There were moments when Cape Town lawyer Carmen Dippenaar thought she would never be able to resume normal life after developing a dural tear on her lower thoracic spine.
It was caused by a sharp bone spur on a calcified intervertebral disc earlier this year, leading to intense pain that rendered her virtually bedridden for three months.
“At its worst, for a period of three months (March, April and May) I couldn’t be upright for longer than 10 minutes at a time without feeling the worst headache I have ever experienced – I can barely describe how debilitating it was, like my brain was in a vice and being squeezed. There were other symptoms too – dizziness, nausea and tinnitus. I could not drive to work or sit at a desk, I could not exercise at all, not even go for a short walk and I couldn’t be upright long enough to do ordinary activities like shower, socialise or have a meal seated at a table.
There were some very dark moments. I wondered if I would ever be able to resume a normal life again” she recalls.
But thanks to a groundbreaking advanced endoscopic spinal procedure at Netcare Christiaan Barnard Memorial Hospital, the 52-year-old Gardens resident has begun her recovery journey.
The procedure lasting three hours was successfully completed by German and South African neurosurgeons who collaborated to repair a cerebrospinal fluid leak caused by the extremely rare condition.
They exposed the dural defect, shaved off and removed the sharp bone spur that had been piercing the dura and patched the leaking area.
“After developing severe headaches that didn’t respond to any pain medication, Mrs Dippenaar had previously undergone two blind epidural blood patches and two targeted epidural blood patches, which failed to resolve the dural tear as the bone spur kept piercing the nervous system’s protective membrane known as the dura, causing her cerebrospinal fluid, which acts as a shock absorber for the brain, to lose pressure. This was causing the brain to sag in the skull, pressing on the brainstem resulting in debilitating pain,” said neurosurgeon Dr David Roytowski.
He explained that he cause and location of Dippenaar’s dural tear made this a very rare pathology: “It was situated directly anterior (in front) to the spinal cord.
Accessing this area is particularly difficult and traditionally requires much more invasive surgery, involving collapsing one of the lungs, cutting through the diaphragm and opening the T12 vertebra to access the site of the dural tear.”
“Yet today there are endoscopic spinal techniques that are becoming established elsewhere in the world that show great promise for such procedures, reducing risks associated with open surgery. There are a few South African centres that offer endoscopic spinal surgery, but this is mainly limited to surgery of the lumbar spine, an area which carries much less risk of neurological injury,” said Roytowski.
Dr Vincent Hagel, a leading senior physician at the Spine Centre of the Asklepios Hospital in Lindau, Germany, renowned for his expertise in endoscopic spine surgery in the thoracic spine, said: “The benefit of the endoscopic transforaminal approach is that we can precisely access the point on the side of the spinal column to remove the small, calcified disc herniation that is causing the cerebrospinal fluid leak without having to move the organs and retract the spinal cord.
“Although this can be a challenging procedure if using the traditional techniques, it is something I regularly do endoscopically in Germany for treating disc herniations.”
Dippenaar said she was amazed at being able to get out of bed the day following her procedure and walk around with little to no pain.
“I spent one night in high care and one night in a general ward, and then I could return home. Within 10 days of the endoscopic spinal intervention, I was able to return to everyday life.
“I have been looking forward to exercising again after living with the leak for six months, three of which were spent lying down in bed. I am so grateful to the doctors for making it possible for me to have this minimally invasive procedure.
“All the specialists were exceptional and went above and beyond what was expected of them.”
Cape Times