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Thread: Removal of a section of spinal cord - affect on a future cure?

  1. #1
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    Removal of a section of spinal cord - affect on a future cure?

    My son has a tumour in his spinal cord, and is a T6 complete para, as the result of partial removal of the tumour almost 5 years ago.

    Unfortunately the remaining tumour has shown some recent growth (within the original area of the tumour, between T3 and T9), and more surgery has been suggested. The surgery this time would totally remove the T3-T9 section of the spinal cord, thereby (hopefully) removing all traces of the tumour.

    One question that we have is will this surgery drastically change the prospects of a cure for my son, if and when a cure is found/developed? (The answer is probably affected by the thoughts of a tumour remaining in his spinal cord or not - I guess we want to know the answer to the question ignoring the tumour issue altogether).

    This is only one of many questions we have, so the answer to this question won't be the deciding factor in selecting surgery, or not.

    Thanks for any input.
    Gordon, father of son who became t6 paraplegic at the age of 4 in 2007 as a result of surgery to remove a spinal tumour.

  2. #2
    My thoughts would be to make certain to get that tumor out of there if at all possible and not to alter your plans at all due to a potential change in prospects for a cure sometime in the future. There will likely be a clean cut at each remaining segment of cord above and below the lesion and this will actually improve the ability to perhaps someday build a bridge across the gap. Also, since the lesion will be absolutely complete this will also help in the decision to build a bridge because of the inability to cut any remaining axons in the gap, since there are none. I wish you and your son the very best as you go forward. You should also make sure to discuss with your neurosurgeon the potential effects of removing a large component of the pre-ganglionic sympathetic nerve cells.

  3. #3

    Tumor

    Gordy I had a tumor removed 19 yrs.ago.I have never heard of a complete removal of a section of the spinal cord as a treament for recurrent tumor.Has the tumor become aggressive or malignant.I strongly advise you to get another opinion.I know your choices are restricted by Australia's socialized health system,I saw your other post on the SCT website.Go back there and get the information for Dr.Jallo here in the states.He will review your sons MRI via email for free.The solution you have been offered seems much to radical.I have read papers by and have been treated by the top surgeons for SCT in the USA and have NEVER seen the severing of the cord offered as an option.

  4. #4
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    Thanks for the responses.

    Yes, one part of me thinks that we should just remove the whole tumour portion from his body, and the other part thinks that the proposed surgery is too extreme.

    We are contacting Dr Jallo, but I just want to get all my thoughts together before doing so.

    Jsilver, what is your concern about removal of the pre-ganglionic sympathetic nerve cells? (Just so that I know roughly what I'm talking about when I ask an NS the question!).

    Cheers,
    Gordon
    Gordon, father of son who became t6 paraplegic at the age of 4 in 2007 as a result of surgery to remove a spinal tumour.

  5. #5
    My concern is that of bringing on the phenomenon of autonomic dysreflexia. This is a syndrome where there is massive imbalanced reflex sympathetic discharge which often occurs in people with lesions of the cord above T5-6. I don't know if your son is experiencing AD presently because his lesion is right at T6. But with removal of the cord so far up this could be a side effect of the surgery. You should surely discuss this with your doctor(s) to weigh the pros and cons of the proposed procedure. AD can be managed and you can read all about this on line.

  6. #6
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    Thanks JSilver, that makes sense. No AD to date, but we were made aware of it several years ago, and are aware that a change from T6 to T3 may make it a problem.
    Gordon, father of son who became t6 paraplegic at the age of 4 in 2007 as a result of surgery to remove a spinal tumour.

  7. #7
    Quote Originally Posted by Gordy1 View Post
    My son has a tumour in his spinal cord, and is a T6 complete para, as the result of partial removal of the tumour almost 5 years ago.

    Unfortunately the remaining tumour has shown some recent growth (within the original area of the tumour, between T3 and T9), and more surgery has been suggested. The surgery this time would totally remove the T3-T9 section of the spinal cord, thereby (hopefully) removing all traces of the tumour.

    One question that we have is will this surgery drastically change the prospects of a cure for my son, if and when a cure is found/developed? (The answer is probably affected by the thoughts of a tumour remaining in his spinal cord or not - I guess we want to know the answer to the question ignoring the tumour issue altogether).

