University of Minnesota

Doctors build new spine  

A young girl born with no spine below her ribs gets an implant and a chance to grow.  

October 23, 2013

If you think somebody who lacks backbone lacks gumption, you haven’t met Aulana.

The spunky, 9-year-old Nebraskan hasn’t the use of her legs, but learned on her own how to get around by walking on her hands. And all because she lacks a backbone—at least a complete one.

Born with no spine below her ribcage, Aulana is now getting one at the University of Minnesota Amplatz Children’s Hospital. The procedure, being performed in stages by Dr. David W. Polly, Jr., allows her tiny torso to grow and make room for her internal organs. Only Polly, professor and chief of spine surgery at the University, had ever performed the procedure.

Aulana’s condition, caudal regression, is a rare birth defect that impairs the development of the lower half of the body. It is associated with maternal diabetes, “so we may see this rare condition more in the future, because diabetes is increasing in our society,” says Polly.

Before surgery, Aulana’s ribs rested on top of her pelvis when she sat, and she couldn’t sit at all without continually pushing up with her hands.

“Her stomach and intestines and bladder were being squished, and she vomited and had bowel issues,” says Rachel, Aulana’s mother.

Now 9 years old, Aulana is three feet tall. But her spine is seven inches longer and her torso—from the top of the thorax to the pelvis—is about 29 percent longer than a year ago, thanks to two surgeries by Polly and his team. Instead of the usual procedure, in which surgeons amputate the legs and use leg bone to make a new spine, Polly and his surgical team figured out a way to craft new spine using one of Aulana’s ribs, along with bone from a bone bank.

The donated bone is attached to the upper spine and the pelvis, so it constitutes the whole length of the graft.

Then, “we swing a rib down to it, leaving the rib’s blood vessels attached,” explains Polly, professor and head of spine surgery at the University. “The rib gives the graft a blood supply and provides cells. It should help her turn the graft into her own bone by replacing the donated bone’s crystalline structure and growing new blood vessels and bone cells.”

Aulana’s post-surgical life has definitely improved, her mother says.

“She’s only missed one day of school, for flu,” notes Rachel. “Before, she missed one day a week. She still has a few stomachaches, but now she can better feel when she has to go potty—before, she couldn’t always tell.”

Aulana also finds it easier to sit up without pushing with her hands and to use a wheelchair, though her mother says she’s still faster on her hands.

But lengthening the spine also lengthens major abdominal blood vessels, which can only take so much stretch at a time. Therefore, bone must be added gradually, and so Aulana will need at least one or two more surgeries, Polly says.

Which is all right with Aulana’s mother.

“We’ve been happy with the results, and we trust in Dr. Polly. Both times we’ve been there, it’s been great,” she says.

And Aulana? “She’s ready to be taller.”

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