Pune: Doctor’s in a city hospital recently performed a full endoscopic internal gibbectomy on a 12-year-old patient suffering from a rare spinal deformity.The boy could walk again within12 hours of surgery without needing any support.Twelve-year-old Divyansh* (name changed) started facing nagging backache, difficulty in walking and loss of bladder control almost three years ago. After numerous consultations, Divyansh was diagnosed with rare and complex spinal deformity —congenital thoracic kyphosis.Divyansh’s condition was extremely rare. According to doctors, such congenital spinal anomalies affect only 2–5 percent of patients among one lakh. Dr Pramod Lokhande, consultant spine surgeon at Jupiter Hospital said, “While the exact cause is not always clear, some cases are linked to genetic factors such as consanguineous (within family) marriages, which can increase the risk of congenital birth defects affecting the heart, kidneys, or spine. The condition can go undiagnosed until it starts affecting movement or bladder control.”According to doctors, Divyansh’s rare condition of congenital thoracic kyphosis was caused by fusion of two vertebrae at T4 and T5 levels.“This fusion created a bony hump inside his spine, known as an internal gibbus, which pressed hard on his spinal cord. The pressure was slowly paralyzing him. He was unable to walk for three years. If we had not operated on him, he would have lost the ability to walk completely and ended up in a wheelchair,” said Dr Lokhande.Dr Lokhande further claimed that this is the first such case in the world wherein a patient underwent a full endoscopic internal gibbectomy — that required no screws, no rods, and no large incisions.Traditionally, such conditions are treated with open surgery involving large incisions, removal of the vertebra’s back portion, and insertion of rods and screws to stabilize the spine. However, the surgical team opted for a far less invasive route. On 11th April, they performed a full endoscopic transforaminal internal gibbectomy under general anesthesia and neuromonitoring using just a 1 cm incision and an 8 mm endoscope, surgeons were able to precisely remove the bone compressing the spinal cord while preserving all the stabilizing structures of the spine.The procedure lasted about five hours and within 12 hours of surgery, Divyansh was up on his feet walking in the hospital’s corridor without any support.“The next morning, around 10 am, we made him sit on the bed and walk a few steps around to get adjusted. After two hours, we made him walk through the corridor and he did it without a walker,” Dr Lokhande said. By April 16, the boy was discharged.Dr Lokhande also added that the operation was challenging as the spine segment was very close to the heart and so the minimal incision helped avoid any trauma to the heart. “When the patient last visited us two weeks ago, we were pleased to see that the boy was walking completely without any support and did not complain of any backache either. The boy has recovered completely,” added Dr Lokhande.
