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| Michael Miller |
In a rare operation, a multidisciplinary team of surgeons at the Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James) removed the left leg, hip and pelvis of a cancer patient, and used the healthy, living bones from his amputated leg to completely rebuild the connection between his spine and remaining right pelvis to support a high-tech prosthetic leg.
“This procedure itself is actually the first time it’s ever been performed in the United States,” Joel Mayerson, MD, an orthopedic oncologist, stated in a press release. Mayerson collaborated with a surgical team that included Ehud Mendel, MD, FACS, a spine neurosurgeon, and Michael Miller, MD, a plastic surgeon, on the complex case.
The pelvic reconstruction surgery was so unusual that it was published online as a case study in the Journal of Neurosurgery: Spine, and voted the “Reconstructive Surgery Case of the Year” by attendees at the American Society of Reconstructive Microsurgeons annual meeting last year.
The surgery is called an “En Bloc” procedure — translated from French to “as a whole, or in mass” — meaning that the surgeon must remove the entire tumor intact.
The surgical team removed the tumor and worked together to design a method to rebuild the patient’s pelvis using titanium supports along with parts of the patient’s leg — including bones, muscles, skin and blood vessels.
“Removing the tumor required removing the leg, yet many of the tissues in the leg were healthy,” Miller, interim chair of Ohio State University Medical Center’s Department of Plastic Surgery, who specializes in reconstructive surgical oncology, stated. “We wondered if it was possible to use the healthy parts of the patient’s leg to reconstruct his pelvis.”
The custom device that Mendel fashioned features two large rods and a couple of smaller rods fixed to the pelvis and spine with 14 screws to help provide support while the leg bones fused together.
The Ohio State surgery marked the first time that surgeons used living bone from the patient’s amputated limb to reconstruct the pelvis in this fashion. This allowed the bones to fuse together to create an intact pelvic ring strong enough to allow the patient to walk again on a prosthetic leg, according to Mayerson, director of the division of musculoskeletal oncology in the department of orthopedics.
The surgical team amputated the patient’s leg, but preserved the femur and fibula, along with their still-attached blood vessels, skin and muscles that Miller then transferred into the pelvis.
The 53-year-old patient had developed a chondrosarcoma tumor on his pelvis and sacrum that, if left untreated, would have eventually killed him. Since this type of bone cancer does not respond to chemotherapy or radiation, surgery was his only treatment option.
The patient’s high-tech computerized prosthetic leg is equipped with mini-computers at the hip joint, knee joint and foot that gauge his step, pressure and speed and adapt accordingly to support his body. At night, his leg is charged through a USB port that also stores data from the day to track to his progress.
“Every time he takes another step, the prosthetic leg learns more about his gait,” Mayerson stated. “The computer actually decreases the amount of energy that he has to spend to move the prosthesis and allows him to move easier. He’s one of the first people in the United States to have a computerized artificial hip and a computerized artificial knee in a prosthetic working at the same time.”
The operations required a team of hundreds of OSUCCC – James staff members, including oncologists, urologists, neurosurgeons, plastic surgeons and general surgeons, along with nurses and surgical technicians.
“We take a multidisciplinary approach, and that makes The James unique,” Mendel, director of spinal neurosurgery, stated. “We are able to bring together surgeons from many different disciplines to decide the best care for each patient.”
