New tailbone replacement enables patient to walk again

Friday, October 9, 1998

New tailbone replacement enables patient to walk again

RESEARCH: UCLA doctor uses surgical advances to remove cancerous
tumor

By Brian Fishman

Daily Bruin Contributor

Sitting up never felt so good for Donna Brownlee, who spent
seven months on her back in the hospital.

Last month UCLA surgeon Jeffrey Eckardt replaced Brownlee’s
sacrum – commonly known as the tailbone – which connects the spine
to the pelvis.

In the summer of 1997, Brownlee was diagnosed with a cancerous
tumor in her sacrum. By March, she had lost the ability to walk and
could not sit up without excruciating pain.

"I was flat on my back for months, even while I was eating," she
said. "It’s hard when your tray is at eye level."

A mother of three and a nurse herself, Brownlee said she was
more upset over the time spent in the hospital than the
life-threatening predicament she was going through.

"It has been frustrating even though my children are all grown.
I had one going off to college, and I missed that," Brownlee
said.

According to Eckardt, this procedure represents a major advance
in the treatment of sacral cancer, and without it, Brownlee may
never have gotten out of bed again.

"We never had a good way of locking the spine to the pelvis, so
we’d turn down cases where we had to remove the sacrum," Eckardt
said.

Before this treatment, the only way to replace the sacrum was to
lock the spine to the pelvis using a complex set of rods and
screws. But this treatment requires a lengthy rehabilitation period
and often leaves the patient in pain.

The new device, created by the German company Howmedica, was
designed to secure the spine to the pelvis more efficiently –
thereby shortening the rehabilitation period.

"We tried to come up with something that would lock it in and
make her stable immediately," Eckardt said.

Stability is important because of the extreme pain Brownlee was
in before surgery. Just rolling over was debilitating.

The pain and inability to move were caused because of a locally
aggressive bone tumor in her sacrum, one of the worst areas of the
body to contract bone cancer, Eckardt said.

"In cancer, location is like real estate," Eckardt said,
explaining that the sacrum is a muscle holdfast that connects to
many other bones, making replacement more difficult than replacing
other bones.

At the junction of the abdomen and the legs, the sacrum is a key
area of the body, both structurally and neurally.

Before treatments like the one pioneered by Eckardt, removing
the sacrum meant that the patient would lose control over many
bodily functions.

Lucky for Brownlee, Eckardt attended an orthopedic conference in
the Netherlands where he caught wind of treatments similar to
Brownlee’s.

While this procedure sounds simple on the surface, Eckardt said
otherwise.

The sacrum is completely removed and replaced by a metal implant
that attaches to the spine and then securely to the pelvis.

There are difficulties, however, in implementing a procedure
like this one.

The first challenge is building an implant that matches the
patient’s body. This was done by giving Brownlee a CAT scan that
produced a model of Brownlee’s sacrum, lower spine and pelvis.

Then Eckardt literally drew lines on the model that indicated
where he would cut in order to create a flat surface for attaching
the prosthesis.

This model was then sent to the Howmedica, which molded the
prosthesis.

The implant was made of Vitallium, a substance originally used
in dental plates, and sent back to UCLA to be put into Brownlee’s
back, explained Debbie Beshaw, the Howmedica representative who
worked with Eckardt.

Once the prosthesis arrived, Eckardt, heeding advice from
European surgeons, devised a plan for implantation.

"The European surgeons made this a two-day process," Beshaw
said. "Eckardt took only one day."

According to Eckardt, the surgery was not without its risks.
Large blood vessels running near the sacrum makes operating there
difficult.

In his 18 years as a surgeon and his over 450 implant
operations, Eckardt said this was the first time he actually warned
a patient there was a significant possibility he or she could bleed
to death on the operating table.

Brownlee considered that a risk she had to take and credited her
confidence in Eckardt as one reason she went forward with the
operation.

Since the surgery, Brownlee’s recovery has been remarkably
quick.

"After the surgery, I was able to sit up almost immediately. I
hadn’t been able to do that since March," Brownlee said.

Only 16 days after the surgery, Brownlee was able to stand up
and take a few steps with the help of an assistant.

Brownlee will go through rehab for months with leg and hip
braces supporting her movement.

Despite this, she remains positive.

"You have to take advantage of the time you have and health that
you have. Of course," she said, "I have to try to take advantage of
this too."

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