Spine prosthetics in oncology
The vertebral prosthesis save you from cancer
Yulia Smirnova, "Science and life"
In St. Petersburg, conducted the world's first surgery for prosthetic five cervical vertebrae affected by metastases.
Cancers can send metastases in various organs and tissues and even bones. New tumor that began to develop from metastasis can often be removed surgically. But let us imagine that the malignant cells settled in the vertebrae. What surgeon will take up this case?
However, doctors still there. In December 2015, Institute of Oncology. N.N. Petrov was held two consecutive surgery for the removal of five cervical vertebrae, with the replacement of the implant. The patient, a 62-year-old Mikhail Alexandrovich, a few years ago was diagnosed with "kidney cancer" which then metastasized to her lungs and spine, causing Mikhail Alexandrovich had to endure several operations.
Removal and replacement of the vertebrae was performed in two well-known of the doctor: head of the Department of neuro-bone Oncology RNIITO them. R. R. Vreden, Professor Dmitry Aleksandrovich Ptashnikov and head of the thoracal surgery Department, Institute of Oncology, Professor Evgeny Levchenko told details of the operation at a press conference on 2 February 2016 at the press center of "Interfax Northwest".
In eleven cases of prosthetic cervical vertebrae affected by malignant tumors. Generally, such operations with the vertebrae – a rarity in medical practice, even in trauma, even though in the first place, trauma forced to come up with technologies that allow for this kind of procedure.
Cervical spine is the most mobile section of the spine, try to count how many you're making head movements for at least one minute. In the transverse processes of the vertebrae are the arteries that supply blood to the brain and in the spinal canal, piercing the body of the vertebrae, the spinal cord passes. In short, the surgeon then as a miner in a mine field is right for mistake does not have.
However, prosthetics metastasize to the cervical vertebrae at this scale still wasn't fulfilled. First, the patient removed the four arches of the cervical vertebrae (from the second to the fifth) and titanium screws fixed the occipital bone, the Atlas is the seventh cervical vertebra and the first thoracic vertebrae. In the second phase was removed the bodies of five cervical vertebrae with the tumor (from the second to sixth) and the implant, which has been there since the earlier operations in a medical facility. The vertebrae were replaced with special titanium tube filled with bone cement. The spinal cord and blood vessels left behind tube.
The operation was preceded by extensive preparatory work. Over 7 years of cooperation Ptashnikov spine and thoracic surgeon Levchenko spent 15 most complex reconstructive operations on the cervical, thoracic and lumbar spine, which removed both primary and metastatic (secondary) tumors.
The first patient was operated on Ptashnikov Levchenko and in 2009, became the 44-year-old resident of Cherepovets Viktor Pavlovich, he removed the chondrosarcoma and affected adjacent areas. Currently, Victor is feeling well and goes to the pool and living a normal life. Cancer is not progressing now in its seventh year, and if it is not returned within 7 years, it is assumed that the patient has recovered.
Another important patient – 29-year-old Victor from Saint-Petersburg. In 25 years, he had a very difficult diagnosis: malignant giant cell tumor of the cervical-thoracic spine with metastatic lesions of both lungs, mediastinal and deep cervical lymph nodes. In 2013, Viktor removed 106 metastases in the lungs, and replaced with dentures three vertebrae (one neck and two breast). In the third year after surgery, the patient feels good, lives a full life, and riding her bike.
Surgery is not the only way for cancer patients. Before deciding, doctors gather a careful medical history, and decided to offer this method to the patient only when confident of success. But the last word remains with the patient.
"To make a decision about the operation, we need to be much information on the patient. This is a very expensive, long-term intervention. Costly, in terms of components and manpower. But in the end we see that patients get the chance to continue life in a very good quality. The removal process of the vertebrae in the cervical spine is architon, because there are vital structures. Are the vessels that nourish the brain, and the structure responsible for the nerves of the whole body. Keep all these structures is not easy," says Evgeny Levchenko.
But the last word even with the full confidence of surgeons over a patient. According to doctors, they are not persuaded to agree to the operation, and only reveal all his cards and suggest to the patient to decide whether he is ready to take this important step. As said Mikhail Alexandrovich, even if he said that the chances of success, only 2% out of 100, he would have agreed because I trusted the doctors. And yourself, of course.
One of the important factors in the cases discussed above, was that the tumor did not respond to chemotherapy and other treatments. Of course, the earlier the disease is diagnosed, the more chances of success. "But even the fourth stage, not a sentence", – says Evgeny Levchenko.
Now in possession of the doctors there are so many ways to prolong life or significantly improve the quality of cancer patients at virtually every stage of the disease. For each individual patient has to make an individual decision: someone shows chemotherapy and some radiation, for some, the best solution would be surgery.
Anyway, the success depends largely on awareness of the patient about the disease, methods of treatment and health care institutions, where he can help. Such operations on the vertebrae, according to doctors, are required in a few cases, no more than 20-30 patients per year. And only in the clinic Oncology research Institute is held annually to treatment about 10 thousand patients.
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04.02.2015