A malignant tumor of the spine, brilliant intuition and an excellent medical team, such as the one at the Rizzoli Institute in Bologna, thanks to the intuition of Dr. Alessandro Gasbarrini. This is how the first transplant of vertebrae in the world was performed.
But let’s go in order and begin to understand what Chordoma is and how this innovative solution was arrived at.
The Chordoma, a malignant tumor of the spinal column
It’s a rare and rather aggressive tumor that literally “eats” the bone, causing severe pain. Moreover, this neoplasm is resistant to chemotherapy and often, unfortunately, the prognosis for the patient is paralysis.
What are the available solutions?
The best solution available to date is the surgical removal of the vertebra being attacked by the tumor and its replacement with an artificial vertebra. For example, a 3D-printed vertebra, and where the materials used are titanium or carbon. Or, it can be replaced with the long part of the femur, diaphysis, from a deceased donor.
At the Rizzoli Institute in Bologna, they’ve used an innovative approach; the transplantation of a vertebra from a deceased donor.
Many people realize that organ transplantation is a complex process, which involves the compatibility between donor and recipient, and also the speed of the transplant that must be performed within a few hours of the donor’s death. A vertebra transplant has never been performed before. The intuition that it could be done came to Dr. Gasbarrini, Director of Spinal Surgery at Rizzoli Hospital, a leader in the treatment of rare musculoskeletal tumors.
How did the vertebra transplant come about?
The Musculoskeletal Tissue Bank of Emilia Romagna is located at Rizzoli. The Tissue Bank’s task is to preserve bone tissue, generally parts of the femur and pelvis. No one had ever thought of preserving vertebrae too, perhaps thinking it was useless or perhaps because no one had ever requested it.
And then came along Professor Gasbarrini’s intuition and then the “good fortune” of having a patient suitable for transplantation and above all, consenting to be the first in the world! It is a 77-year-old man with an untreatable chordoma.
What are the advantages of vertebra transplantation?
The current artificial prostheses bring with them a significant problem (i.e. they render the radiotherapy approach ineffective and therefore temporarily save the patient, but condemn him or her to end their treatment). Vertebral transplantation is a biological approach, similar to femur transplantation but more effective because there’s better compatibility, bone elasticity and optimal fusion with the spine.
In Bologna, in 12 hours the team performed the vertebrectomy, in which they replaced two vertebrae of the patient (T12 and L1) with four vertebrae of the donor because the intervertebral discs of the recipient were also removed.
The operation was performed on September 6, 2019 and after fifteen days of post-operative observation, the patient began physiotherapy. He is now walking again and has reclaimed a good quality of life.
This is an example of Italian Excellence in research, and also of a great ability in identifying synergies between different skills and structures.
In this short video, an interview with Dr. Gasbarrini (in Italian language):
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