As a neurosurgeon, I see many types of tumors. But Jason Smith’s spinal schwannoma tumor was extremely rare for two reasons: its size and presence in a young half-marathon runner.
A schwannoma is a tumor that grows from abnormally divided Schwann cells, which cover the nerve cells in the spine. While schwannomas are a common type of nerve tumor, the National Cancer Institute reports that fewer than 200,000 people have them.
Like Jason’s, most schwannomas are benign and occur sporadically, though some are cancerous or hereditary. Jason’s symptoms included back pain, leg muscle weakness and balance issues. Patients may also experience dizziness and numbness.
Jason’s tumor was roughly the size of a cantaloupe. The 12cm tumor was compressing his spinal cord and had invaded his chest, displacing both a lung and a kidney. Based on the size, it had been there for at least five years, likely longer.
Clearly, the tumor had to be removed. When his original doctor suggested a large, open surgery in his chest and back, Jason sought a second opinion with the UT Southwestern neurosurgery team at the O’Donnell Brain Institute.
We developed a minimally invasive procedure to remove the tumor through one small incision. Jason’s was the largest tumor we have removed using this single-staged technique – avoiding open surgery and getting Jason back to running in less than six weeks.
Jason’s story: Schwannoma tumor removal
After I ran the Austin Half Marathon in 2015, my back was never the same. I had severe back spasms and a lot of tightness in my hamstrings, so I took about three months off from running to recover. When I started feeling better, I tried jogging from my house to my neighbor’s – less than a block, but my back tightened up so much I had to stop.
Over the next few years, I found temporary relief by getting deep tissue massages from a chiropractor. But by summer 2020, the pain became nearly unbearable. I struggled to walk and needed a massage pillow just to sit and watch TV. My chiropractor encouraged me to get an MRI scan to rule out any serious issues. That’s when the tumor was discovered.
My first concern was whether I had cancer. The neurosurgeon assured me the tumor was benign, but it was big and would have to be removed. His plan was to make a large incision in both my back and my stomach, which would require a long, probably painful recovery. Without the surgery, he said, I risked becoming paralyzed because the tumor was pressing on my spinal cord.
I wanted to be out running and playing with my two daughters, spending time with my wife, biking, and exercising as much as possible. I knew I needed surgery to return to a sense of normalcy – but I believed there had to be a better way.
The surgeon referred me to Dr. Carlos Bagley, Director of the Neurological Surgery Spine Program at UT Southwestern and an expert in minimally invasive spine surgery.
The consultation with Dr. Bagley was phenomenal. He and his team were confident they could get the tumor out without big incisions, and my recovery would be shorter and less painful. They explained every step of the process.
They would make a small incision in my back to approach the tumor. Then, they would remove the tumor from the inside out using ultrasonic vibration to “morselize” the tumor – gradually making it smaller until it fit through the small incision in my back.
That sounded a lot better to me than open surgery, so we scheduled the surgery for two weeks later.
‘I feel like I’m in my early 20s again’
I was prepared for up to six weeks of recovery, but I started feeling better a few days after surgery. I took the prescribed pain medication for two days and then switched to ibuprofen as needed. I gradually started walking more, and after five weeks, I felt so good I ran three miles.
Now that I’ve had the schwannoma tumor removed, I feel as if I'm in my early 20s again, even though I’m 45. Without Dr. Bagley and the O’Donnell Brain Institute team, I don’t know where I'd be today; I can run, lift weights, bike, and go on long walks with my family. I’m happier, well-rested, and able to enjoy life again.
As I continue to have follow-up visits, I can meet with Dr. Bagley at different clinic locations, based on what’s convenient for me. The team cares about my progress and my time, and they work around my schedule to make my life easier.
Related reading: A story of Hope and teamwork: Facing a brain tumor at age 24
Making personalization a priority
When we plan spine surgeries for young patients like Jason, we address the immediate problem, of course, but we also consider the next 40 years of active, high-quality life. While our goal was to remove the entire benign tumor, my priority was taking out the portion that had invaded his spinal cord and caused the back and leg pain that had prompted Jason to seek treatment years before coming to us.
Because our team works across traditional borders and pushes the envelope of what’s possible, we were able to develop a procedure that was personalized for Jason’s unique situation. When we can use advanced minimally invasive techniques, rapid recovery is common, making these techniques a game-changer for patients and providers.
While we never say never, the likelihood that Jason’s tumor will return is extremely low. We’ll continue to monitor him, and I’m hoping we’ll be friends for a long time – even though I don’t plan on seeing Jason in the operating room again.