Spinal Cord Abnormality

by Dr. J V Srinivas

A 23-year-old student from Ananthpur district was brought to Aster RV Hospital, JP Nagar, Bangalore with spinal cord abnormality leading to loss of muscle power in both the legs and neglected injury to both his hips. The patient could not move both his hips and had weakness in both lower limbs. He was diagnosed with spinal pathology in 2017 and was bedridden since then. In 2018, he had fallen during a physiotherapy session and fractured his left femur (thigh bone), and in 2019 he met with RTA, and he had fractured his right hip. He was bedridden with bedsores on back and hips.

He was initially treated at NIMHANS for spinal cord problem. He was partially recovering from a neurological problem. For his painful hip problem, he visited multiple hospitals in Bangalore, Hyderabad, Thirupathi and local hospitals.

The patient had spinal cord demyelination (loss of myelin covering with subsequent loss of nerve function) and both sides congenital dysplastic hip (Deformed hip from Birth) with trauma to both the bones. The patient had sustained a fracture on right hip which was neglected for long duration with gross restriction of movements and arthritic changes of both his hip joints along with flexion and adduction contractures with compensatory pelvic tilting with posed challenge for nursing care, perennial hygiene and on bed mobility of patient was difficult and patient subsequently developed pressure ulcers in the back region.

Since, he was having neurological weakness and severe hip deformity, most of the doctors did not suggest surgery and even if the surgery was done may not have good results.

He consulted Dr Srinivas J V, Lead and Senior Consultant, at the Department of Orthopaedics, Aster RV Hospital which is one of the top orthopedics hospital in Bangalore. He assured the patient and family members about the surgery and possible outcomes.

He explained about the unique technique of hip surgery and the cost involved. The family members of the patient took 6 months to organise the money. At Aster RV Hospital, JP Nagar, Dr Srinivas J V offered him a discount to help the crippled boy.

At Aster RV Hospital, he underwent a right hip replacement. After three days left hip replacement is done. Ball and socket joint was replaced. The issue with this kind of cases, the hip joint dislocates if muscle power is low. In this case, a unique technique called constrained liner with subtrochanteric shortening is done which prevent dislocation. The complicated procedure is performed by the famous orthopedic surgeon in JP Nagar, Bangalore.

Considering the Dysplastic hip with both hip fractures with arthritic changes in the hip joint, deformities, muscle imbalance and age of the patient, the Dr Srinivas J V at Aster RV Hospital was successful in performing staged Bilateral Total Hip Replacement surgery using a constrained liner.

Postoperatively patient achieved excellent bedside mobility, which facilitated better nursing care with subsequent healing of ulcers. Now, he is able to sit independently on a wheelchair and move around.