General Pediatrics

A 7-year-old girl presented with persistent pain in the right knee for two months. Initial investigations, including X-ray and MRI, raised suspicion of a malignant lesion in the distal femur near the knee joint.

A biopsy confirmed the diagnosis of osteosarcoma, a rare bone malignancy seen in children and adolescents. A metastatic workup was conducted to assess disease spread, which showed no evidence of metastasis.

The patient was initiated on a structured treatment protocol involving multiple cycles of neoadjuvant chemotherapy, followed by planned surgical intervention and postoperative chemotherapy.

After completion of four chemotherapy cycles, repeat imaging demonstrated a favorable response, and surgical management was undertaken. Considering the child’s age and significant remaining growth potential, the key challenge was to achieve oncological clearance while preserving future limb growth.

A customised expandable prosthesis was designed for the patient to accommodate longitudinal bone growth through future length adjustments. The surgical procedure was completed successfully, and the postoperative course remained stable and uneventful.

The patient continues under follow-up, with the focus on long-term recovery, functional preservation, and support for normal growth and development.
 

Treatment By:
Dr. Nikhil Tandon

Advanced Bronchoscopic Intervention at Yashoda Medicity Removes Eraser from 4-Year-Old's Airway, Restores Collapsed Lung.

Doctors at Yashoda Medicity successfully saved a 4-year-old child after a piece of eraser became lodged in his left main bronchus, causing near-complete airway obstruction and collapse of the left lung. The 4-year old child accidentally inhaled the eraser while playing nearly two days before reaching the hospital.

An emergency bronchoscopic procedure was performed using a flexible ultrathin bronchoscope and cryoprobe. The multidisciplinary team included Dr Rajesh Kumar Gupta, Director; Dr Ankit Bhatia, Senior Consultant in Respiratory Medicine and Interventional Pulmonology; Dr Lokesh, Principal Director & HOD of Anesthesiology & Critical Care; and Dr (Maj) Shaifali Bhatia, Senior Consultant - Paediatrics & Neonatology.

During the 90-minute procedure, doctors successfully removed the eraser and restored airflow to the collapsed lung. The intervention was particularly challenging because the child's airway measured only about 4 mm in diameter, requiring precise airway management and close coordination between the bronchoscopy and anaesthesia teams.

Speaking about the case, Dr Rajesh Kumar Gupta, Director, Respiratory Medicine and Interventional Pulmonology, Yashoda Medicity, said, “This was a particularly challenging procedure because the child’s airway measured only about 4 mm in diameter. Maintaining adequate oxygenation while simultaneously navigating specialized instruments through such a narrow airway required meticulous planning and close coordination between the bronchoscopy and anaesthesia teams over a 90-minute procedure.

Dr Ankit Bhatia, Senior Consultant, Respiratory Medicine & Interventional Pulmonology, said, “Cases like these highlight how small objects such as erasers, toy parts, nuts, and seeds can quickly turn into life-threatening airway emergencies in children. Any episode of sudden coughing, wheezing, or breathing difficulty after playing should never be ignored. Early diagnosis and timely treatment can prevent serious complications, including lung collapse, and can save lives.”

Describing the ordeal as one of the most frightening experiences for the family, the child's parent said, “Watching him struggle to breathe was one of the most frightening experiences for our family. We are deeply grateful to the doctors and medical team at Yashoda Medicity for their timely intervention, expertise, and constant support throughout the treatment. Knowing that specialists from different disciplines were working together and that advanced facilities were available gave us immense confidence during a very difficult time. We hope other parents learn from our experience and seek immediate medical attention if a child develops persistent coughing, wheezing, or breathing difficulty after inhaling or choking on a small object.”

Following removal of the foreign body, the child's breathing improved immediately. Airflow to the left lung was restored, allowing the collapsed lung to re-expand. The child recovered well and was discharged in stable condition on 18 June 2026.

Doctors emphasized that young children are particularly vulnerable to accidentally inhaling small objects during play. In this case, the foreign body had already caused the collapse of the left lung. Further delay in treatment could have resulted in severe infection, persistent lung collapse, irreversible lung damage, respiratory failure, and potentially life-threatening complications.
The successful outcome underscores the importance of timely diagnosis, advanced bronchoscopic expertise, specialized equipment, and a multidisciplinary approach in managing complex airway emergencies in children. Yashoda Medicity remains committed to providing comprehensive, advanced interventional pulmonology and critical care services, backed by state-of-the-art technology and specialist teams capable of handling complex medical emergencies across age groups.

Treatment By:
Dr Rajesh Kumar Gupta, Director; Dr Ankit Bhatia, Dr Lokesh; and Dr (Maj) Shaifali Bhatia.

A G6A5L0 mother with an IVF-conceived pregnancy had a history of threatened abortion and intrauterine demise of Twin A at 22 weeks of gestation. 

Twin B, a 24-week gestation male/female preterm neonate weighing 650 g, was delivered by emergency LSCS in view of placental abruption. The baby cried immediately after birth but developed severe respiratory distress and was promptly shifted to the Level III NICU for intensive care. 

The neonate received three doses of surfactant therapy and required invasive mechanical ventilation for 7 days, followed by non-invasive respiratory support, with gradual weaning to room air. Enteral feeding was initially limited due to feed intolerance, and the baby remained on total parenteral nutrition (TPN) until full enteral feeds were successfully established by Day 18 of life. 

During the NICU stay, the baby was treated with intravenous antibiotics for 2 weeks for sepsis. Subsequently, the baby developed fungal sepsis, which was successfully managed with appropriate antifungal therapy. 

Serial cranial ultrasonography was performed as per protocol and showed no evidence of intraventricular hemorrhage (IVH) or periventricular leukomalacia (PVL). 

ROP screening was initially normal. However, at 33 weeks postmenstrual age, the baby developed pre-plus disease in Zone II, which required laser photocoagulation therapy. Subsequent follow-up examinations documented satisfactory regression of ROP. 

The baby also required packed red blood cell (PRBC) transfusion during the hospital stay for anemia of prematurity. 

The case was successfully managed by a multidisciplinary team comprising Dr. Minu Bajpai, Dr. J.B. Sharma, Dr. Neha, Dr. Samreen, Dr. Divya Arora, Dr. Ayush Jain, and Dr. Nisha. 

After a prolonged NICU stay of 78 days, the baby was discharged in a clinically stable condition on room air, tolerating spoon feeds and breastfeeding well, with a discharge weight of 1,625 g.

Treatment By:
Dr Neha Agrawal (Consultant Neonatologist ) and NICU team.

Robotic Milestone in Advanced Cancer Surgery: Combined Robotic LAR with Portal Vein Ligation

Our surgical oncology team recently achieved another important milestone in minimally invasive cancer surgery by successfully performing a Robotic Low Anterior Resection (LAR) combined with robotic ligation of the right portal vein in a 50-year-old female diagnosed with rectal cancer and synchronous liver metastasis.

The patient presented with rectal adenocarcinoma along with metastatic disease involving the right lobe of the liver. Managing such complex cases requires meticulous planning to achieve complete oncological clearance while preserving adequate liver function.

After multidisciplinary tumor board discussion, a staged surgical strategy was planned with curative intent. In the first stage, a robotic low anterior resection was performed following total mesorectal excision principles to remove the rectal primary tumor. During the same sitting, robotic ligation of the right branch of the portal vein was carried out. This step is designed to induce hypertrophy of the future liver remnant, allowing safe completion of a planned right hepatectomy after approximately four weeks.

The use of robotic technology enabled precise pelvic dissection, superior visualization, and delicate hilar vascular control, allowing two major oncologic objectives to be achieved through a minimally invasive approach. The patient tolerated the procedure well and is recovering satisfactorily while awaiting the second-stage liver surgery.

This combined robotic approach highlights the evolving role of advanced minimally invasive surgery in complex gastrointestinal and hepatobiliary oncology. By integrating colorectal and liver strategies in a single operation, patients benefit from reduced surgical trauma, faster recovery, and preservation of curative treatment pathways.

The case reflects our institution’s continued commitment to innovation, multidisciplinary collaboration, and delivery of world-class cancer care using cutting-edge robotic surgical techniques.

Treatment By:
Dr. Asim Rizvi

A 59-year-old female from Comoros presented with severe bilateral knee dysfunction and associated implant-related complications. She had a Grade 3 valgus deformity with advanced osteoarthritis, a failed primary total knee replacement of the left knee, and significant implant impingement at the left ankle, resulting in marked pain and restricted mobility.

She was evaluated by the orthopaedic team at Yashoda Medicity led by Dr. Brajesh Koushle and Dr. Gaurav Thakral, at Yashoda Medicity. Given the complexity of her condition and functional limitations, a comprehensive surgical plan was formulated. 

