Patient Stories

Neurosciences: Rare complex spine surgery for an 18-year-old female

Doctor: Dr Naveen Mehrotra
MS, M.Ch, SGPGI (Lucknow)
AANS Fellowship (USA), Paediatric Neurosurgery Fellowship (Canada)
Consultant Neurosurgeon
Jul 26, 2013

18 months old girl had difficulty in walking. The patient also has weakness in her both lower limbs especially the ankle and toes. The patient also had history suggestive of sphincteric dysfunction.

Her MRI of the spine revealed a rare but complex disorder of SPLIT CORD MALFORMATION. This will result in breaking of her spinal cord into two at dorsal level by a fibrous spur and reuniting below. The spinal cord was stretched and ending at L5 much below the average level of L1. The aim of the surgery was to release the spinal cord by dividing the fibrous spur with preservation of the neural function.

The surgery for split cord malformation is challenging as the complications might include paralysis of both lower limbs with bladder and bowel incontinence, and if we do not operate, the child will develop irreversible deficits. The patient underwent laminectomy with excision of the spur along with the sectioning of the filum terminale. The child underwent surgery well and her postoperative period was uneventful. She is very thankful for the patient care team at Sunshine Hospitals.

Neurosciences: Spinal tumour surgery for a 55-year-old female

Doctor: Dr Naveen Mehrotra
MS, M.Ch, SGPGI (Lucknow)
AANS Fellowship (USA), Paediatric Neurosurgery Fellowship (Canada)
Consultant Neurosurgeon
Nov 15, 2013

A 55-year-old lady presented with complaints of low back ache with radiation to both lower limbs. The patient ignored the pain treating it as a casual pain. Later the pain intensity and severity increased, and the patient noted to have difficulty in walking. The patient was advised to get an MRI scan which resulted in a tumour in the spinal canal.

She approached Sunshine Hospitals for the treatment. The patient was advised to undergo spinal surgery. The patient underwent spinal surgery with complete removal of the tumour, and preoperative symptoms improved within two weeks. The patient was back to normal life.

Lower back ache is often neglected as a general entity, but if the pain interferes with activities of daily living, associated with difficulty in walking, bladder and bowel disturbances or numbness of legs, then it should not be neglected. A spinal tumour is one of the rare causes of low back pain but can be treated with a good outcome.

Complex Potts Surgery of a 25-year-old patient from Ethiopia

Doctor: Dr G P V Subbaiah
MS (Ortho), Fellow in Spine Surgery (Switzerland, Sweden, Germany & France)
Consultant Spine Surgeon

The patient from Ethiopia visited Sunshine Hospitals with the complaints of low back ache radiating diagnosed as Koch’s spine, and ATT treatment was started. The patient underwent ATT for two months and then discontinued the treatment.
Spine deformity sign was noted on examination of LS spine. No FND or discharging sinuses or palpable swellings were noted.

The following are the investigation reports:

X-ray of LS spine report: Complete destruction of the L3 vertebral body, superior endplate of L4, and in the endplate of L2 were noted as a result and loss of alignment of vertebral bodies.
MRI LS Spine report: Infective spondylodiscitis of L2, L3, L4 was noted with the destruction of L3. Paravertebral abscess and bilateral psoas abscess were also noted.

Treatment Course:
The patient was admitted, and investigations were done. The patient was thoroughly counselled that she must use ATT for a minimum of 6 months. Under GA surgery fusion L1 – L5 with expandable cage fixation L2 – L4 (Basis and Gesco) was done. Postoperative period was uneventful. The pus was sent for C&S, HPE and molecular study. She developed vomiting and paralytic ileus. Upper GI endoscopy was done s/o Drug Induced gastritis. Molecular study was suggestive of AFB positive sensitive to Isoniazid and rifampicin. Pulmonologist consultation was done for ATT treatment. She was ambulated on the 3rd day with Boston brace.

Spine: Complex transforaminal lumbar interbody fusion of a 78-year-old patient

Doctor: Dr G P V Subbaiah
MS (Ortho), Fellow in Spine Surgery (Switzerland, Sweden, Germany & France)

Consultant Spine Surgeon
A 78-year-old male has presented in the OPD with complaints of a low backache, radiating into right & left lower limb since 1½ years difficulty in walking. The patient has a history of neurogenic claudication comfortable with a lumbosacral corset.

The patient has the history of surgery in the year 2004 for L4/L5 IVDP (Intervertebral Disc Prolapse). Following which he had 70% relief for his pain. Now using Proxyvon medication for the past ten years.

The patient underwent X-ray and MRI investigations. LS spine X-ray resulted in post laminectomy status. MRI of LS spine led to canal stenosis for L3/L4, L4/L5 and L5/S1.

After all investigations, Dr. Subbaiah decided to perform spine fusion surgery L3 to S1 and L5 to S1 TLIF and decompression procedure. The patient underwent fusion surgery and decompression procedure. The patient got discharged with the help of lumbar corset on the 3rd day post the operation.

Neurosciences: Complex surgery performed on a 47-year-old male who faced a motor vehicle accident

Doctor: Dr. Naveen Mehrotra
MS, M.Ch, SGPGI (Lucknow)
AANS Fellowship (USA), Paediatric Neurosurgery Fellowship (Canada)
Consultant Neurosurgeon
April 23 2013
A 47-year-old male presented with an alleged history of motor vehicle accident, an incident fallen from two wheeler. The patient was conscious, verbalising coherently and had lacerated wound on the scalp. He underwent a CT scan of the brain to rule out a head injury. He did not have a head injury but had a type II fracture of the odontoid process of the axis vertebrae (2nd cervical vertebrae). At this vertebra, rotation of head takes place, and it forms a part of the craniovertebral junction. The type II fractures of the odontoid are the most difficult to treat as they have a high rate of non-union in the long term.

Surgery at the cranio-vertebral junction is very challenging and associated with disabling complications. This patient underwent TRANSODONTOID SCREW FIXATION, wherein via an anterior approach we exposed the anteroinferior part of axis vertebrae and passed a cannulated screw from the body of the vertebrae through the fractured odontoid and brought the fractured segments together for bony union.

This technique of surgery is one of the recent advances in cervical spine surgery and requires expertise and infrastructure to perform this type of complicated neurosurgery. Post surgery the patient is independent and ambulatory.

Neurosciences: Minimal access brain tumour surgery for a 28-year-old patient

Doctor: Dr Naveen Mehrotra
MS, M.Ch, SGPGI (Lucknow)
AANS Fellowship (USA), Paediatric Neurosurgery Fellowship (Canada)
Consultant Neurosurgeon
Jun 04 2013

The patient is a 28-year-old gentleman, presented with progressive deterioration of vision along with a headache and vomiting. The patient took some treatment but in vain. Because of his vision problem, he consulted an ophthalmologist who discovered him to have secondary optic atrophy (optic nerve damage due to raised intracranial pressure). He was advised MRI scan which revealed a brain tumour with obstructive hydrocephalus (flow of Cerebrospinal fluid is

blocked). The patient had to be operated to relieve hydrocephalus and to biopsy the tumour. The patient underwent endoscopic third ventriculostomy to relieve the hydrocephalus and also the biopsy of the tumour. This surgery was done through a small burr hole. Post-operative period was eventful.