Here’s one more for a few select colleagues who look in on my blog from time to time. This is an older woman from Yemen. She has had a biopsy a year ago and was told she has a tumor. The pathology is not available to me. What she has is a tumor that has taken the skull base and the upper two cervical vertebrae. That means here head is sitting on her shoulders without any support. Having just attended the Jeddah Spine Summit, I found several surgical solutions. The good thing about a meeting like this is that there is never a time when something is completely inoperable. In other words, beware. I don’t walk on water and still must dress one leg at a time. But it’s good to have some alternate suggestions. So far the patient has not returned. Which in the scheme of things might not be the worst that could happen.
I have to say that at this point, ‘What is there that I haven’t seen neurosurgically?’ And my answer is that when you go somewhere else, you’ll find out. Even if you have no idea, understand that this is a side view of the neck and you are looking at the spinal cord. It has dents in it and there’s a white streak in the middle. That’s a bad thing to see. It’s an automatic recommendation for surgery when I see it. Others might disagree, but I have seen, even recently, what happens if you fail to act. So this woman comes in… and after I look at the scan and go through my recommendation for surgery, I look closer and see that this image was from 2008 – five years ago! Well, I have now learned that if you are indeed lucky, you might go on for years and never get worse.
Just when I was questioning my sanity and about to throw over what I believed, a 39 year man came to see me. he’s virtually paralyzed. He has contractures so bad that he can’t even straighten his arms or legs. He has had bed sores so bad that they required surgery to repair. And he has the same condition. His family wants to know how soon after the surgery he will begin to walk again. I can only say that I don’t do magic.