By IMT News Desk
The team of doctors was led by Dr V Anand Naik, senior consultant, spine surgery, Bone & Joint Institute at Medanta – The Medicity, Gurugram where the damaged vertebrae was replaced with a 3D printed titanium vertebrae to bridge the gap between the first and fourth cervical vertebrae.
As a pending history of infertility, the patient suffered tuberculosis due to high intake of steroid (by quakes) which lowered her immunity to a level where the patient developed TB at 10 different vertebrae in the spine.
The first, second and third cervical vertebrae were severely damaged up to an extent that there was no skeletal support available between skull and lower cervical spine (there was disconnect between skull and lower part of the spine) due to which the head was sliding forward and curved in such a way which was causing obstruction to the spinal cord which was causing progressive weakness in all the limbs – inching towards quadriplegia; compression of the respiratory nerves and eventually death.
According to the hospital, the 10-hour long surgery is the first of its kind for reconstruction with 3D printed vertebrae in India and probably third in the world, following similar surgeries that were conducted in China and Australia for different parts of spine.
Dr V Anand Naik, said, “It was a very complex surgery and the patient’s condition was deteriorating each day. It would not have been possible to do it without a 3D printing technology.”
“It is comparatively an effective method of surgery since everything is planned before, and also a new dimension to complex spine reconstruction in difficult anatomy and complex tumours and infections,” he added.
Dr Gopal Kumar, consultant, head & neck oncosurgeon at Medanta – The Medicity, said, “The challenge for our team was to reach high into the neck without altering the position of the patient. Anterior approach, small working field, in cases such as these is not basis one’s choice but a necessity. Patient being a singer, preservation of laryngeal nerve was of prime importance. Swallowing, chewing and movement of tongue, all was at risk. After mobilisation and retraction of larynx and oesophagus space was created for Dr Anand to work and perform the implant.”
Dr Naik and his team used an intricate computer software to plan every detail of the operation. The titanium cage was customised according to the patient’s original spine. The high resolution CT & MRI scans of the patient’s spine were uploaded on the software and a dummy of the patient’s spine was 3D printed to measure the gaps and surgical resection between the first and the fourth cervical vertebrae.
Finally, the 3D titanium implant was printed, which was to be placed in the body. The printed 3D titanium vertebrae was further tested for biomechanics and stress risers post receiving inputs from design team in India, Sweden and USA.
The standard time to plan and perform the surgery is between three to four weeks. Dr Naik and Dr Kumar effectively planned the approach and executed the complex upper cervical spine surgical approach and reconstruction, within a week, in a much lesser time citing the emergency of the case.
According to the doctors, the patient who is a teacher by profession is recovering fast with newly reconstructed cervical vertebrae. She has recovered from all her weaknesses and radiculopathies in upper and lower limbs within four days of surgery and is now able to walk. She is expected to lead an independent pain and risk free life in two weeks.
Dr Naik and his team are now looking forward to a long-term result and a decent independent lifestyle for the patient.
Dr S K S Marya, chairman, Institute of Bone & Joint, Medanta – The Medicity, said, “Medanta believes in constant innovation in medical technology and healthcare practices. The outcome of the surgery clearly demonstrates our commitment towards improving the standards in patient care.”
This article was originally published in India Medical Times on 15 February 2017: