PUNE: Ruby Hall Clinic, a leader in pioneering medical treatments in Pune, has achieved a significant medical breakthrough with the successful performance of Maharashtra’s first Phrenic Nerve Neuromodulation surgery. This rare and complex procedure, led under the expert care of the Intensivist Dr. Kapil Zirpe, Head of the Neuro Trauma Unit at Ruby Hall Clinic, and performed by Dr. Manish Baldia, Consultant Functional Neurosurgeon, has enabled a 58-year-old man, Mr. Sanjay Yashwant Pai, to breathe independently after being dependent on a mechanical ventilator for six months due to a spinal cord injury.

Mr. Pai, who had suffered a high cervical spine injury (C3-C4 fracture) from a fall in his bathroom on July 25, 2024, was initially treated at another hospital. Despite undergoing C4 corpectomy, C3-C4 discectomy, and a range of spinal fusion surgeries, he remained quadriplegic and ventilator-dependent. Imaging studies confirmed a C3-C4 anterior subluxation and spinal cord compression, though no acute brain changes were observed.

Recognizing the need for advanced care, Mr. Pai was transferred to Ruby Hall Clinic on September 19, 2024, for further management, including neuro-monitoring, ventilator weaning support, and rehabilitation. Upon arrival, he was conscious, oriented, on mechanical ventilation, and undergoing PEG (Percutaneous Endoscopic Gastrostomy) feeding and antibiotic therapy.

Aware of the serious risks posed by prolonged ventilator use, including ventilator-associated pneumonia, stress ulcers, deep vein thrombosis, and pulmonary embolism, the medical team (Dr Richa Singh, Dr Manish Baldia, Dr Zirpe with his ICU team,  and Dr Grant) at Ruby Hall Clinic chose to perform the Phrenic Nerve Neuromodulation surgery. This advanced surgical therapy stimulates the diaphragm, the major muscle required for breathing, and provides an essential solution for patients with neuromuscular weakness due to high cervical spinal cord injuries.

Dr. Manish Baldia, Consultant Functional Neurosurgeon at Ruby Hall Clinic, who performed the surgery, said, “Despite all the extensive weaning efforts, we were unable to wean him, but soon after phrenic nerve stimulation surgery, we could notice a remarkable improvement in his breathing.   This was a highly delicate and rare procedure in which we placed a small device near the phrenic nerve. With the help of this device, we were able to activate and control Mr. Pai’s diaphragm externally through a remote and initiate the process of ventilator weaning. We programmed the stimulator as per the patient’s physiological response, gradually enhancing diaphragm strength without inducing fatigue. The success of this surgery provides a new hope for patients with severe spinal cord injuries and long-term ventilator dependence.”

Following the surgery, Mr. Pai showed excellent recovery. Gradually, his ventilator support was reduced, and by April 28, 2025, he was successfully shifted to the general ward for continued rehabilitation.

Dr. Purvez Grant, Chief Cardiologist, Managing Trustee, and Chairman of Ruby Hall Clinic, remarked, “At Ruby Hall Clinic, innovation and patient-centric care are at the heart of everything we do. Successfully performing Maharashtra’s first Phrenic Nerve Neuromodulation surgery showcases our commitment to pushing the boundaries of what is possible in medical care and giving our patients a second chance at life.” This remarkable achievement was made possible through the dedication and expertise of Ruby Hall Clinic’s ICU team (NTU2), setting a new standard for critical care and neurosurgical rehabilitation in Maharashtra

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PUNE: Sahyadri Hospitals is proud to announce the successful treatment of a 13-year-old girl diagnosed with Pott’s Spine, a rare and serious form of spinal tuberculosis. The treatment was expertly handled by Dr. Rajesh Parasnis, Spine Surgeon at Sahyadri Super Speciality Hospital, Deccan Gymkhana whose prompt and precise surgical intervention has led to the full recovery of the young patient only in three days.

The patient initially experienced progressive upper back pain for two months. Her symptoms began with severe back pain and tenderness over the upper back. Despite seeking treatment at a government hospital in Pune, where she was diagnosed with Pott’s Spine and placed on anti-tubercular therapy (AKT) and bed rest, her condition deteriorated. Over the next two months, her back pain intensified, and she eventually developed paraplegia, losing the ability to move her lower limbs.

When the patient was brought to Sahyadri Super Speciality Hospital, Deccan Gymkhana, Dr. Rajesh Parasnis and his team conducted a comprehensive evaluation. The diagnosis was confirmed through a combination of clinical examination, MRI findings, and an open biopsy performed during surgery. To ensure accuracy, the team employed the GeneXpert MTB test, a highly sensitive and specific method for detecting tubercle bacilli from the surgical site. The challenges of diagnosing such a condition in a young patient were significant, but the patient’s coordination and compliance with the medical team at Sahyadri played a crucial role in overcoming these challenges.

Pott’s Spine, also known as spinal tuberculosis, is a less common manifestation of tuberculosis compared to pulmonary TB. It often develops as a secondary infection following pulmonary tuberculosis. In urban areas, the incidence rate of spinal TB is higher, with 1.43 cases per 100,000 people, compared to 0.76 per 100,000 in rural areas. This condition can have devastating consequences if not treated promptly, as was evident in this case where the patient developed paraplegia due to the pressure on her spinal cord.

Understanding the urgency of the situation, Dr. Parasnis decided to perform a D1-D6 Dorsal Decompression, Debridement, and Pedicle Screw Fixation immediately after the patient presented at the clinic. The primary goal of the surgery was to relieve the pressure on the spinal cord and stabilize the spine to prevent further progression of the disease. The surgical team utilized advanced technologies, including O-arm Navigation for precise screw placement and intra-operative neuro-monitoring to assess spinal cord function in real-time, ensuring the highest level of precision and safety during the procedure.

“The urgency of the situation necessitated immediate surgical intervention,” said Dr. Parasnis. “Our goal was to decompress the spinal cord and stabilize the spine to prevent further neurological deterioration. The use of advanced surgical techniques was crucial in ensuring the best possible outcome for this young patient.”

Post-operatively, the patient was carefully monitored by the spine team at Sahyadri Super Speciality Hospital, Deccan Gymkhana. Her recovery process was managed with daily neurological assessments and pain management strategies. After three days of bed rest to allow for initial recovery, she was fitted with a Taylor’s Brace (Thoraco-lumbar orthosis) and began a rigorous physiotherapy program. The physiotherapy team focused on strengthening her lower limbs and improving her respiratory function through deep breathing exercises and incentive spirometry. Remarkably, by the fifth-day post-surgery, the patient was able to stand and take a few steps with support. By the time her sutures were removed on the fifteenth postoperative day, she was walking independently without any support.

At her one-month follow-up visit, the patient had made a full recovery. She reported no back pain, leg pain, or weakness, and her neurological function was completely restored. Reflecting on the success of the case, Dr. Parasnis highlighted the importance of early surgical intervention in cases of spinal cord compression leading to paraplegia. “The timely decision to operate before permanent neurological damage set in was crucial to the successful outcome of this case. The multidisciplinary approach, combining surgical intervention with ongoing antibiotic therapy and close monitoring, was key to this young patient’s full recovery.”

The successful outcome of this case achieved at Sahyadri Hospitals demonstrates the effectiveness of a collaborative approach and the use of advanced medical technology in treating complex spinal conditions.

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