The patient underwent primary total knee replacement of the right knee, revision total knee replacement of the left knee, and removal of the impinging implant from the left ankle in the same sitting. The surgery was successfully completed with meticulous intraoperative management.

Postoperatively, the patient showed excellent recovery. Early mobilisation was initiated, and she was able to stand and walk from the first post-operative day. She was discharged in a stable condition, walking unassisted and with significant improvement in functional outcomes.

Treatment By:
Dr. Brajesh Koushle, Dr. Gaurav Thakral, and Team

A 65-year-old female, a known carcinoma colon survivor, presented with altered sensorium, severe headache, diplopia, and worsening vision.

On arrival, she was drowsy, disoriented, with gaze palsy, hemianopia, and significantly elevated blood pressure. MRI brain revealed a large left occipital tumor with acute haemorrhage, requiring emergency intervention.

She underwent urgent craniotomy with total tumor excision and evacuation of the hematoma. The surgery was completed successfully.

Post-operatively, she showed rapid and remarkable recovery, with significant improvement in neurological status. She was discharged in four days and, at one-week follow-up, was walking independently with restored clarity of vision and no headache.

Her recovery was exceptional for the extent of pathology and age, with neurological improvement far exceeding expected timelines.

Treatment By:
Dr. Rajinder Kumar

Minimally invasive and Scarless solution for Brain aneurysm at Yashoda Medicity

A patient with a complex brain aneurysm was treated at Yashoda Medicity through a minimally invasive and scarless approach. This was the first neurointervention for a complex brain aneurysm in the state, performed in our state-of-the-art Philips Biplanar Cath Lab, equipped with advanced softwares including 3D angiography, CBCT, Xper CT, VasoCT, MAFA, and Clarity IQ.

The procedure was led by Dr. Dibya Jyoti Mahakul, Consultant – Endovascular Neurosurgery, who carefully placed a Flow Diverter Stent across the aneurysm. Using MAFA software, the first of its kind in North India, the team successfully achieved and recorded the target aneurysmal flow parameters.

The use of these advanced technologies aided in faster decision-making, reduced radiation exposure, and improved procedural precision, reflecting our belief that “Time is Brain.” This case demonstrates our preparedness to manage all varieties of complex neurovascular conditions, from ischemic stroke to hemorrhagic stroke, through minimally invasive and scarless procedures.

When it comes to neurointervention and endovascular neurosurgery, Yashoda Medicity, equipped with the latest technologies and expert teams, is miles ahead in delivering advanced patient care.

Treatment By:
Dr. Dibya Jyoti Mahakul

A 27-year-old patient diagnosed with advanced-stage T-cell lymphoma presented for specialised evaluation and management. Given the aggressive nature of the disease, a detailed clinical assessment and a structured treatment plan were undertaken by the expert team.

The patient was treated with high-dose chemotherapy followed by an autologous stem cell transplant, a well-established approach for managing advanced hematological malignancies. The treatment was carried out under the expertise of Dr. Nivedita Dhingra, Director & Head – Hematology, Hemato-Oncology and Bone Marrow Transplant (Adult & Pediatrics), along with Dr. Karuna Jha, Senior Consultant – Hematology, Hemato-Oncology and Bone Marrow Transplant (Adult & Pediatrics), supported by the dedicated BMT team.

The treatment protocol was designed to achieve optimal disease control while ensuring patient safety. High-dose chemotherapy helped target and eliminate malignant cells, followed by stem cell reinfusion to restore healthy bone marrow function.

The patient responded well to the treatment and was closely monitored throughout the recovery phase, demonstrating a stable clinical course post-procedure.

This case highlights the importance of a protocol-based, multidisciplinary approach in managing rare and complex lymphomas, combining clinical expertise with advanced transplant capabilities to achieve effective outcomes.

Treatment By:
Dr. Nivedita Dhingra & Dr. Karuna Jha

A patient diagnosed with a tumour in the head of the pancreas presented for specialised evaluation and management. Given the complexity of the condition, a detailed clinical assessment and surgical planning were undertaken by the expert team.

The patient was planned for a Robotic Pancreaticoduodenectomy (Whipple’s Procedure), a highly specialised surgery used to treat tumours in this region. The procedure was performed under the expertise of Dr. Syed Asim Rizvi, Principal Director – Surgical Oncology and Robotic Surgery, along with his team, using advanced robotic surgical technology.

