Dr. Paul C. McCormick, Director of The Spine Hospital at the Neurological Institute of New York, has edited a series of spinal surgery videos published by the Journal of Neurological Surgery, Neurosurgery Focus. The videos were produced by Dr. McCormick and other world-renowned experts in order to inform and educate other surgeons.
In one of Dr. McCormick’s videos, the patient is a woman in her early thirties who is five months pregnant. She has been having symptoms of nerve damage in her neck, and it turns out that these symptoms are due to a tumor.
The tumor is not malignant—that is, it will not spread—but it is large, it is unusually shaped, and it is causing trouble in some very important areas. Part of the tumor presses on the vertebral artery, which supplies blood to the brain. Another part presses against her spinal cord and yet another part on some nerves outside the spinal column.
Surgery is essential, and it shouldn’t endanger the baby, but the operation will be complex and delicate. Dr. McCormick hopes that this clear and comprehensive video will be especially helpful for surgeons who might have less experience with such cases.
Dr. McCormick begins the video by showing several MRI images that were used to diagnose the patient’s tumor, and describing to the video audience notable features of the images. He then shows the special surgical table that will keep pressure off the patient’s abdomen as she lies face-down for surgery.
Then Dr. McCormick narrates the surgery: the approach to the tumor, the instruments he uses, and the painstaking separation of the tumor from the many attached nerves, blood vessels, and other tissues. The technical name for the type of tumor he’s working on is a dumbbell schwannoma–dumbbell because of the tumor’s unusual shape, which is narrow in the middle like a dumbbell, and schwannoma because that is the name for tumors associated with nerves.
This tumor’s dumbbell shape makes it particularly challenging to access and remove, but Dr. McCormick works carefully, using a variety of specialized instruments and describing every step in a voice-over he added later.
Whenever a step is especially tricky, he gives tips on surgical technique or useful equipment.
Once the tumor is out, this complicated surgery isn’t over. One facet of a vertebra (spinal bone) was removed to get at the tumor. To keep the spine stable, Dr. McCormick must also graft on new bone, which will grow and form a stable bridge between vertebrae. This procedure is called spinal fusion.
Dr. McCormick ends the video by describing this patient’s post-surgical care and follow-up. The patient was kept flat for two days after surgery, then she began to work with physical therapists. By three months after surgery, she had recovered nearly all of the nerve function she had once lost. And four months after surgery, right on schedule, she had a normal delivery of a healthy baby boy: a proud moment for patient and surgeon alike.
Dr. McCormick knows these videos will help other surgeons, but hopes they will be a resource for patients as well. “It surprised me how often patients request to view a video” of the type of surgery used to treat their condition, he notes.
The videos are available free of charge on YouTube. This video shows the removal of a cervical dumbbell schwannoma—cervical because it is in the cervical, or upper, spine. The surgery is done from a posterior approach—that is, through the back of the neck. Some patients who have undergone, or who will undergo, this surgery might be interested in the video.
But be aware: this video is graphic. Some patients will want to watch such a detailed video of surgery, but not all will.
You can watch the entire video here: Resection of a cervical dumbbell schwannoma with stabilization through a single stage extended posterior approach.
Originally Posted on Oct 27, 2014
Updated June 22, 2017