Dr Joshua E. Schroeder: «Any wrong movement could have left her paralysed»
Coral, a nine-year-old girl from Jerusalem, will never forget the last Purim. Instead of dressing up and enjoying an upcoming holiday party with her friends, she was lying down on the floor with back pain that prevented her from walking, sitting, or standing straight.
At first, Coral’s parents thought the pain was due to a fall, so they took her for an x-ray of her back. It did not reveal any abnormalities. They were sure that it was only a matter of time before the pain would go away on its own. “But, the intensity of the pain increased with time,” Revital says. Further tests led to a diagnosis of scoliosis, “but we still could not understand why Coral’s suffering was so great”. So, they made an appointment for a CT scan at Hadassah Hospital. “After the CT scan was completed, the technician asked us to wait outside. I immediately knew it was something out of the ordinary, and I told my husband it sounded strange to me,” Revital said.
The technician explained that Coral had a rare tumour and that she should be taken immediately to the emergency room. “It was 6:30 pm, and we were standing in the middle of the hallway,” Revital said. “We felt the sky had fallen on us. It’s a horrible situation when your child has been complaining of terrible pain and everyone has been telling her to straighten up, that everything is fine, and then you discover the worst scenario of all.” According to Dr Joshua E. Schroeder, director of Hadassah’s medical unit for spinal deformities, Coral was brought in with uncontrollable back pain, lying in bed and barely able to perform routine functions. “She was suffering from a very rare tumour that had enveloped her entire spinal cord. Any wrong movement could have left her paralysed, or even endangered her life. The very severe pressure that the tumour exerted on the spinal cord caused a vertebral fracture and severe scoliosis in the spine.” Coral was immediately admitted to hospital and doctors tried to find a solution that would get her out of this situation safely.
As it was necessary to shrink the tumour before any back surgery could be performed, Coral was admitted to Hadassah’s paediatric haemato-oncology department, under director Dr Gal Goldstein and head of paediatric nephrology Dr Oded Volovelsky. In consultation with colleagues at Memorial Sloan Kettering Cancer Center in New York, they developed a treatment plan to shrink the tumour using a biological therapy. “It was a vascular tumour that needed to be analysed very carefully,” Dr Schroeder explained. “If it were operated on without the greatest care, the child could die on the table. It was a real drama because, on the one hand, the tumour was endangering Coral’s life and could lead to her death at any moment, and, on the other hand, the surgical procedure was a complex operation in which any wrong movement could cause the girl to become paralysed.” To come up with the best solution, Dr Schroeder and his team took the information they had about Coral and combined their Hadassah knowledge and experience with that of their colleagues at Memorial Sloan Kettering. The result was a multi-layered treatment plan.
After Coral having spent a month under treatment in the paediatric haemato-oncology department, she was finally prepared for her back surgery. “We began by giving Coral a medication that, by depriving the vascular tumour of its blood supply, would turn it into a soft tissue tumour,” Dr Schroeder said. “It is an experimental drug for tumours of this type.” Then, Prof. Jose Cohen, director of the medical unit for endovascular neurosurgery, and senior anaesthesiologist Dr Rawhi Hashem blocked the blood vessels that supplied the tumour, reducing its tendency to bleed. Finally, Dr Schroeder said, he and orthopaedist Dr Hananel Shear Yashuv “excised the tumour in its entirety, stabilised the spine and corrected the severe scoliosis.”
Wearing a brace and walking tall, Coral has finished her school year and is enjoying a well-deserved vacation.