Case Study: Congenital Scoliosis in an 18 Month-old Boy

18-month old Arannya Adhakary with congenital scoliosis waiting for his surgery

Operation Straight Spine (OSS) is an annual mission trip to Kolkata, India, where doctors, nurses and spinal monitoring technicians from the US, England and India treat patients with spinal disorders. During the 2017 trip, Dr. Jeffrey McConnell and the OSS team treated an 18-month old boy with congenital scoliosis.

Arannya Adhakary, 18 months old, was the youngest patient treated during OSS 2017. He was diagnosed with congenital scoliosis when he was just 3 months of age.

Congenital scoliosis can be caused by a number of different defects in the development of the spine during the first trimester of fetal growth. Abnormalities occur when part of a vertebra fails to form or several vertebra fail to separate during the very earliest stages of fetal development when the spine and other major organs are starting to form. Patients can have a single abnormality or multiple defects throughout the spine.

Arannya’s congenital spine defect was known as a hemivertebra, which occurs when the vertebra is triangular in shape instead of the normal rectangular shape. This type of congenital defect has a very high propensity to cause a severe and progressive deformity of the spine, usually a kyphosis or scoliosis, as the child grows.

Arannya’s hemivertebra was located at the 11th thoracic vertebra, approximately in the middle of his spine. Hemivertebra are best treated at an early age by removing the abnormal vertebra, correcting the deformity and fusing the growth plates above and below the hemivertebra so the deformity does not recur. Arannya’s surgery consisted of removal of the T11 hemivertebra, correction of the local kyphosis and scoliosis, and limited fusion from T10 to T12. To stabilize the spine and help fuse where the hemivertebra was removed, two small screws and a single 3.5mm diameter rod was placed from T10 to T12 on the right side.

Arannya did amazingly well after surgery, a testament to his young age, and by the 4th postoperative day was going on walks in the courtyard, smiling, carried in his mother’s arms.

Pre-operative MRI of the thoracic spine showing the T11 hemivertebra and acutely angled scoliosis deformity.

Post-operative X-ray after removal of the T11 hemivertebra and placement of spinal screws and rod.

Four days after surgery on walk with his mother.