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New lease of life for a Patient who is cripled with serious Myopathic Scoliosys

Hyderabad -July, 2013

Excellence & innovation have always been key attributes of Kamineni Hospitals, Kingkoti, Hyderabad. This Hospital is known for handling complex and challenging health problems. They have become pioneers in bringing the latest advancements in healthcare to people.

We present a 14-year-old girl with thoracic scoliosis (spinal deformity) scheduled for scoliosis correction (spine deformity correction) at our hospital. A corrective surgery for same problem was attempted 2 years back at a different hospital in a neighboring state. As she developed malignant hyperthermia (very high fever) during the surgery, the procedure was abandoned. Subsequent muscle biopsy showed a rare muscle disorder of congenital myopathy. Because of which she had severe restrictive lung disease and tendency of developing high temperature following exposure to certain anaesthetic agents. When she presented to us she had severe spinal deformity and breathing difficulty even walking for a few feet.

It was a challenge both for anaesthetic and surgical team. A detailed working plan was developed to combat the situation by avoiding the anaesthetic agents that can trigger the high temperature and in case if she develops it, ways to counter the problem with drugs and other means. The team had procured 'Dantrolene' (a specific medicine to counter high fever in these conditions) and kept as reserve option. Additionally an alternative anaesthetic technique coupled with latest gadget namely 'muscle evoked potential' monitoring of the nerves and muscle functions was done during the procedure.

The surgical procedure was a very difficult one. Re-Explorative surgeries are always difficult as the planes of operative dissection and the landmarks are lost. Placing screws and rods is a great challenge which were accomplished successfully. We took bold steps intraoperatively and got excellent correction of spinal deformity. Intra Operative -Neuromonitoring is very useful as it warns us of any problems related to spinal cord during the operation.

During surgery, all the necessary measures to avoid as well as managing an episode of malignant hyperthermia were taken. Surgery was uneventful but after the surgery she developed breathing difficulty, which responded to noninvasive ventilation. She recovered completely and was successfully discharged a week later.
At discharge the breathing problem had considerably improved and she was able to walk well without breathing issues.

We thereby report the successful management of a redo corrective scoliosis surgery in a case of congenital myopathy and severe restrictive lung disease with prior history of malignant hyperthermia. This has transformed the life of the child for good.

The involved anaesthetic team lead by Dr. Muralidhar Joshi & surgical team lead by Dr V.Surya prakash Rao of Kamineni Hospitals adds "It is always an endeavor for us to constantly upgrade the facilities for the benefit of patients and Kamineni Hospitals takes it as a moment of pride to offer the best in the healthcare space and consistently sustain the quality of service to ensure that every achievement will be a new benchmark for our service standards. Our hospital has the complete state of art technology where we do both complex and challenging procedures and offer the best treatment possible matching global standards."


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