Six-month-old undergoes metal-free spine fixation surgery at AIIMS

Doctors at AIIMS here have conducted a successful metal-free spine fixation surgery on a six-month-old boy using a bone graft from his mother, making him the youngest infant in Asia to undergo such surgery, the hospital said.

The infant was kept on a ventilator for 11 months after undergoing the 15-hour surgery on June 10 last year and was discharged on May 10, the All India Institute of Medical Sciences (AIIMS) said in a statement.

The child had sustained spinal cord and brachial plexus injury during normal vaginal delivery at another hospital. He weighed 4.5 kg (macrosomia) at birth, said Dr Deepak Gupta, professor of neurosurgery at AIIMS.

After birth, the child was put on oxygen support and had episodes of aspiration pneumonia in another hospital.

"At the time of presentation to us in May 2022 at 5 months of age, the child had respiratory distress and minimal movement of all three limbs (left upper and lower limbs, right lower limb) and no movement of right upper limb. Examination revealed an injury to the spinal cord and cervical spine dislocation (cervical spondyloptosis)," Gupta explained.

"It is almost impossible to fix such young spines using metallic implants/cages due to the very small size of cartilaginous bones in such young infants... the mother consented to give part of her iliac crest bone for her child," he added.

The boy's mother was put under general anaesthesia and the infant was undergoing surgery in parallel operation theatres.

Interestingly, the mother's blood group was B positive and the boy's was A positive but there was no rejection of the bone graft. Good bony fusion and spine stability has been achieved at the time of discharge, Gupta said.

"As per literature search, this happens to be the youngest infant in Asia and the second youngest in the world to undergo cervical spine fixation surgery at such a young age," he said.

"Only one such case in a younger infant has been reported from the USA in 2016 of a similar injury fixed using autograft," he added.

Gupta said, "Looking at the age of the child and the urgent need of surgery, we improvised and used mother iliac crest graft for fusion of child spine (cervical spine cord decompression and 360 degrees fusion) and fixed it with absorbable 2.5 mm PLLA plates (front of spine) and special suture tapes for back of spine to allow for growth avoiding complications of metallic implants."

At this young age, most bones are cartilaginous, very small in size and unsuitable for any available metallic screws, rods or cage fixations, he said.

The child needs prolonged rehabilitation support and was discharged on a tracheostomy tube prophylactically, the statement said.

He is interacting well with his parents, feeding well and has shown partial neurological recovery in his limb movements after surgery, it said.

He celebrated his first birthday in December 2022 in JPN Apex Trauma Centre (AIIMS) and stayed in TC5 ward of the trauma centre for 11 months while he was being weaned off ventilatory support and undergoing neurorehabilitation support, it added.

The boy was looked after by a team of doctors including neuroanaesthesia professor Dr G P Singh, neurophysiology professor Dr Ashok Jaryal, and Dr Sheffali Gulati, Dr Rakesh Lodha and Dr Jhuma Shankar from paediatrics department besides Dr Gupta.