A specialized surgical navigation system provides doctors with the ability to preserve joints and bones during surgery for bone cancer.
Michael Grosswald got an MRI he didn’t need. The 60-year-old Northeast Philadelphia resident supplements his income as a healthy subject or as part of a control group in clinical research studies to advance medical research.
In March he went in for an MRI, a mandate for his latest study, and it revealed a mass in his sacrum – the large, triangular bone at the base of the spine. Before and since the discovery of the mass, Michael has not experienced any pain or discomfort. Nor did he in any way think there was anything wrong with him.
The mass was diagnosed as a malignant bone tumor called a chordoma.
“These tumors can get incredibly large and intertwined with the organs of the bowel and lower abdomen before pain is felt,” says orthopedic oncologist John A. Abraham, MD, of the Rothman Institute at Jefferson.
Chordomas are rare and members of a family of cancers called sarcomas which affects the bones, cartilage, muscles and other connective tissue. They are slow-growing, but recurrence is common.
Dr. Abraham recently removed Michael’s tumor using a specialized surgical navigation system that provides the surgeon the ability to visualize the operating field to within the millimeter. Jefferson is one of the first to use this system for the resection of pelvic tumors.
During the complex surgery Dr. Abraham carefully cut the tumor from the bone and adjacent organs.
“It’s intricate, as the field is small and we have to operate delicately to not interfere with the structure or function of the surrounding anatomy,” explains Dr. Abraham, director of the Musculoskeletal Oncology Center which combines the expertise of Jefferson Orthopedics with the oncology services of the NCI-designated Kimmel Cancer Center at Jefferson. “The navigation system allows us to cut only what we need to remove and preserve as much of the joint and bone as possible.”
The system resembles a CT scanner and circles the patient during the surgery at 30-second intervals taking images at the location of probes which are inserted into the bone within the area of the surgery – in this case, the pelvis.
The system displays the image on a screen showing the surgical field and instrumentation in relation to the bone and surrounding complicated mix of organs, blood vessels and nerves.
Michael’s tumor was the size of a small watermelon and blocked the view of these structures.
The system is essential in these cases where one small, out of line movement can cause patients to lose feeling in their leg or lose bladder control. For this complex operation, Dr. Abraham was joined by a plastic surgeon, general surgeon, urologist and a vascular surgeon.
“We are finding that we can do resections and reconstructions that we never thought were possible. By using this intraoperative tool to help make complicated cuts in bone, the result is we are able to save joints and therefore improve function in patients who would have had a mechanical joint placed, or even an amputation,” says Abraham.
Following his eight-hour surgery and recovery, Michael was scheduled for a regimen of 25 radiation therapy treatments as a preventative measure against recurrence.
Today, he is grateful for that MRI he thought he didn’t need because his situation could have ended much differently.
And for that Dr. Abraham notes: “Mr. Grosswald is lucky.”