The robotic approach provided enhanced precision and superior visualisation, enabling meticulous removal of the tumour while preserving surrounding structures. This minimally invasive technique also helped reduce intraoperative blood loss and supported a more controlled surgical environment.

The patient demonstrated a smooth postoperative recovery with reduced pain, early mobilisation, and overall improved comfort. He was discharged in stable condition.

This case highlights the role of advanced robotic surgery in managing complex pancreatic tumours, combining surgical expertise with precision technology to achieve optimal patient outcomes.

Treatment By:
Dr. Asim Rizvi

A 78-year-old male patient presented with difficulty in swallowing and a small growth at the base of the tongue. Initial evaluation, including biopsy and imaging, confirmed a malignancy involving the tongue along with an affected lymph node in the neck.

As part of routine staging, a whole-body scan revealed an additional lesion in the upper lobe of the lung with associated chest lymph nodes. Further evaluation confirmed this to be a second, unrelated primary cancer. This rare presentation of two simultaneous primary cancers required a carefully coordinated and highly specialised treatment approach.

After a detailed assessment by a multidisciplinary team, a comprehensive treatment plan was developed with curative intent. The patient was treated using advanced adaptive radiotherapy, a technique that allows real-time adjustments to radiation delivery based on daily imaging and anatomical changes, ensuring high precision and safety.

Both cancers were treated concurrently. The lung and chest lymph nodes received a planned course of radiation over six weeks, while the tongue and neck region were treated over seven weeks. Each session was guided by high-resolution imaging, enabling accurate targeting of the tumours while preserving surrounding healthy structures. The patient completed the treatment successfully with good tolerance. He showed a steady recovery and continues to remain stable on follow-up.

This case highlights the power of advanced radiation technology and multidisciplinary expertise in managing rare and complex cancer presentations.
 

Treatment By:
Dr. Gagan Saini

A 55-year-old woman diagnosed with advanced high-grade serous ovarian cancer presented after completing three cycles of neoadjuvant chemotherapy. She had responded well to treatment, with imaging showing significant disease resolution and tumour markers returning to normal levels. Following a comprehensive evaluation, she was planned for interval debulking surgery combined with Heated Intraperitoneal Chemotherapy (HIPEC).

After detailed counselling and preoperative optimisation, the patient underwent surgery under the care of the expert team. A meticulous cytoreductive procedure was performed to remove all visible disease, followed by the administration of HIPEC, a targeted chemotherapy delivered directly into the abdominal cavity using specialised equipment over a controlled duration. The entire procedure was carried out with precise monitoring and a highly coordinated approach.

Postoperatively, the patient was closely monitored with a structured care protocol, including optimal fluid management and regular assessment of clinical parameters to support recovery.

The patient demonstrated a smooth and steady recovery and was discharged in stable condition on the eighth postoperative day. She continues to do well on follow-up.

This case marks a significant milestone as one of the successful HIPEC procedures performed at Yashoda Medicity, highlighting the team’s expertise in delivering advanced oncological care with precision and safety.

Treatment By:
Dr. Satinder Kaur, Dr. Hemlata Garg, and Dr. Ipshita Sahoo

A 65-year-old male patient, weighing 44 kg, presented with long-standing coronary artery disease, a recent myocardial infarction, critical multivessel disease, unstable angina, and severe left ventricular dysfunction with a left ventricular ejection fraction (LVEF) of 20–25%. Considering the complexity of his condition, he underwent coronary artery bypass grafting (CABG) under the care of the expert cardiac team.

The procedure was successfully performed, with the patient requiring minimal inotropic support and no intra-aortic balloon pump (IABP). He was extubated within four hours, reflecting a stable and well-managed immediate postoperative course.

Post-surgery, the patient was closely monitored and managed with a highly calibrated clinical approach. Advanced hemodynamic support strategies, including the timely use of an intra-aortic balloon pump (IABP), along with optimised inotropic management, judicious fluid administration, and targeted medical therapy, ensured effective systemic and organ perfusion.

Over the next few days, the patient demonstrated steady clinical improvement, with stabilising metabolic parameters, improving organ function, and gradual return to normal physiological activity. This enabled the phased withdrawal of advanced support measures, including ventilatory and circulatory assistance.

Following a structured period of intensive care and rehabilitation, the patient was discharged in stable condition. The case highlights the team’s expertise in managing complex high-risk cardiac conditions with precision, resulting in a successful recovery.

