Issue link: https://beckershealthcare.uberflip.com/i/1483210
10 SPINE anterior-posterior revision. I was pretty nervous about drilling out the facets at the index level and getting the level mobilized enough to be able to then do a two-level anterior interbody fusion and then finally reduce her slips from behind. She is almost 8 months out, fused great and is walking upright and off all meds, including gabapentin. Jeremy Smith, MD. Hoag Orthopedic Institute (Irvine, Calif.): One of my patients is an active firefighter in his 30s who had se- vere thoracic level pain and was bounced around to multiple medi- cal providers and had several visits to the emergency room. He had no neurologic concerns and the symptoms were vague. A col- league who is a family friend referred him to me. A simple X-ray saw a unilateral absent pedicle in the mid-thoracic spine. An MRI scan we obtained found a large infiltrative lesion occupying two vertebra causing severe spinal cord compression with myeloma- lacia. The CT scan showed erosions and a pending fracture. His fate seemed ominous. I performed a lateral vertebrectomy with expandable cage at two levels and a posterior instrumented fu- sion. The pathology report came back metastatic melanoma. After surgery and a year of immunotherapy, he is in full remission and back to work as a firefighter. I see him every year and when I do it reminds me why we do this job. Brian Fiani, DO. Weill Cornell Medicine/NewYork-Presbyteri- an Hospital (New York City): A recent spine surgery I am particu- larly proud of was my resection of an intradural extramedullary spinal tumor. The patient had suffered from debilitating weakness in his legs for almost 6 months before he visited the hospital. On physical exam, he had a marked sensory level and only muscle contraction — but no active movement — of his lower extremities, even with gravity eliminated. After proper radiographic workup identifying the tumor, gross total resection was performed the next day. One week later, the patient was ambulating independently. Sometimes the challenge is not something we can control. For ex- ample, the challenge in this case was the patient waiting to pres- ent until the symptoms were so severe, making the outcome after surgery less predictable. The surgical approach was not a concern or challenge in this surgery (laminectomy, dural opening, coring of tumor for decompression, then working around it for complete resection). The concern is how can we as spine surgeons do the best we can for a patient regardless of the given circumstance/con- dition in which a patient presents. This surgery was particularly gratifying because it highlights the degree of impact we can have on a patient's life. "Impact" is why I love spine surgery and the ability to help people return to func- tionality. I think spinal tumors is also an important differentiating qualification of neurosurgeons compared to orthopedic spine sur- geons which brings a sense of pride as well. Chester Donnally, MD. Texas Spine Consultants (Addison): Recently, I featured the 6-month follow-ups on my various media platforms showing a patient in his 50s with kyphoscoliosis in the setting of neurofibromatosis type one. The required three-level corpectomy and management of the neurofibromas of the anterior cervical spine. There were probably 10 things that could have gone wrong. I am extremely fortunate to be in a spine group in Dallas that has some experts in cervical spine surgery, so I invited my friend and senior partner Dr. Andrew Park to join me on this all day case. I am proud that this patient did fantastic. He legitimately is a living billboard for me in many social media forums. I am proud that my own digital marketing resulted in a med school col- league sending me this opportunity, as opposed to her in-house spine surgeons. And I'm proud I have enough self-recognition to ask for help when doing certain surgeries. Vladimir Sinkov, MD. Sinkov Spine Center (Las Vegas): I am proud of any surgery where I get to improve a patient's quality of life and return them to full function. A recent example was a man who presented with lumbar stenosis and instability due to adjacent segment degeneration above prior fusion surgery. The original procedure was done in traditional "open" fashion that created a lot of scar tissue and prolonged recovery. Using minimally invasive techniques, including computer naviga- tion and robotic assistance, I was able to remove the old hardware and perform minimally invasive lateral fusion and decompression at the adjacent segment through very small incisions in single po- sition with minimal blood loss while avoiding most of the prior scar tissue. The patient felt immediate improvement in his back and leg pain and went home the next day. He was off pain medi- cations within days and returned to full function 3 months after surgery — much faster than with traditional "open" spinal fusions. Francisco Espinosa-Becerra, MD. NorthShore Neurological In- stitute (Arlington Heights, Ill.): I had a patient in his 30s with four disc herniations and spinal cord compression. He was not able to walk. I performed a three-level discectomy and fusion at C4-5, C5-6 and C6-7, and an arthroplasty at C3-4. I had a clinic visit with him after the operation and he is experiencing excellent outcomes. He is able to walk and does not have any apparent neu- rological deficits. Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): As an employee of a large health system, the predominance of our complex spine case- load is those aged patients with previously failed interventions, precluding comorbidities, bariatric concerns or insufficient sure- ties. Most community spine surgeons will forgo these cases for all the aforementioned reasons, subsequently leaving a larger pool of complexities for larger healthcare centers that provide this type of service. Recently, an adult syndromic patient from a rural town presented to our clinic with heterotopic ossification from a previous spine surgery as a child. Ambulating two years previous had now de- clined into wheelchair-bound paraparesis and familial care issues had escalated. Radiological modalities confirmed the diagnosis of bony overgrowth and severe multilevel lumbar stenosis in both the old and new lumbar levels. In short, a prolonged, belabored decompressive surgery followed, reconstituting and near normal- izing the intercanalicular distance was achieved. A microscopic technique utilizing lateral (normal tissue planes) to medial dural detethering was accomplished. Dural compromise was avoided throughout. The patient is currently at home standing with assis- tance and initiating ambulatory mobility. n