The difficult whole spine resection was successfully completed in Baoji Traditional Chinese Medicine Hospital

Sunshine News (reporter Zhang Wei intern Liu Yiru) 2022 for 61-year-old Uncle Wu (alias) family, is undoubtedly the most difficult!In the year when he was diagnosed as a spinal tumor, this is like a bolt from the blue, let this family into a great gray, but the luck in the misfortune, they met a group of people who dare to “dance on the tip of a knife” excellent medical people!With a delectable and highly difficult whole spine resection operation, brought hope to the family again!Lumbar back pain unbearable, was tumor “eat” the entire vertebral body living in Fufeng County of Baoji City wu uncle some time ago appeared unidentified lumbago with left hip pain discomfort, pain aggravation after sitting for long time, in Baoji city hospital of Traditional Chinese medicine after a comprehensive examination diagnosed as primary lumbar 1 vertebral osteosarcoma.Spinal tumor refers to the primary or secondary tumor occurring in the spine. In people’s impression, once the tumor grows in the spine or has been transferred to the spine, it means that the patient has been terminally ill or needs to be paralyzed for life in bed.The majority of patients with spinal tumors have severe pain or nerve compression symptoms, which can seriously affect the quality of life, or even shorten the survival of patients.Due to the special anatomical structure of the spine, the front is adjacent to the large blood vessels and viscera, and there are nerve roots running on both sides, and the spinal cord is inside the spinal canal.Therefore, spinal tumor surgery is difficult, high recurrence rate, poor efficacy, has been the difficulty in the treatment of bone tumor.At present, total spinal resection is one of the most technically difficult surgical procedures in the field of spinal tumor surgery. Its main advantage is thoroughness and completeness of tumor resection.However, the exposure of surgical field, tumor resection and spinal stability reconstruction are very demanding. Tumor resection needs to avoid dural nerve root injury, and it is easy to hurt abdominal great vessels, segmental arteries and intraminal venous plexus during surgery, leading to massive bleeding, which requires superb technology and close team cooperation.Its surgical process is known as “dance on the tip of a knife” and “forbidden area of surgery”.As a result, this surgery has become a taboo area for many orthopedic surgeons.Facing this difficult case, with more than 20 years of rich clinical experience in spinal surgery, Director Wei Jianmin, a master in the field of spinal surgery in Baoji Hospital of Traditional Chinese Medicine, is also a great challenge.Operation is faced with great difficulties, how to ensure spinal nerve safety?How to maximize total vertebral resection and avoid tumor spread?How to accurately implant the artificial vertebral body?This series of problems are like a movie in wei Jianmin’s mind repeated, deduced.There are difficulties that one by one to solve, never unprepared battle!This is where tacit, multidisciplinary collaboration becomes more important.Preoperative organized by baoji city Chinese medicine hospital medical department floor multidisciplinary consultation to discuss the surgical emergency plan, intervention for embolization of tumor blood supply, blood transfusion department coordinate to secure sufficient blood supply, anesthesia group backbone to closely monitor all the way, electrophysiological monitoring electrophysiology expert entire journey, postoperative intensive care management monitoring.The general department was organized, professional instruments were deployed, the division of labor was coordinated, literature was consulted, surgical rehearsal was conducted, and the details of surgical plan and surgical risk response plan were finally determined after repeated discussions from the aspects of intraoperative bleeding, surgical approach, total resection of lesions, artificial vertebral implantation, and perioperative nursing.Lasted 10 hours relay operation stable accurate resection and reconstruction when all preparations were made, on January 27th, the much-anticipated whole vertebral blocks the official start of the surgery, spinal two surgical team with excellent surgical technique, expose the posterior vertebral body carefully, and in the adjacent vertebral body lesions accurately implanted with pedicle screws to keep stability,On the premise of sufficient decompression and protection of spinal nerves and blood vessels, the entire vertebral body invaded by the tumor was finally completely resected, and the artificial vertebral body was successfully implanted and fixed.The operation lasted exactly 10 hours and 15 minutes.All the surgeons from this surgical department are on stage, working together to finish the relay.Ten hours after the operation, the patient recovered from anesthesia and his lower limbs moved freely.At present, the patient has recovered well, and can sit and stand. On February 9, we saw Uncle Wu after surgery, and he can walk independently with the help of a walker.”The difficulty of the patient’s operation is that, first, there is a lot of bleeding. Patients with vertebral metastasis have a lot of intraoperative bleeding, which can be as much as thousands or even tens of thousands of millilitres. Therefore, precise embolization of segmentary artery of tumor before surgery is needed to reduce intraoperative bleeding.Second, the risk of surgery is large, the need to protect the large blood vessels and spinal cord in front and back of the vertebral body;Third, it is difficult to peel off the whole vertebral body. There are important vascular organs such as aorta in front of the vertebral body, which should be carefully protected and patient to peel off during the operation.Fourth, perioperative management is difficult due to the trauma of the operation, which requires multidisciplinary team collaboration.”Director Jianmin Wei concluded: “The successful completion of this highly difficult operation embodies the wisdom of the multidisciplinary team of the hospital.In recent years, the spine department of Baoji Hospital of Traditional Chinese Medicine has been developing new technology and new business, constantly challenging one case of high, fine and sharp surgery, demonstrating the confidence and strength of orthopedics staff in the hospital who dare to challenge the “forbidden area” of life with superb technology.This is the first time to independently carry out such a difficult spine tumor resection and reconstruction surgery in Baoji city, which also marks that the spine surgery department of Baoji Hospital of Traditional Chinese Medicine has reached the advanced domestic level in the surgical technology of spine tumor.Editor: Liu Yiru

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