New Delhi [India], May 13 : A six-month-old male child underwent successful metal-free spine fixation surgery at All India Institute of Medical Sciences (AIIMS) Delhi Trauma Centre in June 2022, the healthcare institution said on Friday.
Doctors at AIIMS Delhi said that the child sustained a spinal cord and brachial plexus injury during normal vaginal delivery. He was born in another hospital with a birth weight of 4.5 kg. After birth, the child was kept on oxygen support and was having aspiration pneumonia in that hospital.
"At the time of presentation to us in May 2022, the child had respiratory distress and minimal movement of all three limbs (left upper and lower limbs, and right lower limb) and there was no movement of the right upper limb (Erbs' palsy). Examination revealed injury to spinal cord, and cervical spine dislocation (Cervical Spondyloptosis)," AIIMS, Delhi said in a statement.
"It is almost impossible to fix such young spines using metallic implants/cages due to very small size of cartilaginous bones in such young infants. On being explained, the mother consented to give part of her iliac crest bone to her child. The mother of the child was subjected to general anaesthesia same time as the child was undergoing 15-hour-long surgery for his spine fixation in the parallel operation theatre," it said.
"Interestingly, the mother was blood group B+ while the Child was blood group A+ in this case. There was no rejection of bone graft and at 1-year follow-up, good bony fusion and spine stability has been achieved in the child. Spine fixation surgery in such young infants has never been reported or seen from India ( to be best of my knowledge)." Said Dr Deepak Gupta, Professor of Neurosurgery, at AIIMS, Delhi.
According to the team of doctors, it was metal-free surgery, "Looking at the age of the child and urgent need of surgery, we improvised and used mother iliac crest graft for the fusion of child's spine ( cervical spine cord decompression and 360 degrees fusion) and fixed it with absorbable 2.5mm PLLA plates (front of the spine) and special suture tapes polystyrene braided suture) for the back of the spine to allow for growth while maintaining the motion of the neck."
"Child required ventilatory support for almost 11 months ( Date of operation 10th June 2022, Date of discharge 10th May 2023). The child needs prolonged rehabilitation support and was discharged on a tracheostomy tube prophylactically. The child interacts well with his parents, feeding well and has shown partial neurological recovery in his limb movements after surgery. He has a long way to go still in his path of recovery and runs of chest infections," Dr Deepak said.
During his prolonged 11-month stay in the hospital at JPN Apex trauma centre, various doctors, nurses and paramedical staff of the hospital provided non-stop support to the child and parents who were present all the time.
The child celebrated his first birthday in December 2022 in JPNATC (AIIMS) and stayed in the TC5 ward of the trauma centre for 11 months while he was on ventilatory support and undergoing neurorehabilitation support. The child was looked after by a team of doctors from the Department of Neurosurgery, Neuroanesthesia, Pediatrics and Trauma Surgery.
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