Spinal deformity- kyphosis Reconstruction surgery -A challenging task – safety role of Neuromonitor

Sumit Singh

Pune – Congenital Spine Kyphosis is a problem since birth which may increase during childhood and if not attended at right time, it can lead to severe deformation of the back with neurological issues.

We present a case of 10-year-old Adarsh from Nanded district, who came with complains of deformity of the back, worsening in 2 years. Worried parents took him to different clinics, Physiotherapy was done, Ayurvedic treatment was also done but the deformity continued to increase. Few centers offered him belt and brace but in vain. The case was challenging and complex.

Dr Shailesh Hadgaonkar, Spine surgeon at Sancheti Hospital, told Punekarnews.in that these are always rigid and stiff curves with fused vertebra leading to the spinal deformity. “The patient has a hump in the back, shortening of height, difficulty in walking in severe cases. We planned for the Pedicle Subtraction Osteotomy (PSO) correction and spinal stabilization.”

The surgeon further added that these days with the advent of technical & technological advancement these surgeries have become reasonably safe. Advanced pediatric spinal instrumentation helps in a big way in getting a better sagittal balance. Neuromonitor device which constantly monitors the MEPs & SSEPs helps to reduce the risk of neurological damage. We routinely use Neuromonitor for such complex cases, added Hadgaonkar.

Adarsh’s father Bhaskar Reddy (41), a farmer, brought him to Sancheti Hospital in April and surgery was done. Now Adarsh has regained height and felt taller and straight after surgery which was his parents dream. “Now he does not feel pain. His weight has also increased from 26 kg to 31 kg”, his father said.

Dr Barry a French Surgeon in the European journal article mentions that the said procedure – PSO is very useful in kyphosis correction and achieves spinal balance. We have a thorough check list for such cases, said Dr Hadgaonkar.

When asked about counselling, Hadgaonkar said it’s very important to explain the parents and the patients as the post operative protocols are bit different.

We have a thorough check list for such cases, added Dr Hadgaonkar.

1. Detailed x rays- Scout films, Dynamic x rays
2. MRI scan
3. 3D Reconstruction CT scan
4. Medical & Anaesthetic fitness
5. Neurological consent

Prevention

Screening of children @ school will reduce the neglect as there is very little awareness about the issue

Regular doctor consultation and appropriate bracing will reduce the problem in a growing child significantly

Advise to parents-

1. Periodic check up by your doctor
2. Without treatment, some form of spinal deformities will progress to severe bad level to tackle
3. Surgery is a last option when there is progressive deformation with clinical hunchback which may progress.