Guntur neurosurgeon reports walking recovery after salvage spine surgery

A 14-year-old patient who became wheelchair-bound after an earlier spinal stabilization procedure regained the ability to walk after salvage surgery and remained stable at five years. Dr. Mohana Rao Patibandla presented the case as part of a six-patient series on endoscopic transnasal odontoidectomy at the Society of British Neurological Surgeons meeting in London.

Why it matters: - The case shows that spinal stabilization alone may not relieve dangerous pressure on the brainstem and upper spinal cord. - For selected patients with complex craniovertebral junction disease, salvage decompression can restore function after an earlier operation fails. - The five-year follow-up adds uncommon long-term evidence that walking recovery can be sustained in at least one complex case.

What happened: - Dr. Mohana Rao Patibandla, Founder and Chief Neurosurgeon of Dr. Rao’s Hospital – International Institute of Neurosciences (IIN) in Guntur, presented a six-patient surgical series in London in October 2026. - The presentation, titled “Transnasal Endoscopic Odontoidectomy for Failed Posterior Craniovertebral Fusion: Salvage Decompression and Outcomes in 6 Complex Cases,” was delivered at the Society of British Neurological Surgeons centenary meeting. - One patient, who was 14 at the time of the original surgery, had undergone DCER at AIIMS, New Delhi, for a complex craniovertebral junction disorder. - The patient initially improved, then gradually worsened and eventually became wheelchair-bound. - After endoscopic transnasal odontoidectomy, the patient regained the ability to walk and remained able to walk at five-year follow-up.

The details: - The craniovertebral junction is the area where the skull meets the upper cervical spine. - In this case type, the problem is not only alignment or stability. Residual compression can remain at the front of the junction. - Endoscopic transnasal odontoidectomy uses the nose as a surgical corridor to reach the odontoid process, the bony projection of the second cervical vertebra. - The goal is to remove compressive bone and create more space for the brainstem and upper spinal cord. - The six-patient series included cases treated between 2019 and 2022. - Two patients had basilar invagination, and four had retro-odontoid pannus. - Neurological status was measured with the Nurick grading scale, which tracks disability linked to spinal cord dysfunction and walking difficulty. - Mean preoperative Nurick grade was 4.33. - Mean postoperative Nurick grade was 2.83. - The mean improvement across the group was 1.50 Nurick grades. - The study had no comparison group and involved only six patients, so it cannot prove the procedure is superior to other operations. - The authors also note that the 14-year-old patient’s outcome is an individual result and does not predict the same result for other patients. - The procedure requires CT and MRI planning, attention to anatomy and prior surgery, and a plan for maintaining stability after decompression.

Between the lines: - The key clinical distinction is between stability and decompression. - A posterior fusion may secure the spine, but it does not automatically resolve ventral pressure on the brainstem or spinal cord. - When neurological decline continues after surgery, the next step is reassessment of symptoms, exam findings and imaging. - The series argues for matching the surgical route to the pathology, not assuming one approach fits every patient. - The case also reinforces that long-term follow-up matters, because early improvement can still be lost if compression persists.

What's next: - Larger studies are needed to identify which patients are most likely to benefit from endoscopic transnasal odontoidectomy. - Further collaborative research is needed to assess long-term outcomes, complications and patient selection. - In practice, surgeons will continue to weigh decompression, stability and neurological recovery separately when treating complex upper-spine disorders.

The bottom line: - In carefully selected patients, a second operation aimed at decompression can reverse severe disability even after a prior stabilizing surgery fails to fully solve the problem.