Category Archives: T3/T4 decompressive transpedicular tumor resection

February 5, 2015

Written by Vickie Nguyen (class of 2014-2015)

Since today was a Thursday, I entered the OR just a little bit after 11am as suggested by those who do attend their OREX days on Thursday. By then a lot of the surgeries looked like they were just starting or just being finished up, I ended up choosing Dr. Patel’s laminectomy, T3/T4 decompressive transpedicular tumor resection. It was a particularly long surgery, though I spent about 5 hours in the OR, a bulk of it was spent in Dr. Patel’s surgery.

His patient was diagnosed with colon cancer, and unfortunately the cancer spread to his bones. The proper term for this is mestastic colorectoral cancer. His backbone, in the T3/T4 region, was affected by tumor growth, and if left alone would eventually leave him paralyzed. A soft white membrane called the dura covers the spinal cord; the spinal cord sits inside of the dura and is surrounded by cerebrospinal fluid. The tumor was in fact squeezing the spinal cord, and began affecting his motor functions.  To avoid his eventual paralysis, Dr. Patel, accompanied by another doctor who introduced herself to me as Jennifer (I never got a chance to see her last name, though I really wished I had), worked together to remove the tumor.

Before beginning the surgery, a radiology team came in to perform some x-rays. The entire time, Dr. Patel was the conductor, asking for many different positions in which to examine her spine. Every now and then, Dr. Patel would point to certain parts of the spine using something similar to a peon (like scissors) but with a long and curved end. After about an hour of taking x-rays, the surgery began. An interesting thing to note about this surgeon is that he brought in his own set of CDs and a speaker system to play music throughout this surgery. I didn’t know you could do that!

I got a pretty awesome view during this surgery. Jennifer as well as Lydia, the student nurse-anesthetist, suggested I stand at the front of the operating table, where her head was! At first I got to see the top of the spine, it looked a lot smaller than I had imagined, but nonetheless I thought it was quite cool to see it in real life. Next thing you know, Dr. Patel takes a tool, which looks similar to small pliers, and completely removes the top of the spine! It was mind-boggling! I thought to myself “Woah man, this can’t be right, don’t we need that?”

Later, Jennifer told me that he was suffering from spinal stenosis because of the tumor and this would help relieve his symptoms. With some research, I also found out that the top of the spine that was removed is called a lamina, hence the surgery name ‘laminectomy.’ A lot of bone was removed, and eventually Jennifer pointed out the dura, it was this off-white looking piece that ran vertically up and down his back. She told me that the spinal cord is supposed to be even in width, but for him this wasn’t the case, it looked similar to that of an hour glass, pinched right in the middle and equal in size everywhere else.  Their job that day was to remove all the cancerous bone they could, and all that they could not would be removed via chemotherapy.

Standing at the front of the operating table, I was much closer to the anesthetists and was able to see a lot of the tasks that they had to perform. Normally, I always see a lot of tubing everywhere, and they’re mostly clear. One of the tubes was red, and I then realized it was blood. A few times, I saw Lydia move towards some of the patient’s tubes, and she squeezed in some calcium chloride. Curious, I asked Lydia what the calcium chloride was used for. She said that since he is a very sick patient, he had a low blood count and needed extra blood for this surgery, something that they don’t normally like to give patients. The blood that he was given was mixed with something else, and this causes the blood to bind to calcium. Because of the lower concentrations of calcium in his body, they had to supplement it with more calcium. It’s a pretty awesome thing to learn outside of a classroom.

After the surgery ended, Jennifer showed me to the PACU to see him. They were still trying to wake him up after the surgery, and with the one that he underwent it was crucial to see if he still had function in his arms and legs. Someone at his bed asked if anyone could speak Chinese, as he could not speak or understand English well. Jennifer asked me if I could, and I told her I spoke Cantonese. It worked out well because his Chinese dialect is Cantonese! She asked me to talk to him and get him to wiggle his toes. I said “Uncle! Uncle! Can you hear me? Do you understand me? Uncle, could you move your feet for me?” I tried my best to get through to him, but he was still too groggy and was not compliant. Jennifer thanked me for trying and asked me to follow her into the waiting room. There, we encountered his wife. I helped translate between her and Jennifer. I’m definitely not a professional translator, and I think I often have difficulty interpreting for people mainly because it feels like I’m having a one-on-one conversation with two people at the same time. I think a huge tip for my fellow bilingual/trilingual/multilingual OREXers is to take a lot of pauses in between the conversation so that both parties are included. This is something that Jennifer expressed to me, and I think it was really great advice. It’s a lot easier to talk to someone directly, though having a translator helps with people who speak two different languages, it’s still a highly difficult task.

This was quite an interactive OREX day for me. I’m really glad Jennifer was around to show me things inside the OR as well as outside. I give her 5 stars for the stupendous learning experience, and I’m really thankful to have had her guidance that day. I’m kind of falling in love with OREX, is that a weird thing to say?