    This is only one of many questions we have, so the answer to this question won't be the deciding factor in selecting surgery, or not.

    Thanks for any input.
    Gordy,

    Removal of a section of the spinal cord is sometimes considered for recurrent tumors and, as you might expect, would be associated with complete loss of function below the injury site. I don't think that this means that your son would not be eligible for regenerative therapies of the future. In fact, some promising therapies for spinal cord injury cannot be applied to people who have contused spinal cords because there is simply no room to put in scaffolding or other biomaterials to "bridge" the injury site. Heinreich Cheng, in Taiwan, for example, has been looking for patients who have had a complete section of the spinal cord removed, so that he can bridge the gap with peripheral nerves, something that he showed will direct regenerating axons to grow across the gap and restore locomotor function in rats.

    Since your son is a complete paraplegic below the tumor and previous surgery site, I don't think that the removal of a section of the spinal cord will necessary aggravate neuropathic pain, autonomic dysfunction, or spasticity. When I was at NYU (1977-1997), I did intraoperative monitoring of surgery by Fred Epstein. He frequently removed intramedullary astrocytomas, using the Cavitron device, leaving very thin and almost transparent spinal cord after removing the tumor. Many kids with such spinal cords walked out of the hospital. If your son had some function below the original surgery site, I would have urged the consideration of removing just the tumor. However, since he is a complete paraplegic, I think that the removal of a section of the spinal cord makes sense. It is safer and will not cause additional neurological loss.

    Jerry is correct that there is something special about T6. This is the segment of the spinal cord where the artery of Adamkiewicz from the aorta typically joins the anterior spinal artery. We use to monitor this artery very closely when doing embolization of arteriovenous formations around T5-6. When this artery is blocked for any length of time, it damages gray matter in the area. This may be one reason why your son became a complete paraplegic after his first surgery. If the anterior spinal cord had been damaged during that surgery, this would have caused complete loss of function and gray matter damage below the surgery site. If so, your son should not have much spasticity in his legs. I suspect that removing T5-6 will not damage T4 so much because of the previous surgery that your son has had. His cord proximal to T5 is likely to have revascularized.

    Most kids who have had spinal surgery and spinal cord tumors before puberty develop spinal cord curvatures that progress. Calculating from your signature, your son is now 9 years old. As he approaches 11 years old, he needs to be checked annually for kyophoscoliosis. These can and should be corrected orthopedically to prevent the progression of the curvature as he grows. Likewise, I am assuming that your son is currently doing intermittent catheterization. If he is, he might consider a Mitrafanoff procedure, which is easier and more convenient for him at school. Finally, I don't know where your son is being cared for but if he has not been seen at the Shriner's Hospital in Philadelphia, I would suggest getting a second opinion there. I have great respect for the doctors there and they are very experienced.

    Wise.
    Last edited by Wise Young; 03-08-2012 at 07:00 PM.

  8. #8
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    Wise,

    Thank you very much for your response, I really appreciate you taking the time to respond. (And that's what makes CareCure so good!).

    Your comments about Fred Epstein would have been useful about 5 years ago, when we should have looked around for the world's best neurosurgeon, rather than depending on the words of our local neurosurgeon(s). Hindsight is a wonderful thing, unfortunately! But that is one reason why we are taking our time in making any decisions now, as we want to ensure we get things right this time.

    Thanks for the comments about the arteries around T6. You may not believe it, but that is the first time that anyone has volunteered an opinion on "what went wrong" with my son's first surgery. And you are correct in that my son does not have much spasticity in his legs (ie he does have spasticity when he stretches his upper body, and occasionally at other times, but nothing too hard to deal with).

    As for the spinal curvature, you are again correct, at least on the scoliosis part (I don't believe there is any sign of kyphosis). We tried to keep his posture straight using wheelchair seating supports, on the basis that the only alternative seems to be very uncomfortable (and restricting) body braces. Unfortunately we do recognise that spinal fusion surgery will be required, and sooner rather than later.

