Five spine surgeons reflect on patient cases that left a significant impression on them in 2024.
Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. Becker's invites all spine surgeon and specialist responses.
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Editor's note: Responses were lightly edited for clarity and length.
Question: What is your proudest case of 2024?
Tan Chen, MD. Geisinger Musculoskeletal Institute (Danville, Pa.): Over the years my practice has become both a minimally invasive and a complex revision practice, performing smaller outpatient procedures and larger complicated degenerative and deformity work. My proudest case of the year is a patient who had multiple previous spinal surgeries complicated by infection and hardware failure, all performed at another hospital. She came to me for a second opinion with progressive low back and leg pain, ambulatory difficulties and worsening deformity. Ultimately she underwent complex revision anterior and posterior lumbar deformity surgery and now has significantly less pain, better daily function and a better quality of life.
Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: I would say my proudest case of this year was a very sweet patient who had a surgery in another area of the state and was having horrible postoperative pain. The other surgeon did a good job but the patient was still suffering. I did some investigation and found out the fusion didn't take and needed to be re-done. I ended up having to extend the fusion up and re-do the first part and re-placed the hardware. They ended up going home and doing very well. We had a telehealth visit from their family cabin up north and her whole family was on, saying hello and was over the moon. It was a great feeling seeing them back in their own lives again, with the backdrop of evergreen trees and loving family surrounding them. I am happy to report they are back working and virtually off all medications. It was an incredibly cool moment.
Sohaib Hashmi, MD. UCI Health (Orange, Calif.): One of my proudest spine surgical cases involved performing an L4 spondylectomy for a primary bone tumor. This case exemplified the delivery of high-level, complex oncologic spine care to the Southern California region, addressing a rare and challenging condition. Working closely with a multidisciplinary University of California, Irvine oncology team, including medical and radiation oncologists, we developed a tailored, patient-centered treatment plan. The successful execution of the surgery in collaboration with expert vascular surgeons, not only ensured oncologic control but also restored spinal stability with short segment reconstruction L3 to L5, with carbon fiber expandable corpectomy cage as well as posterior instrumentation. This allows the patient, an otherwise young and healthy individual, with the potential for substantial longevity and improved quality of life. This case highlights the critical role of collaboration, precision, and advanced surgical techniques in achieving life-changing outcomes.
Chanakya Jandhyala, MD. RWJ Barnabas Health (Toms River, N.J.): This year, one of the cases we’re most proud of is helping Michael Daley, a U.S. Army veteran, finally find relief from over a decade of constant back pain. Michael was injured by an IED explosion during his service in Afghanistan, and the damage left him with severe back issues that impacted every part of his life — he struggled to play with his kids, missed family outings, and even had trouble tying his shoes.
When Michael came to me he had tried every conservative treatment available, like injections, but nothing gave him lasting relief. We decided it was time to try surgery. His condition required stabilizing the bottom part of his spine, so we performed a procedure to fuse two bones in his lower back. To get the best results, I collaborated with vascular surgeon Issam Koleilat, MD, and we performed the surgery in April. I accessed his spine through a small incision in the front of his body, which allowed us to be more precise and minimize recovery time.
The result was incredible. When Michael woke up, the pain shooting down his leg was gone and today he's living pain-free for the first time in years. Seeing him back to enjoying life with his family reminds me why I do what I do.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): The unassuming 'Pass and Review' of this year's complex caseload reduces a number of noteworthy presentations and compounded interventions (that fortuitously resulted in prodigious functional gains) with eventual returns to employment and lifestyle. Part patient stock, post-operative motivation and mitigation are all key factors that all of us acknowledge and immeasurably aid in patient recovery and outcomes.
Our case is an ICU/ER nurse with a many-year history of advancing neck pain that rapidly devolved into a myeloradiculopathy with tetraparesis. Hallmarking these periodic symptoms were spasms, gait aberrancy and functional weakness. Radiologic studies revealed multilevel cervical stenosis from a combination of OPLL and most probable, intervertebral disc herniations. The patient's acuteness and level of deterioration warranted accelerated intervention, and a multilevel decompression and fusion ensured. Spinal cord affliction is surgically monitored in our practice without discussion. The degree of anterior calcific compression and disc compression were relieved and principally were the symptoms. This patient returned to their pre-morbid status and employment. Seeing this patient for the six-week post-operative assessment was heartwarming for all.
Surgery aside, this moment carried bipolar potential for all participants because of the patient's well-known position in a large hospital system, her degree of infirmity, and liability for prepatent outcomes. The patient's mental fortitude and 'get well' attitude was the testament to personal strength, resilience and success. Praises to our astute clinical staff (NP's) for referral recognition and action, and an OR team of anesthesia, nurses and technicians who facilitate and manage these elaborate cases on a weekly basis with expertise and non-hesitation.