A 10-year-old girl flew in from Djibouti with a deformed spine that restricted her height to 123 cms. After a life saving critical surgery here, she stands tall at 140 cms, cheerful and confident of facing the world.
No! This is not any cosmetic surgery or a magical cure! The dramatic change came about due to the efforts of a multi-disciplinary team of medical professionals - surgeons, paediatricians, cardiac specialists, anesthesiasts and others - at the Mumbai-based Sir H.N. Reliance Foundation Hospital and Research Centre who set straight the girl's life-threatening curved spine.
In medical lingo, the abnormal curvature of a person's spine is called thoracolumbar scoliosis.
Three weeks back, the bright fifth grade student (name not disclosed) from Djibouti - a country in the Horn of Africa - came to the spine clinic at Reliance Foundation.
She had a deformed spine and a hump on the right side of her back. She could not stand erect.
"Her parents noticed the spinal deformity three years back. The deformity resulted in a severe imbalance in her posture. She also complained of short breath while running," Kshitij Chaudhary, one of the surgeons who operated upon her, told IANS over phone from Mumbai.
What added to the parents' worry is the death of the girl's grand-aunt at the age of 40 due to complications related to untreated scoliosis.
The doctors found that the girl from Africa had severe right sided thoracolumbar scoliosis with trunk decompensation. There was a significant right sided rib hump. Neurological examination was normal.
"Many Indian hospitals turned her away owing to the complications involved in the surgery," Chaudhary said.
The X-rays showed that the thoracolumbar scoliosis curve or spinal curvature measured 125 degrees with an associated kyphosis (excessive out ward curve that causes hunch) of 85 degrees.
"We advised surgery as her life span in her current condition would be only around 40 years as such large curves impacts the functioning of the lungs and the heart," Chaudhary said.
However, the surgery was not simple like opening the back and straightening the spine and closing it back.
"The pulmonary function test showed she already had restricted lung function that was 66 percent of normal. Echocardiogram showed a patent foramen ovale (hole in the heart). The MRI did not reveal any spinal cord anomalies," he said.
According to him, it was the first time the hole in the girl's heart was discovered.
While the go ahead signal was given by the pediatric cardiac services team, a detail plan for the surgery and post-operative care was chalked out after going into minute details.
As the patient would be required to be woken up during the surgery (wake up test), her father's voice recording for some instructions was made.
"She was woken up once during the surgery. She will not feel the pain but would be able to hear as to what she has to do," Chaudhary said.
"We also used the cell saver technology to minimise the blood loss and infuse back the blood that came out during the surgery. So the total blood loss was minimal. Nearly 50 percent of the blood loss was saved and there was no blood transfusion."
According to him, as two surgeons did the surgery - Chaudhary and Arjun Dhawale - the blood loss was less and the surgery time was also cut short by nearly an hour.
The spinal osteotomies or the spinal reconstructive procedures were done at the apex of the deformity for better correction.
Rigid contoured rods were connected to the pedicle screws and good correction was achieved.
As a consequence, she woke up after the surgery with intact neurological function.
Chaudhary said the Djibouti girl can lead a normal life like anyone else.
"Currently physiotherapy exercises are being given to her and her improvement is steady and good," he said.
On the hole in the heart, he said the cardiac specialists felt it will not create any problem and there was no need for any surgery to close the hole.
"There is certainly a change in the girl's attitude. She is now more confident," Chaudhary said.
(The writer can be reached at v.jagannathan@ians.in)
