Dr. Anuj Gupta
Spine Surgery
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
The patient has been treated for complications in his spinal cord. As the metastatic cells have been considered the reason behind some fractures in his spinal cord, he had two chemotherapy. Recently, both his legs got paralyzed, and he lost control of his bladder and bowel. I attached his recent MRI. as the patient is an emergency. Please let us know about your comment on this case. We have been told that he needs surgery, and the success chance is not that high, but the risk is high.
Thank you.
Hi,
Welcome to icliniq.com
I have gone through your MRI images (attachment removed to protect the patient's identity). There are multiple metastatic lesions in the vertebral body with the significant collapse of the L1 vertebral body involving the posterior elements. It is an unstable fracture, and it requires surgery to stabilize it. If the patient has already developed weakness in the lower limbs, the recovery prognosis is low. But there is no other option except trying. I want to ask if the PET scan (positron emission tomography) has already been done or not? Do we know the primary source of the tumor?
Thank you.
Patient's Query
Thank you doctor,
We have been told the same comment previously, but there are other complications around T1 to T3. Do you think we need to do the same surgery there, or stabilizing the L1 would be enough? If you feel another surgery is required, do you think we need to do it at once or in separate sessions? What is the risk of this surgery, and what do we gain from it? We also have been told not to do any surgery and continue the treatment for cancer by doing chemotherapy and radiotherapy. Do you recommend this strategy? Unfortunately, the source of the tumor has never been found, and we had an appointment for doing a PET scan when the legs' paralyzed. The treatment stopped until we did something about the complications around the spinal cord to fix the issue. Because the patient has diabetes and had been doing chemotherapy four weeks ago, do you think the surgery is high risk or not? Is there any time window for such surgery, or can we postpone the surgery until the patient's condition improves according to recent chemotherapy? Please advise.
Hello,
Welcome back to icliniq.com.
After taking a look at the attachment (attachment removed to protect the patient's identity), now I would like to tell you that the tumor has infiltrated the spinal canal at the T1 to T3 region and has severely compressed the spinal cord. This needs to be decompressed as early as possible, ideally within 48 hours. The lower one at L1 can be managed with only fixation and can be done in the same sitting, depending on the level of care at the center. But the upper thoracic region is a must to operate. Ideally, a PET scan should be done before surgery. But this should not delay the surgery. Chemotherapy can help reduce the load of the tumor. Still, it would not help in the upper thoracic region, and delay will result in permanent paralysis and bladder and bowel incontinence. I hope this helps.
Thank you.
Patient's Query
Thank you doctor,
I have another concern. As the patient has diabetes and had chemotherapy around five weeks ago, do you think this surgery could be life-threatening for him or not? Because they told us that chemotherapy could affect the anesthesia administration, which could be dangerous. Please advise.
Hello,
Welcome back to icliniq.com.
An anesthetist decides the fitness of the patient for surgery. Yes, the risks increase after chemotherapy and with the presence of comorbidities, but if it is an emergency, it has to be done. I hope this helps.
Thank you.
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Spine Surgery
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