Dr. Hilary Onyiuke

Unparalleled

By Chris DeFrancesco

Dr. David Choi

Dr. Choi points out spinal tumors needing critical care.


When a man in his sixties recently went to UConn John Dempsey Hospital after four days of severe back pain, an MRI revealed a rapidly growing spinal cord tumor that was placing extreme pressure on his spine.

He was sent straight to the emergency department where Dr. David Choi, the only neurosurgeon in Connecticut with fellowship training in spinal oncology, met him.

But not for the first time.

“Because we’re local, I had been seeing this gentleman for months before this tumor problem arose, so I already knew who he was, I already knew what treatments he was going through, I knew his general attitude about the quality of life that he would want for himself,” Choi recalls. “Now thankfully he did not have any neurologic deficits, but there was just so much compression on the spinal cord that I didn’t want to wait for anything bad to happen.”

Right away — in the middle of the night — Choi operated to decompress the tumor and stabilize the spine with rods and screws.

“The decision to do surgery was a no-brainer for both of us,” says Choi. Before Choi, the product of an elite complex spine surgery fellowship at Brown University, arrived at UConn Health, patients like this one had to travel to Boston or New York City for the same level of fellowship-trained expertise.

Having a comprehensive spine surgery specialist like Choi provides “real-time coverage — you’re getting things done right as they happen, and that gives the best chance for improved outcomes,” he says.

It’s an example of a patient already under the care of familiar providers being able to stay at UConn Health for continuation of that care, including treatment by a spine surgeon with unique subspecialty training in treating spinal tumors.

“In some cases, tumors cannot be entirely removed, requiring further treatments after surgery, such as chemotherapy and/or radiation therapy, coordinated by oncologists and radiation oncologists,” Choi says. “In cases of metastatic tumors, other surgical tumor specialists may continue their involvement in treating the primary tumor.”

Spinal tumors can metastasize to the spine or originate in or around the spinal cord or in the vertebrae. A tumor in the bone can cause fractures and a partial collapse of the spinal cord. In extreme cases, fractured pieces of bone may affect the spinal cord and cause neurologic deficits such as limb weakness or incontinence. Similar neurologic defects can result from a tumor in or around the spinal cord, which can compress the spinal cord or the nerve roots that exit it.

“The possible permanence of these deficits makes surgery necessary,” Choi says. “If you’re not able to walk around, or if you have bowel or bladder issues, that’s a pretty big impact on quality of life for the rest of your life.”

Choi says the opportunity to shape spinal oncology care at UConn Health is what drew him to Farmington.

“Few physicians will have a chance to help develop a new division in a well-established institution,” he says. “UConn Health is poised to become a leading destination center for a wide variety of neurosurgical conditions, and spinal oncology is a field that will serve our community and state well.”

Choi’s addition is a cornerstone of the vision of Dr. Ketan Bulsara, chief of the Division of Neurosurgery, to expand UConn Health’s neurosurgical care offerings and make UConn a world-class destination center.

“Dr. Choi’s expertise adds to the excellent work that was already being done at UConn Health in collaboration between neurosurgery and orthopedic surgery through our comprehensive spine center,” Bulsara says. “His level of training allows him to offer a unique perspective and potential treatment options for spine/spinal cord tumors.”

It also adds to a multidisciplinary team of spine surgeons at UConn Health.

“The recruitment of his talent and clinical expertise buttresses the vision of our comprehensive spine program,” says Dr. Hilary Onyiuke, neurosurgical director of UConn Health’s Comprehensive Spine Center.

The elite skill of the growing neurosurgery program is expanding in other ways as well.

Dr. Kevin Becker recently came from Yale to build a neuro-oncology program in collaboration with the Department of Neurology and the Carole and Ray Neag Comprehensive Cancer Center. Bulsara says the arrival of Becker “continues to build on our collaboration with the Preston Robert Tisch Brain Tumor Center at Duke, bringing an additional dimension to our treatment paradigm.”

Precise Instruments: Better Spine Surgery with Robots

By Lauren Woods
Photography by Janine Gelineau

Close up of Mazor Robotic Piece


For 30 years, Frank Ditaranto worked in the construction field. But a sudden back injury changed that, leaving Ditaranto unable to carry on his normal life.

“Two years ago, my back went out and it stayed that way,” says Ditaranto, a 50-year-old Terryville, Conn. resident. “Ever since, I have been bent over like I was 90, with shooting pain down my left leg to my toes, and I was unable to even straighten my leg.”

Daily life and even walking became difficult for Ditaranto. He tried pain medicine, physical therapy, aqua therapy, and epidurals, but there was no relief in sight — until now.

