Thyroid cancer with multiple bone metastases throughout the body
Spinal metastases cause severe pain
It also leads to paralysis of both lower limbs lying in bed, and the quality of life is extremely poor
Such a heart-wrenching patient
Doctors are often left helpless
For a long time, the clinical treatment of patients with advanced tumors such as spinal metastases has been a dilemma. Chen Kebing, deputy chief physician of the Department of Spine orthopedics of our hospital, gave an answer that can be referred to with his exquisite cooperation with the multidisciplinary team, and let the patient recover partial consciousness "miraculously" after subsequent recovery.
"Hope in despair"
"It really hurts my mother, I can't sleep in pain, and my lower limbs are paralyzed," Aunt Wang's son choked and said.
When Aunt Wang arrived at the hospital, the spinal metastases developed from thyroid cancer were already very serious, and the sphincter could not contract spontaneously.
Huge malignant tumors envelop and severely squeeze the spinal cord and nerve roots, while invading the muscles behind the spinal canal, which is also the main cause of paralysis of both lower limbs, and the expected survival time is less than 6 months.
Chen Kebing and his team faced a great challenge, the operation of a huge spinal metastase, the risk is extremely high, the operation time is long, the bleeding is abundant, the spinal nerves are abundant, and the slightest carelessness is irreparable, and the difficulty coefficient is extremely high.
Faced with the urgent demands of patients and their families, Chen Kebing chose to "face the difficulties" and explained the condition and treatment plan to the patients and their families in detail after MDT (Multi-disciplinary Treatment) multidisciplinary discussion and full perioperative preparation.
After receiving the support and understanding of the patient and his family, the surgical plan was formulated in detail - joint interventional department to advance spinal metastase artery embolism to ensure that the tumor bleeding was reduced during the subsequent surgical process, 360° circular decompression of L2 vertebral malignant metastases, combined with bone cement filling isolation surgery, remodeling the hardness of the spine, and creating a "reinforced iron bone" for the damaged spine.
MDT+ ERAS, regain confidence in life
In order to avoid excessive bleeding of the tumor during the operation, Chen Kebing first asked the interventional department to perform tumor arterial embolization, and then he performed surgical treatment for Aunt Wang, and the amount of bleeding during the operation and the filling position of the bone cement were very precise.
▲Chen Kebing during surgery
"There is a feeling, the legs have a feeling!" On the first day after the operation, Aunt Wang told the doctor that the symptoms of low back pain had improved significantly, and the muscle strength of both lower limbs had miraculously recovered from level 0 before the operation to level 2, and the treatment effect surprised her very much.
At the same time, the Department of Spine orthopedics actively communicated with the Rehabilitation Medical Center, combined with the concept of enhanced recovery after surgery (ERAS), and accurately formulated a postoperative rehabilitation and radiation therapy plan for Aunt Wang.
After active treatment, the patient's low back pain symptoms were completely alleviated 7 days after the operation, the wound recovered well, the muscle strength of both lower limbs was restored to level 2-3, and simple dorsal bending and leg extension movements could be performed.
Aunt Wang, who was originally declared to be only 6 months old, ushered in a "new life", regained confidence in life, and gained new hope.
In the next step, the patient will be transferred to the radiotherapy department for radiation therapy, which will further actively combat tumor progression while stabilizing the effect of treatment.
▲Aunt Wang recovered well after surgery, and the muscle strength of both lower limbs was restored to level 2-3, and she could perform simple dorsal bending and leg extension and other movements
In the face of spinal metastases, a positive mindset wins the hard battle
Chen Kebing introduced that the incidence of spinal metastases is low, but its type is complex, the onset time is short, the disease develops quickly, the treatment effect is poor, and the prognosis is often poor.
In fact, the "bone cement" that has made great contributions to this operation has also been widely used in the treatment of spinal tumor patients, and the cytotoxic and thermogenetic effects of bone cement act on tumor tissues and peripheral nerves, which can effectively kill tumor cells, inhibit local tumor recurrence and alleviate pain symptoms, and its filling effect and physical properties can be restored to a certain extent and maintain spinal stability. Circular decompression combined with bone cement filling isolation for the treatment of spinal metastases can effectively improve the pain and nerve symptoms of spinal metastase patients, improve the quality of life of patients, and avoid the recurrence of neurological symptoms in the original segment after surgery.
(The image comes from the Internet, please contact to delete the infringement)
(The arrow refers to bone cement)
Chen Kebing stressed that the appearance of spinal metastases is not necessarily a "judgment" for the terminal stage of cancer.
With the advancement of medicine, spinal metastases can still be actively treated, and can improve the quality of life and prolong the lives of patients.
This article guides the experts
Department of Spine orthopedics Chen Kebing, Deputy Chief Physician
Deputy Director of the Department (presided over the work), Deputy Chief Physician, Master Supervisor, Doctor of Medicine
He received his Ph.D. from Sun Yat-sen University in 2011 and his M.D. from Fukui University in Japan in 2019. In 2011, he stayed in the First Affiliated Hospital of Sun Yat-sen University to work in the Department of Spine Surgery, from 2012 to 2021, he served as the core backbone of the Spine Surgery Department of the Third Affiliated Hospital of Southern Medical University and Guangdong Orthopaedic Hospital, and joined the Sixth Affiliated Hospital of Sun Yat-sen University in 2021. He has worked in the frontline of orthopedics for nearly 20 years, and has completed hundreds of cervical, thoracic and lumbar spine four-stage surgeries every year. He was awarded the 2020 Yangcheng Evening News Lingnan Good Doctor, the 2020 and 2021 Guangdong Family Doctor Association Lingnan Famous Doctor (Orthopedics).
Academic Appointments:
Member of cervical spine group of Spine Surgery Branch of Guangdong Medical Association
Member of the Minimally Invasive Group of the Pain Branch of Guangdong Medical Association
Research Interests:
Clinical treatment and neuroimmunology of spinal cord injury; research on research and application of orthopedic nanomaterials; clinical treatment and bioinformatics of idiopathic scoliosis; basic and applied research on neuroimmune and social behavior.
Areas of Expertise:
Minimally invasive surgical treatment of cervical spondylosis, upper cervical spine disease, lumbar disc herniation, lumbar spinal stenosis, osteoporosis spinal fractures, microscopic surgical resection of posterior longitudinal ligament ossification of the cervical spine, ossification of the xanthelacanta of the thoracic spine, intraspinal tumors, orthopedic treatment of scoliosis and kyphosis deformity, surgical treatment of spinal infections such as spinal tuberculosis, surgical treatment of spinal cord dysfunction secondary to spinal metastases.
Visits: Monday morning, Wednesday morning
Editor-in-Charge: Zhang Yuanquan
Preliminary: Daisy.com
Review: Jian Wenyang
Approval release: Zhu Changping