob and Joshua, 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.
Her diagnosis was followed by frequent doctors' appointments and meetings among members of the Le Bonheur Fetal Center, comprising a wide-ranging group of specialists that monitors and deals with high-risk pregnancies.
The first decision for doctors and Spates was determining when the boys should be delivered. They chose to have a C-section at 34 weeks, figuring it was safer to have planned premature births than wait and risk having to take emergency measures if one or both boys experienced distress, Mari said.
The operation involved four pediatric surgical teams -- orthopedics, neurological, plastic surgery and general surgery -- that 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, anesthesiologist at 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.
Figures on the cost of the operation were unavailable Wednesday, but it's a "huge number," Langham said. Although Medicaid will cover much of the cost, a fund -- called the Joshua and Jacob Spates Trusts -- has been established at First Tennessee Bank to help pay for supplemental assistance for the boys.
(Contact Tom Charlier at email@example.com.)
(Tom Charlier is a reporter for The Commercial Appeal in Memphis, Tenn.)