When Jiwan Chandra Upadhyay, 65 years old, from Pithorgarh, Uttarakhand was presented to the team of doctors at Fortis Hospital Noida, he had a spinal fracture and was practically bed-ridden due to severe pain. Diagnosis revealed that he was suffering from a medical condition - metastasis where a cancer in his lung was carried through blood to his lumbar spine. This was a rare case that presented multiple challenges of advanced age; fractured spine; and an advanced case of lung cancer. With a successful vertebroplasty surgery, the patient, relieved of pain, was able to walk again. The Neuro-surgical team was led by Dr. Rahul Gupta, Additional Director & HOD, Neurosurgery, Fortis Hospital, Noida and the patient’s Cancer treatment was supervised under Dr. Devavrat Arya, Senior Consultant, Medical Oncology, Fortis Hospital, Noida.
Mr. Jiwan Chandra Upadhyay’s complaints of severe lower backache and difficulty in walking since a month threw up the link between lung cancer and back pain. Tests revealed that he was suffering from lung cancer and due to the metastasi,s the spinal column bones were rendered weak and soft. The spine had sustained a fracture as a result. Further investigations also revealed that the patient was suffering additionally from myeloma. He was treated with Vertebroplasty or kyphoplasty is a medical procedure where the patient’s bones are strengthened through biological cement injections to erase the pain. The compressed nerves in the back region which contributed significantly to the back pain were released by screws fixed in the lumbar spine region. The surgery was beneficial to the patient in many ways as it increased the stability of posture, strengthened the spine and decreased the pain dramatically. Vertebroplasty can be done under local anaesthesia and typically, the procedure takes less than one hour per fracture and may require an overnight hospital stay sometimes.
Dr. Rahul Gupta, Additional Director, Neurosurgery, Fortis Hospital, Noida said, “The surgical procedure adopted in this case takes a minimal stay in the hospital and increases the quality of life significantly. We have seen 100% success rate with nil complications for such kind of cases. In last 3 years we have operated about 100 such cases successfully. Apart from malignancy, vertebroplasty or kyphoplasty also holds a promising treatment in osteoporotic spine fracture. ”
Dr. Devavrat Arya, Senior Consultant, Medical Oncology, Fortis Hospital, Noida said, “This is a very good example of how patient’s suffering from multiple myeloma can be treated. Prompt diagnosis and treatment can rapidly expose the symptom of the patient and prevent long term disability. The patient, Jiwan, is currently undergoing chemotherapy for the disease and is responding very well. He will be followed up regularly for complete recovery.”
Gagan Sehgal, Zonal Director, Fortis Hospital, Noida said, “Our Spine team is doing a great job for not only cancer patients but also for osteoporosis in elderly patients who develop spine fractures and who are deemed unfit due to advanced age and weakness factors for major surgeries. Vertebroplasty is performed under local anaesthesia and can be performed under day care. We are a proud team of doctors in our hospital who have always risen to challenges thrown by patients coming with multiple problems, advanced age or several co-morbidities.”
The patient expressed his gratitude to the doctors, “I was very fearful that I may become bed-ridden. Total dependence on someone can limit one’s life tremendously and I was not prepared for that. My heartfelt gratitude to the doctors for gifting my movement back to me through well thought of treatment that I was given.”
Back pain can actually be one of the first signs or symptoms of lung cancer. There could be multiple reasons for back pain. But in case of lung cancer-induced back pain, this could be a result of the tumour contributing to back pain by creating pressure on the structures in the back. Lung cancer is also known to irritate nerves travelling through the chest region manifesting as back pain in some cases. Spread of the cancer through blood from one part of the body to another is also known to contribute to back pain and roughly 30 to 40 percent people incur this with lung cancer. Metastasis to the adrenal gland located near the top of kidneys could be a possible reason for back pain in patients with lung cancer. In a study in the year 2013, Indians were found to have a 30% lower lung function as compared to western counterparts. The major source of this pollution is due to biomass burning, fuelwood and vehicular emissions. The Global Burden of Disease Project in 2010 reported 223,000 deaths from lung cancer attributable to air pollution among other factors.
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