Pinning Her Hope on New Spinal Surgery

By NANCY WRIDE

Feb. 25, 1999 12 AM PT

TIMES STAFF WRITER

The unusual surgery Marilyn Johnston had Wednesday at UCI Medical Center will not save her from the cancer gnawing at her spine. But the operation, never performed in such a way on a cancer patient, may make her life easier.

And that was the whole point.

Since late last year, when she felt a back twinge while drying her hair and learned two weeks later that cancer had gutted her seventh vertebra, Johnston, 63, has endured months of misery.

For the office administrator and “girl Friday,” sitting is exhausting and painful. Medication doesn’t erase the pain, and it leaves her feeling doped up. She tried a neck-to-pelvis body brace but could not work or drive in it.

“It tips your world upside down,” Johnston said. “It does. A month ago or so I was fine. They thought I had a pinched nerve. But I think this is going to go good. My ex-husband said I’m not taking this seriously enough, but I heard laughter helps reduce cancers, so that’s what I’m going for here.”

She does not know how much time she has left. But the pain has become so severe that the mother of four would trade it for that of delivering her babies.

“I’d rather go through childbirth again,” said Johnston, her humor undaunted just 90 minutes before surgery Wednesday. “At least I would get to take something home with me.”

Her doctors at UCI Medical Center hope that she also walks out of the hospital today with instant relief that will help her to fight for her life with chemotherapy and radiation treatments.

“At the very least, the surgery will give her the best quality of life possible for the activities of daily living immediately,” said Dr. Gregory Carlson, director of UCI Medical Center’s Spine Center, who performed the operation.

So Wednesday afternoon, a procedure that remains in clinical trial and has been conducted mainly on those with osteoporosis or like ailments was performed to relieve the pain of a cancer patient.

Carlson said it was the first time such a surgery was done at UCI Medical Center. The director of a clinical trial now underway at UC San Diego confirmed that a new tool in the surgery has been used only 10 or 20 times in the United States.

In essence, Carlson injected a bone cement into the center of Johnston’s crushed seventh vertebra, and 90 minutes later she had only a pair of Band-Aids to show for it.

The surgery itself is considered relatively risk-free and nonintrusive, Carlson said.

Picture a drinking straw placed against the back. Through it, Carlson inserts a device that drills a tiny opening into the vertebra. Then he inserts a balloon that opens the collapsed vertebra, allowing the injection of the bone cement. That effectively reconstructs the vertebra and renders it immobile, thus eliminating the pain.

The balloon device is what is new to the field of vertebra repair, and it may prove important as the population ages.

Previously, surgeries have been done using a needle to inject the cement into vertebrae without first expanding the bone. And recipients have included some with spinal tumors but mostly people with “osteoporatic” problems, said Dr. Steven Garfin, UC San Diego Department of Orthopedics chairman. Garfin, director of the clinical trial on the balloon device, said Wednesday that the device has been approved by the U.S. Food and Drug Administration, but its manufacturer has opted to test further before putting it on the market.

Carlson, however, made a case for compassionate use of the device, and the company provided him with the balloons for Johnston’s operation.

“We’re doing this under therapeutic means. You weigh the risks and the benefits,” Carlson said. “And we think the benefit far outweighs the risks in her case.”

With daughter Laurie Erhart of Spokane, Wash., at her side, Johnston entered the operating room hopeful that afterward she will be better equipped to fight her disease. The past four weeks of depending on others for transportation and other help have been humbling, she said.

“It’s easier for my children to say, ‘I’d rather have you a cripple than not at all,’ ” she said, growing teary-eyed. “But I’ve never had to have anyone take care of me, and the past two weeks have been tough. I’m not ready to go by any means, but I don’t want to sit in a wheelchair and have people taking care of me.”

She spoke of her four children, scattered around the globe, and of hating to inconvenience the daughter who has been staying with her for four weeks now at her Irvine home. She spoke of living long enough to spend time with her 10 grandchildren and her great-grandchild.

And she and her daughter broke away from their life-and-death topics of conversation to laugh often.

“My oncologist’s name is Winston Ho,” Johnston said. Quipped her daughter: “That’s like a Western movie: Winston Ho!”

Erhart said her mother is extremely fit and active. She works out at a gym. She enjoys her life.

“She’s up at 6 in the morning and going and gone. She has always been very independent. Now I have to watch her. She’ll start doing stuff she’s not supposed to do. She’ll reach. She doesn’t like someone looking over her shoulder,” Erhart said.

(BEGIN TEXT OF INFOBOX / INFOGRAPHIC)

Repairing a Crushed Vertebra

A new surgical procedure uses bone cement to repair crushed vertebrae. Doctors hope that the 90-minute outpatient operation Wednesday will give cancer patient Marilyn Johnston a better quality of life.

Normal Vertebra

* Solid core

* Thick outer wall

* Square shape

Crushed Vertebra

* Cancer hollows core

* Thin wall breaks, collapses

* Compression pinches nerve, causes pain

How It’s Done

Step 1 - DRILL

Insert cannula, drill hole into collapsed vertebrae

Step 2 - EXPAND