Sandeepa Biswas is a 16 year-old girl who we cared for on the OSS 2012 mission trip. She had been in the Ramakrishna Mission Hospital for 6 weeks prior to our arrival, suffering with Tuberculosis of the spine. She originally developed a febrile illness and malaise but was misdiagnosed by her village doctors.
Eventually she came to RMSP where she was diagnosed with TB and during that time she went “off her legs” and was unable to ambulate due to weakness in the legs and pain in her back. X-Rays and MRI revealed destruction of the 12 vertebrae with circumferential abscess, kyphosis and compression of the thecal sack. There was also involvement of the T12 vertebrae on the right but no collapse of the vertebra or spinal canal involvement. At this point she was cachetic, malnourished and had begun to develop bed sores. She could not even sit up because her spine was so unstable and she had so much pain.
Surgery for her condition involved a dual approach. First the spine was operated on from a posterior approach with reduction of kyphosis deformity of the spine, insertion of spinal instrumentation and fusion from T11 to L3. The second stage of the procedure involved an anterior approach with drainage and debridement of the abscess, L2 corpectomy, decompression of the nerves and placement of a titanium, expandable cage from L1 to L3 with additional bone grafting jusing the 12th rib.
Sandeepa initially had a very stormy post-operative course. Most of the OSS team was waiting to return to the hotel when our surgical nurse Marian, came running through the courtyard shouting, “the child has arrested, emergency!”. We all ran back into the hospital, stopping on the way in the store room to get a paedeatric ambu bag and oxygen tubing which was not available in the adult ICU. Marian and Holly ran up 5 flights of steps to the ICU. Caroline Davies, our paediatric anaesthesiologist, was making rounds in the ICU and she told us what had happened to Sandeepa.
While still intubated, fully awake and breathing, Sandeepa apparently chewed on her ET tube, causing it to kink, and shut off her airway. Her oxygen saturation levels quickly dropped and she went into respiratory arrest. Luckily, Caroline and the orthopaedic resident were in the ICU at the time and were able to intervene quickly. After re-intubating the patient, administering fluid and a unit of blood, Sandeepa’s condition stabilized.
Sandeepa’s neurologic recovery was long. In the weeks following her surgery she began to recover motor function in her legs. About five weeks after the surgery she was able to stand. She is expected to make a full recovery and she continues to do physical therapy to optimize the strength in her legs. She will need ongoing medical therapy with drugs to rid her of the tuberculosis infection.