Bader Aladin Tahruri, 19 and a half years old, is the first patient in Israel, and apparently the world, with a replacement vertebra implanted in his back, printed in a 3D printer.
“The doctors told me I was about to have surgery with innovative technology, the first in the world, but I didn’t hesitate at all,” he explains, “not even for a moment, because I counted on the doctors and believed they would do the best they know. Turns out I was right.”
Indeed he was. Less than a week after having the surgery, Bader can sit, stand, and walk without difficulty.
It all started in July 2015. Tahruri, a resident of Qalansuwa, was working in the local supermarket, when suddenly he felt pain in his back. “At first I thought it was because of the heavy boxes, from lifting; so I tried all sorts of different ways to pick up – more slowly or less boxes – but the pains continued,” he tells.
Soon after, he felt the pain radiating to the leg and went to see the family doctor. “The doctor sent me to have a CT of the spine, and when the results came, they showed a pathological fracture in the lower vertebra,” he recounts. With this finding, he was referred to Ichiolov Medical Center.
“A strong young man came to us, with an imaging that clearly showed a fracture of the last lumbar vertebra, L5. The cause of the fracture was a tumor resulting in bone destruction,” explains Dr. Zvi Lidar, director of the Spine Unit at Ichilov. “He arrived at the hospital with intense pains, so he was immediately taken to the operating theater.”
During the surgical procedure – using a minimally invasive approach where only tiny incisions are made; the doctors placed a support device for the broken vertebra to prevent its collapse, which would’ve resulted in the paralysis of his lower extremities. They attached a plate to the spine, which was affixed with four screws, two on each side, to stabilize the vertebra. At the same time, a biopsy of the tumor was taken and sent for lab analysis.
“When the biopsy results came back, we understood that it was a benign but aggressive and violent tumor, which tends to recur and cause enormous damage to local tissue,” explains Dr. Lidar. “Due to its violent content, it might also damage the spinal cord and its nerves, causing paralysis. But the greatest danger from this benign tumor is that it can easily change from benign to malignant.”
Following the surgical procedure, Tahruri recovered and was sent to continue his recovery at home. “I was discharged from the hospital with the recommendation to gradually resume activities, depending on my ability and without exerting myself. I was in much less pain, but I was still not fit to return to work.”
At this point, the doctors didn’t think the treatment was over. “Here was a young man, whose benign tumor location implied the need for an extensive and problematic surgery which we wanted to avoid. Consequently, we decided to give a chance to a relatively new pharmaceutical-immunological therapy, tried on only a few dozen patients worldwide. It’s a medication that is taken orally and used by an antibody that attacks the tumor, destroys it, or at least reduces its dimensions,” explains Dr. Lidar.
For close to a year, Tahruri took the immunological medication, but a check-up CT performed last February showed disappointing results: the treatment, as the imaging clearly showed, did not even “tickle” the benign tumor, and its large dimensions remained the same as before the treatment began.
At this stage, it was clear to the doctors that they had to plan a surgery that would allow the patient to get rid of the problem while maintain his quality of life to the greatest extent possible. “From the start”, explains Dr. Lidar, “the purpose of the surgery was to remove the whole benign tumor, which mandates a reconstruction of the spine, because the broken vertebra obligated us to do an overall reconstruction.”
It should be pointed out, that in recent years, the reconstruction of a spinal vertebra has become common practice – a procedure performed in most spine units in Israel and worldwide. But this time, the reconstruction was more complex, almost impossible. “All the existing implants which are used for the replacement of damaged and shattered vertebras, are unable to anatomically reconstruct this specific vertebra that sits on his tail bone in an angle which is not easy to reconstruct and imitate. These procedures, therefore, have a high failure rate,” explains Dr. Lidar.
The doctors decided to think outside the box and, with the help of Dr. Shlomo Dadia, an orthopedist-oncologist from Ichilov, make unprecedented use of 3D technology.
Initially, the patient’s CT imaging data were sent to the American implant company “4 Web Medical.” From this data, the scientists constructed a 3D model of the damaged vertebra. “The model is a duplicate, completely identical, the same as the original vertebra in the patient’s body,” explains Dr. Lidar. “It is one hundred percent accurate. With 3D we could perform a precise and focused surgery.”
The preparations and the construction of the model took several months. The surgery, lasted over 13 hours. Dr. Lidar, the head of the operating team, was assisted by Dr. Guy Lahat from the Surgery Department at Ichilov, and Doctors Gilad Regev and Ran Lador from the Spine Unit.
After Tahruri lay supine, under general anesthesia, Dr. Lahat began preparing the surgery site. “He made an incision in the patient’s body, in the segment between the navel and the edge of the pelvis, moved aside the intestines and ureters, and exposed the aorta and the venae cavae that carries blood to the heart. “Next, he separated the blood vessels from the tumor.
Following this, the spine team came into action. Once the tumor was separated and isolated from the adjacent organs, we managed to remove it whole, while preserving surrounding organs, blood vessels, nerves, etc. Following excision of the tumor, we inserted the implant, that was 100% compatible and in harmony with surrounding organs; so we were able to place it perfectly.”
The implant was affixed with screws and after the surgery, the patient was transferred to observation at the Intensive Care Unit. “I was anesthetized for two days, and then returned to the ward,” recounts Tahruri. “It took me only two more days, which is only four days from this big operation, until I was able to sit, stand, and walk – and I keep improving every day.”
At this point, it remains uncertain whether the doctors will be satisfied with the full tumor excision they performed or will recommend chemotherapy in addition.
According to the company that manufactured the implant, this is the first documented case of the use of this advanced technology for the treatment on an aggressive oncological tumor.
