One-in-a-Million Diagnosis? Those Odds Don’t Faze Us.

By Ali Bydon, M.D.

Before he came to The Johns Hopkins Hospital for treatment in 2017, Pedro Gil, now 45, had struggled with a thoracic disk herniation for 10 years. His herniated disk had calcified, turning to bone, and it pressed on his spinal cord to produce excruciating pain, weakness, numbness and even paralysis. He was hardly able to move.

Pedro had already tried years of physical therapy, massage and other treatments, plus an emergency surgery in his home country, the Dominican Republic. His injury was so precarious his home surgeons abandoned their attempt mid-procedure, afraid of damaging his spinal cord.

His doctors told him his condition was so severe he might die. He would never walk again.

But at Johns Hopkins, we were able to give Pedro a much more positive diagnosis.

New Hope for Rare Thoracic Disk Herniation
Herniations of disks aren’t uncommon: Millions of people have herniated disks in the neck or lower back. But a herniation in the thoracic spine area is exceedingly rare. That’s because the ribcage completely surrounds the thoracic area — which stretches from the bottom of a person’s neck to the top of the back, just behind the lungs — generally making the area more stable than the neck or lower back.

The likelihood of a herniation like Pedro’s is, quite literally, one in a million, and it’s very difficult to treat.

Other U.S. surgeons recommended that Pedro undergo two operations — one to reach the problem area of his spine and one to decompress the spinal cord — which would involve two days in the operating room and 16 hours under anesthesia.

This approach is doable, but it carries significant risks. In general, the less time spent in the operating room, the better.

While most surgeons will only see one or two patients like Pedro over the course of their career, my neurosurgical colleagues and I have performed more than 70 procedures on thoracic disk herniations in the past 12 years, and we have more than 100 years of collective experience operating on the spine.

Our team pulled from this vast reservoir of experience and arrived at a lower-risk solution for Pedro.

In just one four-hour operation, we drilled his spine very carefully under a microscope, leaving an eggshell layer of bone against the spinal cord. Once I removed the calcified mass that was jamming his spinal cord, there were just micromillimeters separating me and the spinal cord.

I’m happy to report that a year-and-a-half after Pedro’s surgery, his prognosis is good.

During our first appointment, Pedro sat in my office in tears from the pain. He was bound to a wheelchair and thought he would never walk on again. Today, he gets around with a cane as he returns to tackling the everyday tasks of life.

Dr. Ali Bydon is a professor of neurosurgery at the Johns Hopkins University School of Medicine. His clinical practice focuses on degenerative disorders of the spine, spinal tumors, and complex reconstruction and restoration of the spine. He is the director of the Spinal Column Biomechanics and Surgical Outcomes Laboratory at Johns Hopkins. His research focuses on spinal biomechanics, spinal disparities and surgical outcomes. He has co-authored more than 200 peer-reviewed manuscripts and numerous book chapters. Dr. Bydon is also a principal investigator of several national, multicenter, prospective clinical trials evaluating long-term, patient-reported outcomes following spine surgery. He is a medical director with Johns Hopkins Medicine International, overseeing the clinical, educational, teaching and research activities of our Lebanese affiliate, Clemenceau Medical Center.