Unique Collaboration at Strong Between Orthopaedics and Neurosurgery Combines Skills to Repair Woman's Brain Stem

February 04, 2000

For years, excruciating pains, similar to an electric shock or a bolt of lightning, would shoot down the arms and legs of 51-year-old Angelita Heldebrand whenever she moved her head. With her entire body ravaged by rheumatoid arthritis and the base of her skull narrowed by a congenital defect, Heldebrand's brain stem was being crushed with every movement.

A unique collaborative effort between surgeons Paul Rubery, M.D., in Strong's Department of Orthopaedics, and Seth Zeidman, M.D., in the Department of Neurosurgery, along with a new image-guided, surgical navigation system, made it possible to decompress Heldebrand's brainstem and spinal cord, stabilize her spine, and give her back her life.

The instability of the ligaments in her upper cervical spine allowed a portion of Heldebrand's cerebellum - the area of the brain responsible for voluntary muscle coordination - to essentially herniate into her spinal canal. To correct this situation, Zeidman and Rubery performed Atlantoaxial fusion with transarticular screw fixation. During the procedure, Zeidman removed a portion of Heldebrand's skull base and microsurgically decompressed her cerebellar tonsils to restore the normal flow of her spinal fluid. Then, working together, Rubery and Zeidman fused her loosened first and second spinal vertebrae using surgical screws and bone harvested from her pelvis. This stabilized Helebrand's spine.

The use of surgical navigation allowed Rubery and Zeidman to maneuver with the utmost precision and accuracy during this procedure, pinpointing the exact areas of the spine in which to drill, and allowing adjustments to avoid dangerous areas. The University of Rochester is an internationally recognized center in the field of surgical navigation. This technology integrates diagnostic images with surgical tools, and powerful computers aid surgeons in tracking exact location of instruments in three-dimensional space. For the patient, this means a safer, more accurate procedure with decreased risk of injury and a better outcome.

Heldebrand is the first patient in Rochester to undergo Atlantoaxial fusion performed by surgeons from two specialties, using surgical navigation equipment.

"The combination of these two specialties made a very risky and uncommon surgery much safer," said Rubery. "By bringing together our surgical skills, Dr. Zeidman and I were able to treat a very difficult and complex problem."

This procedure can be performed on both adults and children. It is generally used to treat spine tumors, complex degenerative and developmental problems of the central nervous system and spine, and complex traumas. "We continue to build our Spine Center at Strong to provide optimal care for patients. The teamwork exemplified by our work with Angelita Heldebrand is just one of many examples of what is possible when we work together, " said Zeidman.

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