The first time doctors saw the patient, she couldn’t even sit up, let alone walk. A compression on the spinal cord had left the 19-year-old woman unable to use her legs. Doctors at the Rajiv Gandhi Government General Hospital (RGGGH) began a series of extensive procedures for the young woman, following which she has now regained control of her limbs and is even able to walk.
“It truly was a miracle to see her walking, she was literally carried in by her family members because she could not even sit up when we first saw her,” Dean of RGGGH Dr Jayanthi told TNM.
The young woman, who hails from a small village in Tamil Nadu’s Salem region, had been rendered unable to walk for years now. “It’s like she was numb below the knees, no sensation at all. She was completely paraplegic and on examination was found to have zero power in her legs,” the doctor said. Paraplegia refers to lower limb paralysis and is most commonly caused by a spinal cord injury or may even occur due to certain congenital issues.
In this patient's case, she was diagnosed with neurofibroma of the vertebral bones, which was causing a severe spinal deformity. A neurofibroma is a tumour arising from a nerve. The tumour was placing immense pressure on the spinal cord which resulted in the girl being paralysed from the waist down. Using a form of strength testing, known as power, which is used to assess a patient’s muscle tone, doctors deemed her to have a power grade of zero out of a scale of five.
“She was subject to rigid examination, doctors from the orthopedics department and spine worked together to assess her and determine the right course of treatment for her. Noticing the severe spinal deformity, they decided to first address the deformities and correct them,” Dr Jayanthi explained. Both scoliosis and kyphosis, two types of spinal deformities, were noted in this girl. Scoliosis results in a sideways-curved spine which often appears to take on the shape of the letter “S”, while kyphosis is characterised by a spinal deformity manifesting as an abnormally curved upper back.
Doctors opted to fix the compression of the spinal cord, which was pressing onto the vertebral bone, by first stabilising the patient’s spine using a ‘halo vest.’ This is a brace which is worn through the head, with screws fixed to the skull, which aid in spine structural realignment. The team noticed that over time, there was an improvement in the young woman's power: She went from zero to three out of five on the power grading scale.
The next part of the treatment was to sustain the spinal stability further. Doctors achieved this through a surgical procedure in which they used multiple rods and pins (screws) internally to fixate the spine and vertebral bones. In addition, a bone graft was placed to ensure that the bone structure and spinal cord returned to normal.
After a period of 10 days following the surgery, the 19-year-old regained full power and sensation in both her lower limbs. After spending a total period of 10 months in the hospital, she has regained functionality in her legs and was able to walk out of the hospital on her own.
“This is the first time that such a complex procedure has been taken up at a government hospital in the state. It was done free of cost. The patient has now gained complete control of her legs. She was able to walk out of the hospital on her own at the time of discharge,” says Dr Jayanthi.