Naperville Sun HealthAware column:
Doctors treat serious, rare spinal condition
April 30, 2012
James Fijolek of Woodridge has a high-tech job but didn’t realize he’d been living with a short circuit inside his own body.
Fijolek, a mainframe systems engineer, was at work in late April 2011 and simply scooted backward in his chair like he does a dozen times a day.
Then the pain hit him hard, just under his shoulder blades.
“The pain was so severe, I let out a small cry,” he says.
“I went to stand up and the pain hit me again. A couple co-workers came running over to see if I was OK. I thought, ‘Man, what did I do?’”
Thinking he could tough it out, he remained at work and returned the next day, a Friday.
He thought the pain might fix itself over the weekend.
When it didn’t let up, his wife called his primary care physician — who sent Fijolek, 56, to the Edward Hospital emergency department.
A series of diagnostic imaging procedures followed.
Dr. Victor Hu, a radiologist with Naperville Radiologists, questioned an abnormality in the blood vessels in Fijolek’s lower spinal cord.
Dr. Michael Caron, a neurosurgeon with the Edward Neurosciences Institute, diagnosed Fijolek with an arteriovenous malformation (AVM) on his spinal cord and admitted him to the hospital for surgery.
Dr. Ali Shaibani, a neurointerventionalist and medical director of the Edward Neurosciences Institute, says spinal AVMs are very rare and very serious.
“When you get your blood pressure taken, it’s measuring the pressure in the arteries,” Dr. Shaibani says.
“(The blood goes) from arteries to capillaries to veins. With an AVM, there are no capillaries in between, so very high-pressure arteries are dumping directly into veins, which are supposed to be low-pressure. They actually reverse blood flow. You’re backfilling the spinal cord and that can lead to ischemia, or death of cord tissue.”
If left untreated, Fijolek would have risked bleeding in the spinal canal, spinal cord damage, bowel or bladder dysfunction, or paralysis in his legs.
But the location of the AVM made it difficult to operate on without damaging the spine. So, Shaibani found a minimally invasive way in.
He performed a spinal angiogram, which identified two arteries supplying the AVM.
He was then able to treat the AVM by entering one of the two arteries with a small catheter (plastic tube), then “embolizing” (filling) the abnormal tangle of blood vessels with a liquid polymer that hardens to a rubbery consistency.
By filling the abnormal short circuit between arteries and vein, he was able to cut off blood flow to the area and stop its growth. This was all performed through a quarter-inch skin incision over the main artery to the right leg.
Fijolek stayed in intensive care for six days.
He was back to work in late May, and after a couple of months, he experienced virtually no pain except an occasional pinching in his back.
He has an MRI scheduled for his year follow-up, and doctors plan to keep watching the area.
Shaibani says he doesn’t expect any problems.
Fijolek’s voice catches when he talks about his surgeons.
“Since that time in May, I’ve thanked them both very much for doing what they did and can’t say enough about them and how I was treated at Edward,” he says.
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