Treatment By:
Dr. Rachit Saxena, Dr. Vikas Kumar Keshari, and Dr. Kushant Gupta

A 28-year-old male from Nepal was diagnosed with chronic kidney disease after experiencing persistent weakness and loss of appetite for nearly two years. Investigations revealed severely impaired kidney function, and he was initiated on hemodialysis through a catheter placed in the right side of his neck. He was advised to undergo AV fistula creation and maintain regular maintenance hemodialysis (MHD) three times a week.

However, due to irregular dialysis sessions, his condition worsened. He then consulted the expert team of nephrologists, Dr. Prajit Mazumdar and Dr. Inderjit G. Momin, along with urologists, Dr. Vaibhav Saxena and Dr. Kuldeep Agarwal, at Yashoda Medicity. The team counselled him regarding renal replacement therapy (RRT), the importance of regular MHD, and recommended renal transplantation as the most effective long-term solution.

His transplant evaluation began with his mother as the donor. During the assessment, he was found to have significant anaemia and reduced cardiac function, likely resulting from inconsistent dialysis, which increased his peri-operative risk. After thorough counselling, he was optimised for surgery, and immunosuppressive therapy was initiated two days prior to the procedure.

The patient successfully underwent renal transplantation with ATG induction. Post-surgery, he showed excellent recovery with good urine output and steadily improving creatinine levels. He was discharged with a creatinine of 1.2 mg/dl and continues to do well on follow-up.

Treatment By:
Dr. Vaibhav Saxena, Dr. Kuldeep Agarwal, Dr. Prajit Mazumdar, and Dr. Inderjit G. Momin

Conquering a Complex Brain Aneurysm with Advanced Endovascular Therapy

A patient with a spinal condition was treated at Yashoda Medicity through a navigation-guided minimally invasive spine surgery, marking the first such procedure in the state. The surgery was performed in our state-of-the-art Neuro-Spine OT, equipped with O-arm, Stealth-8 Neuronavigation, Allen table, and IONM.

The procedure was led by Dr. Dibya Jyoti Mahakul, Consultant – Minimally Invasive Neuro-Spine Surgeon, who performed the surgery with unmatched precision. Using the neuronavigation system, the team could visualize the movements of all instruments in real time, ensuring the accurate placement of implants.

The minimally invasive approach resulted in minimal blood loss and muscle damage, and the patient experienced immediate pain relief. This achievement underscores our commitment to leveraging cutting-edge technology to provide safe, precise, and effective surgical solutions for spine problems.

At Yashoda Medicity, we care about your back. When it comes to spine conditions, you’re in safe hands.

Treatment By:
Dr. Dibya Jyoti Mahakul

First Navigation-Guided Minimally Invasive Spine Surgery at Yashoda Medicity
A patient with a spinal condition was treated at Yashoda Medicity through a navigation-guided minimally invasive spine surgery, marking the first such procedure in the state. The surgery was performed in our state-of-the-art Neuro-Spine OT, equipped with O-arm, Stealth-8 Neuronavigation, Allen table, and IONM.

The procedure was led by Dr. Dibya Jyoti Mahakul, Consultant – Minimally Invasive Neuro-Spine Surgeon, who performed the surgery with unmatched precision. Using the neuronavigation system, the team could visualize the movements of all instruments in real time, ensuring the accurate placement of implants.

The minimally invasive approach resulted in minimal blood loss and muscle damage, and the patient experienced immediate pain relief. This achievement underscores our commitment to leveraging cutting-edge technology to provide safe, precise, and effective surgical solutions for spine problems.

At Yashoda Medicity, we care about your back. When it comes to spine conditions, you’re in safe hands.

Treatment By:
Dr. Dibya Jyoti Mahakul

A 4-year-old, 11 kg child was brought to the Department of Pediatric Cardiac Sciences at Yashoda Medicity, Indirapuram, with complaints of bluish discoloration of fingernails and toes, poor weight gain, easy fatigue on walking, and recurrent hospital admissions. 
Clinical evaluation revealed an oxygen saturation of 75%, prompting further investigations including echocardiography and CT pulmonary angiography.

The child was diagnosed with Cyanotic Congenital Heart Disease known as Tetralogy of Fallot (TOF), with additional apical muscular VSD and a hypoplastic pulmonary annulus.

The patient underwent open-heart surgery called Intracardiac Repair, including closure of multiple VSDs with a transannular patch over the neopulmonary valve. The procedure was led by Dr. Abhinavsingh Chauhan, Consultant Pediatric Cardio-thoracic and Vascular Surgery. Advanced post-operative care in the Pediatric Cardiac ICU was uneventful, and post-operative echocardiography confirmed a successful repair.

