MDNews - Cleveland-Akron-Canton

A 21-YEAR-OLD MAJOR LEAGUE B a s eb a l l (M L B) pitc her presented with pain in his neck and back that had not resolved with rest or physical therapy. He was just finishing his first MLB season successfully. However, every time he would complete his pitching motion, he'd experience sharp pain at the base of his neck and into his arm. Towards the end of the season, his neck hurt at the end of every pitch. An MRI revea led a marble-sized expansile tumor at the junction of the base of the neck and the upper portion of the thoracic spine. That tumor was starting to destroy bone and putting pressure on the nerve where it exited and went into the shoulder. The tumor was benign but would con- tinue to grow. Traditional removal would involve either an extensive resection of the bone and a fusion of the neck and upper back, or an approach through the front of the collarbone and chest. Either one would have ended this professional baseball player's career. Instead, a modification of an endo- scopically assisted technique for tumor resection in the upper thoracic spine, as well as the cervical thoracic junc- tion, provided a less destructive option. Pioneered three years earlier 1 at the University of California, this procedure utilized a four-millimeter endoscope inserted through a 2.5–3 cm incision to follow the bone resection down past the nerve root, past the spinal cord and into the vertebral body — all without damaging muscles in the front or cutting any of the muscles in the back. Since the baseball season was over, the patient had time to heal and rehab, and he was back in the lineup the very next year. One year later, recurrence was found at a follow-up exam. This time, stereotactic image guidance, along with endoscopy, was used to resect more bone and verify resection to the margins of the whole tumor more definitively. 2 A low-profile implant stabilized the resec- tion site, and, after rehab, the patient returned to pitching and to MLB, where he had several more successful seasons. While this case represents an extreme application of minimally invasive tech- nology for a complex spinal problem, it shows what these techniques did and still can do in the most challenging cases. For many ordinary patients with cervical disc problems, today's emerging technologies allow treatments such as total disc arthroplasty (TDA) instead of fusion. This is especially good news for young and active people and those, such as dentists, athletes, police and firemen, whose careers require neck mobility and strength. Currently, the FDA has approved a limited number of devices for TDA. The ProDisc-C Total Disc Replacement system developed by Synthes and the Mobi-C developed by LDR are both used in my practice. Both spinal implants were designed to treat symptomatic cervical disc disease. The ProDisc was approved for one level. The Mobi-C is the first, and currently the only, approved for one and two levels. A few surgeons in northeast Ohio now offer TDA. Progress in technologies and tools, particularly for surgeons who deal with complex cervical disease, has enabled us to manage problems that weren't considered treatable even a few years ago. As a result, patients are getting good pain relief and returning to good, and safe, function. The point is, for patients who have been told, even a year ago, that nothing can be done for them, it's often worth getting another opinion today. Dr. McLain is a board-certified orthopedic and spine surgeon and a member of the Spine and Orthopedic Institute at St. Vincent Charity Medical Center in Cleveland, and Solon, Ohio. Dr. McLain was involved in the clinical trials for both the ProDisc and Mobi-C and has been an instructor for their training courses. He has no financial relationship with, or commercial interest in, either one of their manufacturers. ■ References: 1. McLain, RF. Endoscopically Assisted Decompression for Metastatic Thoracic Neoplasms. Spine, 23:1130-1135, 1998. 2. Moore, T, McLain, RF. Image-guided surgery in resection of benign cervicothoracic spinal tumors: a report of two cases. The Spine Journal, Vol 5 (2005), Issue 1, pp. 109–114. by Robert F. McLain, MD for Neck Pain Newer Surgical Options ++++++++++++++++++++++++++++++++++++++++++++++++ + +++ + +++ ++++++++++++++++++++++++++++++++++++++++++++++++ SPECIAL CLINICAL SECTION: SPINE SURGERY ❯ 2 0 1 5 M AY/J U N E ■ M D N E W S . CO M ■ MD NEWS Cleveland/Akron/Canton | 1 5

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