On Jan. 7, Dr. Isaac Moss, assistant professor of orthopaedic surgery and neurosurgery at the Comprehensive Spine Center at the UConn Musculoskeletal Institute, was the first surgeon in New England to use the new Mazor Robotics Renaissance Guidance System to assist him during spine surgery. Ditaranto was his first patient.

To relieve Ditaranto’s severe lower-back and leg pain, Moss successfully removed and fused Ditaranto’s deteriorated L4-5 spinal discs using minimally invasive techniques.

“Thanks to the robotic technology, we were able to place screws in the patient’s spine with extremely high accuracy, small incisions, and minimal intraoperative radiation,” says Moss.

UConn Health is the first institution in New England to offer patients this pioneering and more precise robotic guided spine surgery.

A day after the surgery, Ditaranto said he already felt truly transformed: “For the first time I was able to stand up straight and not have pain shooting down my left leg.”

“I am too young to have to live like that,” says Ditaranto. “I now have new discs and hardware in my spine and I am good to go.”

Ditaranto says he feels “great” and looks forward to simply living life pain-free. Perhaps most importantly, as a single dad of a 16-year-old daughter, he most anticipates playing volleyball with her again.

Most spinal procedures like Ditaranto’s involve the attachment of screws and other implants to the spine. Spine surgery has little room for error. Spinal fixations, such as screws, are typically just millimeters away from sensitive spinal nerves, the spinal cord, the aorta, and other critical vessels.

The new technology’s software allows surgeons to plan a patient’s spine surgery virtually, using a 3-D simulation of the spinal anatomy based upon the patient’s most recent CT scan.

“It’s so important to plan in advance of spine surgery,” says Moss. “The Mazor Renaissance technology allows a surgeon to closely review the anatomy of each patient in depth, and get to know the specifics, to make a more precise surgical plan, and eventually execute a smoother operation.”

Once inside the operating room, the Mazor technology matches, in real time, the surgeon’s pre-operative 3-D plan with intra-operative X-ray imaging of the patient’s spine. During the procedure, the technology guides its robotic arm, which is about the size of a soda can, along the spine to help the surgeon pinpoint the precise location to place his tools to ensure the greatest accuracy and safe placement of screws and other hardware into the spine.


Doctors of the UConn Musculoskeletal Institute’s Comprehensive Spine Center use the Mazor Robotics Renaissance Guidance System to perform spine surgery in January.

Doctors of the UConn Musculoskeletal Institute's Comprehensive Spine Center use the Mazor Robotics Renaissance Guidance System to perform spine surgery in January. Janine Gelineau/UConn Health Photo

Dr. Isaac Moss of the UConn Musculoskeletal Institute will be New England’s and Connecticut’s first surgeon to use pioneering robotic guidance technology to assist him during spine surgery at UConn John Dempsey Hospital

Mazor robotic software images- which will help him pinpoint the most precise spot to place screws and other hardware into a patient’s spine.

Orthopaedic surgeon Dr. Isaac Moss uses the Mazor Robotics Renaissance Guidance System to perform spine surgery in January.


UConn Health is using the robotic-guidance technology for a wide range of spinal procedures including biopsies, thoracic and lumbar spinal fusion, and reconstruction for a wide variety of conditions such as scoliosis (abnormal curves in the spinal column), spondylolisthesis (when one vertebra slips forward onto the vertebra below it), tumors, and trauma, among others.

“Using this advanced technology puts UConn Health at the forefront of spinal surgery,” Moss says. “This technology allows us to perform both traditional and minimally invasive spine surgeries more effectively and safely.”

Other potential benefits of the robotic guidance technology include smaller incisions, shorter operative times, shorter hospitalization and recovery, less pain for patients, and less exposure to fluoroscopy X-ray radiation for both a patient and the surgical team.

To refer a patient to a UConn Health surgeon, call 860.679.5555.

Research shows that compared to freehand spine surgery, the robotic guidance technology can increase the accuracy of screws and other hardware placement by 1.5 mm. This increased accuracy may also reduce the potential for neurologic risks to patients, which may include future nerve pain, tingling, or tissue numbness.

Two other UConn Health surgeons in addition to Moss — Dr. Hilary Onyiuke, director of the Comprehensive Spine Center at the UConn Musculoskeletal Institute and chief of the Division of Neurosurgery, and Dr. Ryan Zengou, assistant professor in the Department of Surgery’s Division of Neurosurgery and the Department of Orthopaedic Surgery — plan to use the system.

“I look forward to using this technology to help patients with spinal pathology by performing complex procedures with optimal precision and the best outcomes possible,” Moss says.