Case Study: How Spinal Tumours Hide In Mild Symptoms

Case Study

How Spinal Tumours Hide In Mild Symptoms

 Back pain is a common complaint in the general population that it is said most adults will experience an episode of back pain at some point in their life. The important distinction between regular back pain and the more sinister type is that one is self-limiting and resolves with rest or change of activity and the other is persistent and does not respond to simple measures. A particular symptom that should never be ignored is pain that worsens at night and is localised in the mid back level. This should always be investigated appropriately by a specialist.  

Ms Lawrence

Ms Lawrence is a 49-year-old project manager who leads a very active lifestyle. Her week included running 3 to 4 times a week. Typically, when she started feeling pain in her side and tingling in the anterior thigh, she took a break from running as she thought it might be a running injury. Unfortunately, the pain did not stop; it only started getting worse to the extent that she was unable to sleep for more than 4 hours before being woken up with the excruciating pain.  

She was referred to Mr Ahmed Ibrahim from another neurosurgeon where he performed the necessary tests and eventually diagnosed her with a lesion at the T9-10 level causing compression of the cord. According to Mr Ibrahim, surgery was the best option as surgical treatment is safe and for some tumours is a curative procedure which can prevent significant neurological disability from developing.  

When do you decide to see a doctor? How does it feel to be informed of a tumour? What’s the recovery like both mentally and emotionally?  

Lots of questions came to mind when we first heard about Ms Lawrence’s case; so, we conducted an interview with her to get more insight into the entire process, how she felt about it and get a glimpse of her remarkable recovery.   

1. Please can you describe the problems you were experiencing before your first appointment? Who was your first line of contact for your symptoms?  

 

"I was in quite a lot of pain to the extent that it was having a detrimental effect on my everyday life - I was reliant on painkillers daily to make the pain bearable. I actually found it quite difficult to describe the pain or articulate how it felt: I could tell it wasn’t joint, muscular or soft tissue pain, but I couldn’t explain what is was as it manifested itself in different ways at different times. 

 

Looking back, the symptoms developed gradually, probably over several months. Initially, I experienced slight discomfort in my left side when getting out of bed in the morning and had a bit of pain when walking or running, but the pain was short-lived and I assumed it was the result of a running injury that would pass, or at most would require a bit of physiotherapy. The symptoms worsened and became more persistent just as we went into lockdown so under the circumstances I decided to stop running for a while to allow my injury to heal. However, the pain intensified rather than improved. Over the next month, I experienced increasing pain in my side (radiating to the back and front) when trying to stand upright in the morning. Once upright, it was painful for some time to then bend, put my chin to my chest or lift my foot upwards. During the day I had a pain like a knitting needle twisting in my side and it would “catch” sharply at times.  I couldn’t run or jump without pain in my side.  The most debilitating pain was at night when a belt of pain gripped intensely around my back at the waist level.  Lying down became intolerable and I found it incredibly difficult to get to sleep or stay asleep for very long.  

 

Blood tests and abdominal ultrasound were carried out via my GP surgery and both came back normal.  It was only when I had an MRI scan that the tumour was discovered."

 

2. Did you have prior information about the disease? Was the information provided with enough? 

"I was referred to Mr Ibrahim for treatment by another consultant neurosurgeon so by the time of my first consultation with Mr Ibrahim, I had been through the findings of my initial MRI scan and had a pretty good understanding of what I was dealing with."

 

3. After referral, how was the first visit to the consultant? Can you tell us what was good about your consultant’s approach? 

"I was extremely grateful to be able to see Mr Ibrahim in person for my first consultation. Remote appointments were fine during the initial investigation, and understandable given where we were in the pandemic, but at this juncture, it was really important to me to be able to talk through the diagnosis, the treatment and the prognosis face to face.  Mr Ibrahim took the time to go through everything thoroughly. His approachable manner meant that I was comfortable asking questions, whether during my first visit or at any point thereafter. I felt reassured after my first consultation that this was the right course of treatment, although I was still nervous!"

 

4. What was your reaction to hearing the diagnosis? Who gave you the support needed?  

"I was a bit shocked, although at the same time relieved that there was an explanation for the pain I had been experiencing. I instinctively knew something wasn’t right, but despite all my efforts to find the answers myself on Google prior to diagnosis (never a good idea!), I never suspected a spinal tumour."

 

5. Can you tell us how you felt about undergoing surgery? Did you feel well-informed and confident? 

"Incredibly nervous. I knew that the risks were low in relative terms, but it was still my spine… 

 

What I found invaluable in terms of my confidence, was the remote consultation with Mr Ibrahim the day before surgery. He went through what to expect the following day in some detail and by the end of the call I was as mentally prepared as I could have been and was less fazed once in the hospital than I might otherwise have been! 

 

I have also felt confident post-surgery having had both remote and in-person reviews. Also, any questions or concerns I have had during my recovery period have been addressed swiftly. "

 

6. Please tell us in detail about the kind of activities you are able to do now and how has your life changed before and after the surgery.  

"It is still early days, but I am no longer on painkillers of any kind. The pain that I felt previously from the spinal cord compression has gone and I am now under the care of a physio with a programme to build on my flexibility and strength so that hopefully I can start running again very soon. I am incredibly relieved and grateful to be able to lie down and sleep without being in agony. 

 

7. Please are you able to describe how you feel about the outcome of your surgery?  

"I am delighted.  The surgery went to plan and I am recovering well with no neurological deficit. Also, the wound is really neat and will be a good scar, if there is such a thing!"

 

8. Please tell us about any positive comments you have had from family and friends? 

"People are generally surprised that I am back up and about so quickly after what was quite a major operation. Apparently, I look better now that I am not in constant pain."

 

9. Please let us know, what advice would you give to patients who are considering having this type of surgery? 

"Obviously, each patient’s decision is personal to them, but ultimately for me the upside far outweighed the downside in that the sooner the tumour was removed, the higher the chances of a full recovery. I could have delayed my surgery, opting to continue with pain management and accepting that I couldn’t be active as I was before, but a delay would have been at the risk of losing neurological function that I may never regain, even post-surgery. "

 

10. Is there anything else you would like to tell us about? 

"It was tough not to feel guilty going to the GP during the pandemic, but I am glad that I persevered.  I feel incredibly fortunate and grateful to have been under the care of Mr Ibrahim and his team."

 

Consultant

Ahmed Ibrahim

Mr Ahmed Ibrahim