Anushka Sain, a five-year-old girl from Kothputli, Rajasthan, has successfully undergone a crucial spine surgery at Amrita Hospital, Faridabad, in a bid to save her life. Suffering from severe congenital scoliosis, Anushka faced extreme pain and significant risks to her heart and lung development due to her spinal deformity, making the surgery urgent and indispensable.

A normal spine appears straight when viewed from the front or back, but in scoliosis, it curves in a C or S shape. Severe scoliosis, with curves exceeding 60 degrees, can put pressure on the heart and lungs, particularly in growing children. Congenital scoliosis arises from abnormal spinal development during pregnancy, with no definitive causes, though folic acid deficiency, smoking, and certain syndromes are risk factors. Scoliosis can also result from neuromuscular disorders like cerebral palsy or polio, certain syndromes, spinal infections, or unknown causes (idiopathic scoliosis). Congenital scoliosis is a rare condition with a prevalence of 1 in 1000 live births, but the exact incidence is unknown and is likely underreported. Reports of occurrence are more often in females with a ratio of 2.5-1.

Anushka, the daughter of a cloth dealer from Rajasthan, first started displaying signs of spine deformity when she was around three years of age. This started increasing rapidly as she grew. She also started developing severe pain on one side of her waist as her rib cage had started digging into her pelvic bone because of spinal curve. Additionally, she started developing shortness of breath after normal work and play, possibly because of compression of lungs on one side of the spinal curve. It is at that time that her parents consulted Dr. Tarun Suri, Senior Consultant and HoD, Spine Surgery, Amrita Hospital, Faridabad, after hearing about him through local references and digital media.

Dr. Tarun Suri said, “Anushka was evaluated in detail by the Spine Surgery team at Amrita Hospital, Faridabad. Her scoliosis curve was around 90 degrees at admission and was increasing at rapid rate as seen in serial X-rays. She had also developed severe costo-pelvic impingement, a condition in which patient’s rib cage starts digging into pelvic bone and causes severe pain; the space available for left lung and heart had also decreased considerably due to the severe scoliosis, making this surgery so vital. Her parents were explained in detail about this condition and that, if left untreated, the curve would increase severely, and it will hamper child’s future growth. The effects on lung and heart were also likely to bring down the life expectancy of the child. The only way this could be managed was with a complex spine surgery.”

Anushka’s parents were initially apprehensive about the surgery and its risks and effects on her future growth. They were explained that such surgery, if done through a surgeon trained and experienced in such complex procedures, at an institute capable of managing such children through excellent neuro-anaesthesia team and ICU and with advanced technology – Intra-operative Neuro Monitoring (IONM) – is extremely safe. Intra-operative neuro monitoring is a technology in which the function of spinal cord is continuously monitored throughout the surgery and if any chance of developing paralysis develops, an alert gets raised and surgical team can take steps to correct the same during the surgery itself.

“Since Anushka was only five years old at the time of surgery, extensive fusion of the thoracic spine was not possible as it would impede the growth of her thoracic cavity, crucial for lung development. Therefore, she underwent growing rod surgery, where screws are placed at the top and bottom of the spine, connected by rods that are lengthened every six months to accommodate spinal growth until she is about 10 years old, at which point definitive fusion surgery can be performed. Anushka’s complex spinal deformity involved 6-7 vertebrae with a high Cobb’s angle, and her small body size required low-profile implants and technology to minimize blood loss. Corrective bony cuts and limited fusion were performed around the apex of the curve, followed by the application of growing rods and distraction under IONM system guidance. The six-hour surgery minimized blood loss using cell saver equipment, which filters and returns blood from the surgical site back into the body. Anushka tolerated the surgery well, woke up a few hours after shifting to the ICU, and experienced no postoperative complications like paralysis,” added Dr. Suri.

The surgical team was headed by Dr Tarun Suri. A team of around 15 people including Neuroanaesthetists – Dr Gaurav Kakkar and his team, junior spine surgeons, pediatric critical care specialists, neurophysiologists and OT staff supported the complex surgery. Successful outcomes of these kind of complex surgeries is also dependent on dedicated Neuroanaesthetist who ensure smooth anaesthesia for monitoring IONM signals during the surgery.

The five-year-old recovered very fast after the surgery. A brace was made for her to support the spine and she was made to walk 2 days after the surgery. She had a good correction of the curvature of her spine and the pain also reduced owing to improvement in costopelvic impingement. Postoperative X-rays showed good correction and Anushka’s parents were happy with the results.

Sunil Sain, Anushka’s father, said, “We are incredibly grateful to Dr. Tarun Suri and the entire team at Amrita Hospital. When we first learned about Anushka's severe congenital scoliosis, we were deeply concerned about her future and her life was at stake. The growing rod surgery has given her a chance at a normal life, and seeing her recover so well after the operation fills us with immense relief and happiness. The care and expertise provided by the hospital have been exceptional, and we are confident that Anushka now has a much brighter future ahead.”

Institutions with dedicated teams and specialized equipment are essential for successful scoliosis surgeries, particularly in cases of early onset scoliosis where growth-friendly techniques are crucial. These surgeries pose unique challenges that require expertise and experience to ensure optimal outcomes for young patients. Early consultation with a dedicated spine specialist is key for parents noticing signs of spinal deformities in their children, ensuring timely intervention and the best possible path towards a healthy future.