Imagine being pushed into the hospital in a wheelchair with your pelvis so disintegrated from bone cancer that you can’t stand. Then walking out the next day with the aid of a walker and the promise that within weeks, you’ll probably be walking on your own again.
That’s not a dream but a reality at Presbyterian-St. Luke’s Medical Center where two physicians have combined their expertise in a state-of-the-art operating suite to repair the pelvises of patients whose bone cancer or osteoporosis is so bad that large sections of bone have just melted away.
“Classically, patients with pathological pelvic fractures had no reasonable surgical intervention,” says Dr. Daniel Lerman, an orthopedic surgeon with OrthoONE Denver, who works with Dr. Anthony Brown, an interventional radiologist with Radiology Imaging Associates, to perform these complex surgeries.
“Patients nowadays should be able to be mobile indefinitely. It’s better for patients physically and mentally if they’re able to be up out of bed, engaged in the world, engaged in their family and activities they enjoy.”
Many cancers that originate in other parts of the body like the breast, prostate, or colon can spread to the bones, weakening them and causing pain. When cancer spreads (metastasizes) to the pelvis, it eats away bone, which may ultimately disintegrate and break, leaving many patients with pain so severe that they are unable to walk or even get out of bed. Radiation is most often used to stop the cancer from growing further, but it doesn’t repair the damage already done.
In traditional surgery to repair fractured bones, an orthopedic surgeon would connect two sections of healthy bone with screws or rods. Over time, the healthy bone grows back together around the screws and welds the fracture closed. But that technique doesn’t work in patients where large portions of bone have been destroyed by bone cancer or osteoporosis, leaving no healthy bone to grow back.
In these cases, Brown is using bone cement to substitute for normal bone. Using incisions less than an inch long and real-time CT scans in the operating room to plan the surgery, Lerman places screws in the bone that is left. Brown then uses bone cement to build a bridge between screws and between healthy bone, basically rebuilding the pelvis.
“It’s sort of like using rebar and cement when building a house,” Lerman explains.
Because the procedure is performed through the small incisions, there is very little blood loss. Additionally, because the patient’s bones don’t need to grow back, the surgery is almost an instant success with patients going home within 24 hours—typically walking with just the aid of a crutch for the first few weeks.
“One patient went from needing two crutches to walk to hiking without a limp in just a few weeks,” Lerman says.
Presbyterian-St. Luke’s is performing more complex version of this procedure than any other facility in the country. The need for these procedures is rare, but for the individual patients, tremendously impactful. Lerman and Brown continue to study patient outcomes and have presented their results at national meetings.
“One patient said this was like science fiction,” Lerman says. “I call it science for real. Even for someone with just months to live, this surgery is a benefit because it’s a small operation with no recovery time to speak of. They can leave the hospital and immediately begin to engage in life again.”