Record operation on back: 2 vertebrae removed, patient starts walking again

Record intervention in Bologna. An operation was performed for the first time at the Rizzoli Orthopedic Institute with the simultaneous removal of two non-contiguous thoracic vertebrae to bring straight the spine of a patient, forced into a wheelchair due to a very serious kyphosis that caused a curve beyond one hundred degrees considered to date inoperable. The 54-year-old patient – a note reports – had undergone a pathological fusion (ankylosis) of five thoracic vertebrae: the vertebral column, bending forward, caused a kyphosis that prevented her from standing and walking. The numerous operations he had undergone were useless, and the deformity was considered no longer operable due to the very high risk of injury to the spinal cord, imprisoned within the curve. The intervention, unique of its kind – reads the note again – was performed by the team of Cesare Faldini, director of the Rizzoli Orthopedic Clinic 1, flanked by anesthesiologists, resuscitators, neurophysiologists and nurses, and lasted about 8 hours. Absolute innovation for this type of intervention is the use of a 3D reconstruction technique of the deformed column starting from the patient’s CT scan, which has allowed to plan the removal of the two vertebrae and ‘guide’ the correction without injuring the spinal cord, with a correction movement of over ninety degrees in a single operation. “A result that was unthinkable until now – Faldini specifies – obtained by combining tradition in orthopedic research, Rizzoli is now 125 years old, with highly innovative techniques, to offer the possibility of surgical correction to those rare scoliosis and kyphosis until now considered inoperable due to their severity. Fortunately rare situations, but seriously crippling for patients: if the spine deforms over 90 degrees, that is, it makes a right angle, it becomes horizontal from vertical, making it impossible to stand upright and have an acceptable relationship life. These patients, despite having their spinal cord intact, have voluntary control of the legs but are unable to use them and are forced to sit down due to the shape of their spine. “From the patient’s CT scan it was possible to perform a 3D reconstruction of the deformity to plan the removal of the eighth and twelfth thoracic vertebrae, and simulate the spinal realignment maneuver without damaging the spinal cord. 12 masks were also designed on the CT scan, which, built through 3D printing, allowed to apply the screws in the vertebrae through the peduncles, compromised by the deformity and previous operations. The patient, after a short period in intensive care, was assisted in the ward by the nursing staff: standing 7 days after the operation, she began the rehabilitation to start walking again. “Removing multiple vertebrae simultaneously to realign the spine is a significant step forward – concludes Faldini – as it offers a solution to correct kyphosis and scoliosis of a very serious entity that cannot be faced with alternative techniques. In this context, the fame of the Rizzoli Institute far exceeds national borders: the prestigious American magazine Newsweek has placed us in eleventh place among the excellent orthopedics in the world, and at research level a ‘simplified preview’ of this procedure, presented in the United States at the prestigious American Academy of Orthopedic Surgeons in 2020, it was awarded as the best scientific work in the field of vertebral surgery “.