A 15-year-old Ethiopian girl suffering from scoliosis underwent surgery in a Mumbai hospital. What made the procedure challenging was that the patient, Selam Engida, belonged to Jehovah’s Witness, and thus could not be given blood transfusion. Doctors said they undertook a multi-modal team approach to ensure minimal blood loss during the procedure.
Scoliosis is a condition in which there is a sideways curvature of the spine. As Selam had a significantly crooked spine, she could not walk much or run.
Her mother had detected the condition two years ago but could not get her operated upon due to lack of finances. “If scoliosis is not treated at an early stage, there are chances that the heart and the lungs could get affected,” said Dr. Akhil Tawari, paediatric spine surgery consultant at SRCC Hospital, who operated on her. The reconstruction surgery involved inserting screws and rods in the spine to straighten it.
“Firstly, the patient was given saline for hemodilution, which increases the volume of fluids in her body, so the effective blood loss is less. Her blood pressure was also maintained to an optimum level and external fluids and medications were used to arrest the bleeding from the bones. Instead of using the normal procedure to cut the bone, we used a bone scalpel to reduce the bleeding, which cuts through the bone without injuring the soft tissues,” Dr. Tawari said.
The entire surgery was very risky as it was to be done near the spinal cord and misplacement of the screws or rods could lead to paralysis, he said.
“To get the real-time signals of the functioning of the spinal cord, we had to carry out neuromonitoring, so if any problem occurred, we could reverse the step,” the doctor said. A team of paediatric doctors including spine surgeons, the anaesthesiologist and critical care consultants worked together. Doctors inserted 24 screws and two rods, and ensured much less bleeding.
While the patient was operated on January 22, she was able to walk within two days and recovered from pain in two weeks. The surgery cost ₹4 lakh, and Selam got a donor among the Jehovah’s Witness community to sponsor it. She was allowed to fly back to Ethiopia last month.