The child was discharged in a stable and ambulatory condition on the 5th post-operative day, with oxygen saturation improving to 99%. This case reflects Yashoda Medicity’s expertise in managing complex pediatric cardiac conditions, combining cutting-edge surgical techniques with specialized intensive care to ensure safe, life-transforming outcomes for children.

Treatment By:
Dr. Abhinavsingh Chauhan

A 4-year-old male child with congenital Pelvi-Ureteric Junction (PUJ) Obstruction underwent Robot-Assisted Pyeloplasty at Yashoda Medicity. The child had an excellent postoperative recovery and was discharged on postoperative day 2.

Robotic surgery offers superior precision and control, providing a significant advantage not only in cancer surgeries but also in pediatric minimally invasive procedures.

The benefits of robotic surgery over conventional techniques include smaller incisions, minimal intraoperative blood loss, enhanced surgical precision and dissection, reduced postoperative pain, and faster recovery and discharge.

The Department of Urology at Yashoda Medicity is committed to providing the highest standard of care to every patient, with special expertise in Robotic Surgery, Reconstructive Urology, Uro-Oncology, Stone Diseases, and Renal Transplant Surgeries.

Treatment By:
Dr. Vaibhav Saxena

Conquering a Complex Brain Aneurysm with Advanced Endovascular Therapy

Brain aneurysms are often described as ticking time bombs—silent, unpredictable, and potentially life-threatening if left untreated. They pose one of the most complex challenges in modern neurosurgery, requiring both precision and cutting-edge technology for successful management.

A 60-year-old woman presented with multiple episodes of severe headache, prompting her to consult Dr. Sumantao Chaterjee (Neurologist). Given the persistence and pattern of her symptoms, a brain angiography was recommended and performed by Dr. Dibya Jyoti Mahakul (Endovascular Neurosurgeon).

The imaging revealed a complex brain aneurysm, one that demanded meticulous planning due to its size, shape, location, and blood flow dynamics. After careful evaluation, the patient was offered a scarless, minimally invasive endovascular treatment. A flow diverter stent was strategically placed across the neck of the aneurysm to divert blood flow away from the aneurysm sac, promoting healing and preventing rupture. While technically challenging, the procedure was greatly aided by our state-of-the-art biplanar cath lab, equipped with advanced imaging tools like Vaso CT, CBCT, and MAFA software. These technologies ensured maximum precision, safety, and speed for both the patient and surgical team. Remarkably, the patient was discharged the very next day in a stable condition—aneurysm secured, risk averted.

Today, she is back home with her family, free from the shadow of a life-threatening condition, and ready to embrace life on her own terms.

Treatment By:
Dr. Dibya Jyoti Mahakul, Dr. Sumantao Chaterjee

A 51-year-old lady with left arm pain more than neck pain of 10 years duration, with BMI 44 and a short neck nearly the chin touching the chest, was diagnosed with OPLL C3-6 with myelopathy and fixed kyphosis of 20°. MRI showed cord signal changes at C5, and CT  confirmed OPLL C3 -6 with high probability of intradural mass ( double density sign). Conventional wisdom (K line, kyphosis, anterior pathology etc.) dictated towards an anterior surgery, but possibility of dural laceration (intradural OPLL mass), with potential for other complications (cord / trachea / esophageal compression by pseudomeningole, meningitis, spinal cord hernia etc.) were discussed in detail and a decission was taken to decompress and fix from the posterior aspect. The pre-op CT angio showed B/L high-riding vertebral arteries, which precluded the  C2 screw. 
 

Per operatively, the patient was positioned prone with the head clamped and a posterior exposure done. LM screw entry points were made from C3-6, followed by grade 1 facet resection at C3-4, C4-5, and C5-6 bilaterally. Further lordosis was achieved with manipulation of the head with the head clamp and closing the osteotomy gaps. LM screws (C3-6), a laminar screw at C2, and a pedicle screw at T1 & 2 were inserted and connected with rods. 
 

C3-6 laminectomy was done, and the surgical site was closed after bone graft mixed with vancomycin was applied laterally.
 

Postoperative x-ray showed adequate lordosis (approximately 10 degrees) attainment.

The patient reported complete pain relief in the left shoulder and arm postoperatively.

Treatment By:
Dr. Ankur Goswami