An advanced spine surgery gets Yury back on his feet

Imagine waking up one day with a strange sensation in your legs. It’s not pain exactly, but it’s not normal — you don’t quite feel like your brain is coordinating with your limbs. As time goes on, the strange feeling in your legs affects your balance and gait. You begin to worry and make an appointment with your primary care physician. They’re concerned — enough to refer you to a neurosurgeon.

This was the case for Yury Lagoviyer, a scientist who ended up in the office of Brenton Pennicooke, MD, MS, a Washington University neurosurgeon at Barnes-Jewish St. Peters Hospital, with strange sensations in his legs and movement challenges. Even though Yury’s symptoms were in his lower extremities, Dr. Pennicooke decided to run two tests on his patient’s spine: an MRI that would take images of his upper spine and an angiogram, during which dye was injected into Yury’s spinal cord to detect any abnormal blood flow.

Dr. Pennicooke’s hunch was right: the two tests revealed that Yury had a condition called dural arteriovenous fistula (DAVF). DAVFs are abnormal connections between the arteries and the veins in the covering over the spinal cord known as the dura mater. People are either born with these malformations or develop them over time, and they can lead to symptoms such as lack of coordination, headaches and dementia. In Yury’s case, the DAVF developed over time.

The good news was that there was a solution to Yury’s condition that would also prevent future complications from DAVFs: a laminoplasty, a surgery that would open Yury’s spinal canal through the lamina bone to create space within the spine in order to access and clip the DAVF. The surgery wasn’t as straightforward as it seems, however. Dr. Pennicooke compares performing a laminoplasty to diffusing a bomb — you have to “clip the right wire.”

Preparing for Success

Yury’s surgery would last about three and a half hours, but the preparation for the procedure was even lengthier. Typically, laminoplasties are performed at larger academic centers or tertiary care centers because they require extensive coordination between teams. Dr. Pennicooke had to make sure that he had all the necessary equipment and coordinated with the operating room (OR) managers, anesthesia team, neurosurgical team, OR staff and angiography suite staff. He also called upon Washington University neurosurgeon Ananth Vellimana, MD, to perform the procedure with him.

Once Yury was in the operating room, Dr. Pennicooke and Dr. Vellimana removed a portion of his lamina bone to access the spinal cord. Guided by preliminary X-rays, the two surgeons sussed out individual blood vessels, clipping off one at a time. The surgeons then tested electrical signals from Yury’s brain to his hands and feet and back to make sure the spinal cord functioned normally. In the cases in which there was no change, the surgeons fully cut the vessel to change the flow dynamics around the spinal cord. Afterward, the portion of Yury’s lamina bone that was removed to access the vessels was returned and secured with plates and screws.

After Yury’s procedure, another angiogram confirmed that the three and-a-half-hour surgery was a complete success, and Yury was able to walk that same night. Yury still does regular physical therapy to aid his recovery, but immediate recovery from these procedures is usually quick, with patients leaving the hospital after one or two days, depending on their pain levels and drain output.

“All I can say to Drs. Pennicooke and Vellimana is a big thank you, and that I’m very grateful for their kindness, attentiveness and skill,” Yury says. “I’m extremely pleased and grateful to the doctors and the entire team.”

Dr. Pennicooke is also satisfied with Yury’s outcome and pleased that a community hospital like Barnes-Jewish St. Peters Hospital was able to perform this more advanced surgery. “It was particularly impactful for us,” he says. “We were able to do it at a community hospital safely and with a good outcome to show our community that we can do these very complex and technically demanding surgeries close to home.”

To learn more about the Neurosurgery Center at Barnes-Jewish St. Peters Hospital, visit BJSPH.org/Medical-Services/Neurology-and-Neurosurgery/Neurosurgery-Center