Amidst the chaos of the COVID 19 pandemic, a middle aged lady underwent a complex neurological surgery in Central Referral Hospital (CRH) under Sikkim Manipal University recently.
The patient was suffering from advanced spondylosis involving the cervical spine (neck). She happens to be a hardworking vegetable vendor from Gangtok and because of her illness she was unable to go to work to earn her living. Even at home, severe neck pain radiating all the way to her limbs with electric shock like sensations made it impossible for her to carry out her daily chores. She even lost sleep and her symptoms of clinical depression, which she was already suffering from, were beginning to worsen.
Eventually she visited the neurosurgery outpatient clinic in CRH few months ago, anxious and scared. After a detailed history taking and thorough neurological examination it was established that she had cervical radiculopathy and early myelopathy. MRI scan of the neck showed advanced degenerative cervical spine disease with multiple levels of intervertebral disc prolapses causing compression of the spinal cord and nerve roots. This explained her symptoms altogether.
It is known that the majority of cases improve with conservative treatment and therefore keeping this in mind she too was advised a trial of rest and medications. However, unfortunately her pain did not resolve and she visited the doctor again after a week.
Procedures like lateral mass stabilization, transpedicular stabilization, laminotomy, decompressive laminectomy, laminoplasty etc are routinely done at CRHOvercoming her fear of surgery she agreed to go for a surgery and came for admission. A detailed preoperative workup, planning and preparation made it possible to post her case under general anesthesia. She underwent a C5-C6 and C6-C7 intervertebral discectomy (removal of the intervertebral disc between the 'numbered' vertebral bones) and fusion using an interbody cage stuffed with bone chips and an anterior plate that was secured with screws.
These implants are made of titanium and are much stronger than steel and resistant to corrosion and so can be kept permanently. It requires extensive planning and intraoperative X-ray guidance to achieve a stable construct. A small incision in front of the neck was used to reach the intervertebral disc space in target. The procedure was performed by Dr Pranav Rai, consultant neurosurgeon and his team, taking all precautions and safeguards for COVID 19 infection.
After the procedure the patient had significant reduction in her symptoms. The pain was relieved and she recovered without any complications. And after a few days in the ward she was all ready to go home. A big smile on her face obscured the barely visible scar on her neck as she walked out of the hospital. There is nothing more satisfying to a surgeon than knowing that the patient is going back home happy and satisfied.
She still has to undergo long term physiotherapy to strengthen her muscles at home which has been tailored to her case by the experts in CRH. There are various other such procedures, which are done routinely at CRH. Procedures like lateral mass stabilization, transpedicular stabilization, laminotomy, decompressive laminectomy, laminoplasty etc. These can be done not only in degenerative spine disease but in other conditions like trauma, benign and malignant conditions of the spine, spinal tuberculosis, congenital anomalies etc.