When business owner and consultant Dawn Pirthauer first came to Och Spine at NewYork-Presbyterian at the Weill Cornell Medicine Center for Comprehensive Spine Care, she thought her back pain would be a fairly straightforward case. Life intervened to make things unexpectedly complicated, including a spinal cyst, breast surgery, and even a distracted driver. But through the tireless efforts of her doctors, along with a team of specialists across all disciplines, Dawn is back to business, and back to her normal life.
“Dawn’s case seemed simple enough at first, with general back pain and joint aches,” recalls Dr. Jaspal Ricky Singh, the physiatrist who oversaw Dawn’s treatment. “After some time, however, we had a sense that something wasn’t right.” An MRI found the cause: a fluid-filled sac around the joints in her spine — a synovial cyst.
“A cyst is benign, but as it grows, it puts pressure on nearby nerves and can cause leg weakness and lower back or leg pain,” Dr. Singh explains. “To treat Dawn’s pain, we worked together with specialists in the radiology department — they used CT image guidance to locate, pressurize, and rupture the cyst. There’s always a chance a synovial cyst can return, but this procedure helps manage pain. And in Dawn’s case, that pain management was essential to helping her get through the long road ahead.”
A post-operative x-ray of Dawn's lumbar hardware
A Bump in the Road
That long road included a challenge that wasn’t related to the synovial cyst — it was breast surgery. “I ended up in the care of the Breast Center a short time after the MRI,” says Dawn. “My sister had just passed away, and out of caution the doctors there put me on the high-risk program. While they were observing me, they diagnosed a rare tumor. It was benign but aggressive, having grown massively in just four months.”
Her doctors advised that the benign tumor could turn into cancer quickly, so Dawn opted for a prophylactic mastectomy — a procedure that removes both breasts to reduce the risk of developing breast cancer. Over the next few years, she would have to balance treatment for the synovial cyst, which recurred, while she was undergoing cosmetic breast reconstruction.
Dr. Kai-Ming Fu was the spine surgeon in Dawn’s corner. “Dawn’s case required careful balance and coordination between various offices and the operating table,” says Dr. Fu. “Whenever a synovial cyst returns, the pain returns. We suspected she would do best with fusion surgery, but our game plan as a team was to give her as much pain relief as possible while she was undergoing breast reconstruction. So when the cyst returned, we performed a soft tissue resection to remove it and relieve pressure from the nerve root, giving her the mental break she needed for her reconstruction.”
Dawn soldiered on, attending appointment after appointment for her reconstruction. But as that treatment was finishing up, the synovial cyst returned again. “I was told that I had a cyst on top of a cyst,” recalls Dawn. “The radiation specialists weren’t even sure that they could get it, but they tried and got it on the first try. To be able to finish my reconstruction surgeries and have downtime without pain was so helpful. It helped give me a mental break and recover before my fusion surgery with Dr. Fu.”
“After Dawn was recovered from her reconstructive surgery, we went ahead with the spinal fusion to take care of the synovial cyst once and for all,” says Dr. Fu. “After we fused together the vertebrae, there was finally no place for the synovial cyst to reappear. The fusion surgery also carried the interdisciplinary spirit of Dawn’s treatment — Dawn’s plastic surgeon, Dr. David Otterburn, closed her up so that her spine muscles would heal better. The whole surgery was tricky, but it was a success!”
In fact, the surgery was so successful that, at Dawn’s next post-op appointment, Dr. Singh had to tell her to take it slow. “Her hardware hadn’t fused yet and there she was, standing on one leg at one point,” laughs Dr. Singh. “It finally felt like the light was at the end of the tunnel.”
“I couldn't be happier, it was life-changing!” recalls Dawn.
After the SI fusion, Dawn has more hardware installed
An Unexpected Development
Two weeks after that post-op appointment, Dawn was in the car with her parents when they were slammed from behind. “We were in standstill traffic and a woman rear-ended us going just under 50 MPH,” Dawn says. “Unlucky for me, I was in the back seat with hardware in my spine that hadn’t totally fused yet. I had visions of titanium being knocked loose in my body. I was in a complete panic.”
“I remember reading her x-rays from the ER,” says Dr. Singh. “She certainly dodged a bullet, and I can’t emphasize enough how much worse this could have been. You can do everything right, but some things are just out of your control. But we did what we do best — we made sure this accident wouldn’t set Dawn back.”
The team came together once more to see Dawn’s journey to the end. “Thankfully, the hardware remained in place, says Dr. Fu. “She felt pain in her hip, which I thought could just be general trauma, but we found that her sacroiliac joint was injured in the accident. As always, we were cautious before moving towards surgery and tried to manage her pain with minimally invasive solutions. Unfortunately, they were ineffective, so we scheduled Dawn’s third, and hopefully last, surgery.”
Now that it's all over, Dawn is almost as good as new - and back in heels, no less!
Photo: Claudine Williams
“As Dr. Fu and I like to joke, the third time was the charm,” laughs Dawn. With her sacroiliac joint fused and her synovial cyst gone, she’s glad to no longer be a patient. But she’ll always remember Dr. Fu’s last words to her at the Spine Center. “We all love you here, but take it slow, stay out of the car with your parents, and don’t come back!”
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