Antonio Gonzalez knows about back pain, having endured cervical spine surgery some years ago after a globe-trotting career as a purser with American Airlines and later suffering injuries to his back. But this pain was something he had never felt before.
“I have always had back pain but this was different,” says the 67-year-old Tamarac resident, thinking maybe it was a pulled muscle. “It was a throbbing pain in the middle my back on the left side, coming towards my stomach, and it would come and go at night.” Because he thought it might just be a pulled muscle, Mr. Gonzalez waited a month or so before finally giving in and seeking care at a local hospital’s emergency department.
(Watch now: Antonio Gonzalez talks about being diagnosed with kidney cancer and lytic spinal metastasis, and how surgery by Baptist Health spinal neurosurgeon Robert Rothrock, M.D., helped relieve his chronic back pain. Video by Michael Justiz.)
In what turned out to be a case of good luck/bad luck for the patient, doctors there discovered he had renal cell carcinoma, otherwise known as kidney cancer. If not for his back pain, it may have gone undetected. Fortunately for Mr. Gonzalez, it had been caught early enough that effective treatment was still possible.
“If caught early, patients with renal cell carcinoma and the lytic lesions that sometimes result generally have a much better prognosis,” says Robert Rothrock, M.D., spinal neurosurgeon at Baptist Health Miami Neuroscience Institute and Baptist Health Miami Cancer Institute. “If not, it can be a much bigger problem. They’re much harder to reverse.”
Making matters worse
Unfortunately, imaging also showed that Mr. Gonzalez’s cancer had also metastasized to his spine, where doctors also found a lytic spinal metastatic lesion.
“There was a highly symptomatic and aggressive cancer in his T9 vertebra eroding through the back of the vertebra, with clear spinal cord compression,” Dr. Rothrock recalls. “While Mr. Gonzalez was still able to walk and didn’t have compromised neurological function, he was having radiating pain into his chest wall.”
Dr. Rothrock says that lytic spinal metastases occur “when bone is eroded and replaced by tumor, which then extends to and compresses the spinal cord.” If they become severe, spinal metastatic lesions can lead to painful and even disabling vertebral compression fractures.
Robert Rothrock, M.D., spinal neurosurgeon at Baptist Health Miami Neuroscience Institute and Baptist Health Miami Cancer Institute
Cancer spreading to the spine is extremely common, Dr. Rothrock notes. “Unfortunately, within the cancer population, the bone is the third most common site of metastatic lesions,” he says. “In other words, if you live long enough with a cancer, chances are you’ll develop some form of bone metastasis.”
Mr. Gonzalez was, understandably, alarmed at his diagnosis. “The day I found out, of course I was very scared. I was nervous. It was shocking,” he recalls. “When you find something like that, you keep wishing that it may not be cancer, but you kind of know.”
Eradicating the tumor
Fortunately for Mr. Gonzalez, both tumor sites were addressed during the same hospitalization, with urology surgically removing the tumor on his kidney, and Dr. Rothrock the lytic lesion of his spine. The goal of these surgeries, he explains, is to provide a “safe and effective margin” for the radiation treatment that follows.
“These tumors require a very high dose of radiation therapy but the spinal cord cannot be exposed to that degree of radiation,” says Dr. Rothrock. “Otherwise, you’ll actually get all the problems you’re trying to prevent.”
To avoid delivering excess radiation to Mr. Gonzalez’s spinal cord, Dr. Rothrock cut enough of the tumor away from it so that the radiation oncologist would have a clean target. “Now we can hit that tumor as an open target rather than with the ‘hostage’ of the diseased spinal cord,” he says.
Reconstructing the spine
Dr. Rothrock then set about reconstructing the portion of Mr. Gonzalez’s spine that had been damaged by disease. “We have ways to reconstruct the bone and the posterior elements of the spine to help stabilize it,” he says. “So we not only were able to effectively remove his tumor from the dangerous spots, but we also relieved his pain symptoms and effectively reconstructed his spine.”
Mr. Gonzalez jokes that his recovery was on the fast side only because he was so anxious to get out of the hospital after several weeks of surgery and recovery. Today, he says he’s feeling great. “There’s nothing showing in all the CT scans or MRI’s. I’m able to drive, I’m able to walk and I’m able to go shopping and able to deal with the dog. There’s pain sometimes here and there, but my legs feel fine.”
Dr. Rothrock says Mr. Gonzalez was extremely fortunate to have been diagnosed early. As a result, “we were able to give him a much more effective treatment earlier in his disease course.”
Improving patient outcomes
Mr. Gonzalez is grateful that he ended up in Dr. Rothrock’s care. “Dr. Rothrock is the best. He explains everything, and he’s very knowledgeable, friendly and compassionate,” he says.
Thanks to checkpoint inhibitor drugs and advances in chemotherapy and systemic therapy over the past five to 10 years, Dr. Rothrock says that patients like Mr. Gonzalez, depending on their age, can expect to live a long and normal life following treatment. “Just 10 years ago, the median survival for his type of cancer diagnosis was less than a year.”
Dr. Rothrock says Mr. Gonzalez benefited from the team-based approach at Baptist Health and the deep experience of its physicians. “When you have a condition that some might consider rare, it’s extremely important to seek treatment someplace where it’s not rare,” he says.
Successful outcomes require a lot of people working together, Dr. Rothrock adds, and Mr. Gonzalez is a great example of the high-quality multidisciplinary care Baptist Health provides. “Any delay in care or discoordination of care or, most commonly, miscommunication, can have real consequences for the patient. All those details matter.”