    Yes, he does intermittent catheterisation, which works pretty well for us all. I wouldn't choose to go down the Mitrafanoff procedure route, partly because it makes him "differ" even more from other kids his age, but also because he loves playing in the the ocean, and I can imagine that any procedure like that can be affected by sand etc. Foreskin = protection!

    Our next step is to contact Dr Jallo. We have already had some communication with oncologists at John Hopkins, who interestingly recommended that we consider radiotherapy. From our investigations, it is difficult to find anyone else who recommends that approach, due to the inherent longer term risks (in addition to the immediate risks).

    If there is a specific contact you can provide at Shriners, then I would appreciate it.

    Also, if you have the contact details of Heinreich Cheng, that would also be appreciated, as we would like to know more about his work. Perhaps he would be interested in a patient who might be about to have a section of spinal cord removed?!?

    Many thanks again for your responses.

    Cheers,
    Gordon
    Gordon, father of son who became t6 paraplegic at the age of 4 in 2007 as a result of surgery to remove a spinal tumour.

  9. #9
    Quote Originally Posted by Wise Young View Post
    When this artery is blocked for any length of time, it damages gray matter in the area. This may be one reason why your son became a complete paraplegic, this would have caused complete loss of function and gray matter damage below the site. If so, your son should not have much spasticity in his legs.
    Wise.
    Hello Dr. Wise Young

    I am a T4, T5 complete injury, caused by a bullet, but the bullet did not go through my spinal canal, he went through between my T4, T5. from side to side. and push the disc a bit in to the spinal canal and causes a contution injury

    What you say about the arteries around T6 can this be also in my case ? since my injury is around T6

    Because i also have not spasticity in my legs, but i have a good tone in my legs, (they are not so thin) they are almost normal. but when I stretch my upper body, I also (only than) get spasticity, and I get very stiff and hard, so hard that i almost can not sit down on my bed, and almost can not displace my legs from one pleace to another

    Thank's in advance
    Last edited by Johnnie Walked; 03-13-2012 at 07:26 PM.
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  10. #10
    Quote Originally Posted by Gordy1 View Post
    Wise,

    Thank you very much for your response, I really appreciate you taking the time to respond. (And that's what makes CareCure so good!).

    Your comments about Fred Epstein would have been useful about 5 years ago, when we should have looked around for the world's best neurosurgeon, rather than depending on the words of our local neurosurgeon(s). Hindsight is a wonderful thing, unfortunately! But that is one reason why we are taking our time in making any decisions now, as we want to ensure we get things right this time.

    Thanks for the comments about the arteries around T6. You may not believe it, but that is the first time that anyone has volunteered an opinion on "what went wrong" with my son's first surgery. And you are correct in that my son does not have much spasticity in his legs (ie he does have spasticity when he stretches his upper body, and occasionally at other times, but nothing too hard to deal with).

    As for the spinal curvature, you are again correct, at least on the scoliosis part (I don't believe there is any sign of kyphosis). We tried to keep his posture straight using wheelchair seating supports, on the basis that the only alternative seems to be very uncomfortable (and restricting) body braces. Unfortunately we do recognise that spinal fusion surgery will be required, and sooner rather than later.

    Yes, he does intermittent catheterisation, which works pretty well for us all. I wouldn't choose to go down the Mitrafanoff procedure route, partly because it makes him "differ" even more from other kids his age, but also because he loves playing in the the ocean, and I can imagine that any procedure like that can be affected by sand etc. Foreskin = protection!

    Our next step is to contact Dr Jallo. We have already had some communication with oncologists at John Hopkins, who interestingly recommended that we consider radiotherapy. From our investigations, it is difficult to find anyone else who recommends that approach, due to the inherent longer term risks (in addition to the immediate risks).

    If there is a specific contact you can provide at Shriners, then I would appreciate it.

    Also, if you have the contact details of Heinreich Cheng, that would also be appreciated, as we would like to know more about his work. Perhaps he would be interested in a patient who might be about to have a section of spinal cord removed?!?

    Many thanks again for your responses.

    Cheers,
    Gordon
    I suggest contacting Dr. Randy Betz at Shriners. He is the Chief of Staff of Shriners and an orthopedic surgeon.

    Wise.

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