Nere Almonte has a smile for her neurosurgeon Dr. Chris Kager, weeks after he performed spine surgery to remove a large tumor.
It began on a January evening, and Nere Almonte thought she could tough it out like before. Disabling back pain had limited the activities of the Lancaster mother and grandmother for a year, but x-rays and CAT scans in New York and Lancaster had not revealed a cause. She wrote it off to degenerative changes from aging, and lived with it.
This time it was different. As the night wore on, the pain grew unbearable, and her side and leg became numb. "It felt like it was swollen where it wasn't," Nere Almonte said. "It was a desperate pain."
The next day her son and daughter-in-law took her to Lancaster General's Emergency Room, where the E.R. physician administered pain medication and ordered a CAT scan. This one revealed the possibility of a growth, and the call went to Chris Kager, M.D., the neurosurgeon on emergency call that afternoon at Lancaster NeuroScience & Spine Associates. The practice has two surgeons on call at all times to meet any emergencies that occur in the community.
Nere Almonte has appreciated the support of her family: sons Michael and Juan Carlo, and her daughter-in-law Lioseli Placencio, shown here.
Dr. Kager was just completing his last patient appointment when he got the CAT scan results over the phone. He was in the E.R. within minutes, where he ordered an MRI, admitted Nere Almonte to the hospital, and prescribed steroids to reduce swelling and ease her pain. He showed Nere and her family the MRI results, which exposed a very large spinal tumor in her thoracic (mid-back) spine. Two days later, he was able to perform the surgery to remove the growth, which was pressing on her spinal cord.
Spinal cord tumors occurring in the lining, or dura, of the spinal cord are rare. They affect only a minority of the population, happening more often with women than men. If they grow and compress the spinal cord, they cause a reduction in neurological function, resulting in pain, arm and leg weakness and dysfunction, and loss of motor and sensory abilities. Dr. Kager says that such tumors are generally slow growing, till eventually the body cannot compensate any more, and the result can be hemorrhage and paralysis. "If left for a few days or weeks, she would have been weakened, and very possibly paralyzed," He said.
Trained at the Cleveland Clinic Spine Institute in complex spinal surgeries like the one that Nere required, Dr. Kager has performed it many times. Her three-hour surgery required that Dr. Kager first broaden the opening of the dura to get at the tumor, which was too large to be taken out all at once. It had pushed the spinal cord "all the way over to the left side" according to Dr. Kager, so he had to perform multiple laminectomies, a surgical procedure that relieved pressure on he spinal cord and allowed him to create more space for the spinal nerves, in order to remove the tumor by sections.
Constant intraoperative monitoring gave Dr. Kager real-time feedback during the surgery, to identify any nerve or retraction injury. In Nere's case, there were no changes, and the procedure was a total success. With the tumor completed removed, Dr. Kager said that the chance of it coming back were nil. "She was normal post-operatively," he said, and she was up and moving on day one."
Nere is still dealing with back pain resulting from degenerative discs, and is undergoing therapy for the low back pain. She knows it will be a long run, but she says that she feels very fortunate that the tumor is gone. "I was shocked when I found out that it was a tumor," she said, "and a very large tumor. I felt much better that it was removed, and to know that it wasn't malignant," she said with a smile.
