Redefining the Spine

Neurosurgeon goes boldly, for spinal tumors, where many haven’t.

Spring 2002, Volume 15, Number 1

Neurosurgeon Ziya Gokaslan

You can’t live without a sacrum.” Those are fighting words to Maisolet Richmond, a healthy Texas woman in her early 30s who walks, drives, lives a rich life and happens not to have a sacrum. Hers was removed five years ago by Ziya Gokaslan, M.D., a neurosurgeon who approaches tumors and degenerative problems of the spine—his colleagues say—with unusual skill and brio.

This June, Gokaslan leaves Houston’s M.D. Anderson Cancer Center, where he treated Richmond, to fill a Hopkins niche as a full-time spinal surgeon. The neurosurgeon performs standard procedures, but he’s also developed at least five novel surgeries and has refined a half-dozen others. His transthoracic approach to the spine, for example, saves bone and offers better ways to stabilize the spine. Other tactics involve molding supportive columns of plastic gel that later harden during surgery.

Gokaslan headed the team that performed the first successful total sacrectomy in North America and, fortunately for Richmond, did the first version that left patients able to walk.
In Richmond’s case, her problem was a giant-cell tumor that extended from the mid- lumbar back to the coccyx. It invaded both soft tissues and bone. In two separate surgeries, Gokaslan removed her entire tumor-entrenched sacrum, freeing it from the iliac bones and the spinal column.

To substitute for the missing “keystone” and stabilize what remained, he inserted pedicle screws on either side of the lumbar spine, threaded titanium rods through the screws and extended them into both halves of the now-separated pelvis. Both a rod and a segment of tibia joined both pelvic pieces firmly enough to prevent their free rotation and close enough, with the aid of transplanted bone chips, to let them fuse.

Like most surgeries Gokaslan performs, the sacrectomy ended Richmond’s immobilizing pain. “The pain is no longer my life,” she says. “I get by on low-level analgesics.” Also, because Gokaslan removed her tumor en bloc and because it’s a sort that rarely metastasizes, Richmond remains tumor-free. She’s adjusted to the unavoidable loss of bladder and bowel function and says her sharpest annoyance now is local physicians “who won’t believe I have no sacrum!”

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