The pain in 7-year-old Logan Freitag's back was so excruciating, at times he would lie on the floor of his classroom at Metamora Grade School and just cry.
The Hancock-Henderson Quill, Inc.
Using latest technology, surgeons remove rare tumor from spine of 7-year-old child
February 19, 2003 (by Lisa Coon of the Peoria Journal Star used with special permission of the Managing Editor)
The pain in 7-year-old Logan Freitag's back was so excruciating, at times he would lie on the floor of his classroom at Metamora Grade School and just cry.
When he stood up, the second grader would press his hands against his lower back and push inward.
"He looked like an old man walking around," said Logan's dad, Mark Freitag.
Mark Freitag and his wife, Sandra (Hartman) Freitag, first noticed their son having difficulty last November.
He was taking gymnastics, and it was then he began complaining his back hurt. The parents thought their son pulled or strained some muscles doing backbends and walkovers.
Little did they know that just three months later, Logan would undergo a long and complex surgery to correct a rare condition called osteoblastoma, a tumor that was encasing one of the vertebras of his spine. These type of tumors account for less than 2 percent of all primary bone tumors.
When the pain persisted, the Freitags took Logan to their family friend and chiropractor, Dr. Tim Kaufman. On Dec. 4, Kaufman examined Logan and gave him an adjustment.
"Logan had been a patient since he was 2 months old and I treated his colic," Kaufman said. "He said his back hurt from doing backbends in tumbling."
The adjustment seemed to help, although Logan's parents noticed his flexibility was limited. "His hamstrings were really tight, he just wasn't very flexible," said Sandra Freitag, a special education teacher at Metamora Junior High School. The couple took their son out of acrobats, but he continued to play basketball on a team coached by his father.
"He just couldn't run like he used to," Mark Freitag said.
At a basketball game in late December, Logan cried in pain after being pushed to the floor from behind. Kaufman happened to be at the game, so the Freitags took Logan to the chiropractor's Germantown Hills office.
"I adjusted him again and gave them some stretching exercises to do with him," Kaufman said.
By the end of January, Logan's condition hadn't improved.
"Mark said the stretches just seemed to hurt Logan. He obviously had gotten worse. That's when I suggested we get an X-ray," Kaufman said.
The X-rays told Kaufman something was terribly wrong.
"When you take an X-ray of a friend, and see something like that . . . there was an area of the spine that looked like it had a tumor or congenital anomaly," Kaufman said. "My first impression was that it was a tumor, and of course, probably cancer."
But Kaufman never let on his fears.
He had the X-rays read by a radiologist to confirm what he was seeing. He then delivered them to Logan's pediatrician, Dr. Scott Carlson with the OSF Medical Group in Washington. For insurance purposes, it was the pediatrician who needed to order further testing.
"We looked at it together, indeed it was abnormal," Carlson said. "By this time, Logan was experiencing the back pain along with intermittent weakness and pain in the left leg. That's always concerning, especially in a child that age.
"The X-ray showed the L5 vertebrae and part of the side of that area to be gone, and it looked like there was something growing in there," he said. "We didn't know what it was."
Carlson ordered more tests to be taken at Children's Hospital of Illinois at OSF Saint Francis Medical Center.
At this point, however, the Freitags still weren't overly concerned.
"I still didn't think too much about it," Sandra Freitag said.
Her husband agreed.
"We were thinking maybe a compressed vertebrae or maybe a slight fracture," Mark Freitag said.
Sandra Freitag shook her head at the memory.
"The poor kid. We had just been sledding and the only thing he cried about was getting some snow in his boot," she said. "And here he was in this terrible pain."
The tests Carlson ordered were done on Jan. 31. Logan underwent a CAT scan and MRI.
"The MRI showed the anatomy pretty good, and we could tell there was some type of tumor in there," Carlson said.
As the Freitags waited for results, they left the hospital for something to eat. They had just received their food while sitting at the counter at Maid-Rite when Carlson called.
"Dr. Carlson said they found something, and we need to admit him," Sandra Freitag said. "We just sat there, looking at our food, thinking ÔOh my God.'"
Back at the hospital, Logan met with neurosurgeon Dr. Dzung Dinh, who specializes in complex spine cases.
"We did a few more tests and came up with a pretty good preoperative diagnosis of osteoblastoma. These bone tumors are very rare. When you see them, you have to decide whether they are benign or malignant, and deciding this dictates your treatment plan," he said. "Our goal was an effective surgical cure, and the second goal was to preserve all neurological function."
A third goal was to stabilize Logan's spine to prevent further injury.
"The tumor was very large and very extensive," Dinh said.
For Logan to be cured through surgery would take a multi-disciplinary approach involving a variety of specialists.
"For this kind of tumor, that's the only approach if we want to achieve those particular goals. And that approach is only available at a surgical center like this," Dinh said. "In the old days, these are the cases that would probably be done only at Mayo or John Hopkins.
"I feel very fortunate we have all these capabilities here," he said. "Unfortunately, the population, the people here, do not realize the capability we have right here in Peoria.
"For complex spinal or brain tumors, we have all the leading edge, state of the art equipment to perform any procedure right here in the Heart of Illinois," Dinh said. "Sometimes people go to Chicago seeking the opinion of Ôexperts.' What they don't realize is some of these Ôexperts' are our former students."
Logan's treatment began several days before surgery when Dr. Kenneth Fraser, an interventional neuro-radiologist, cut off the blood flow from the vessel feeding the tumor.
"By cutting off the blood to the tumor, it made surgery much safer and easier," Dinh said.
Logan's surgery took place on Feb. 6. Since the tumor was so large, however, it required more than a neurosurgeon going in through the back.
The surgery also required Logan's left side to be surgically opened, allowing the tumor and L5 vertebrae to be completely removed. For this part of the procedure, Dr. Ravindra K. Vegunta, a pediatric surgeon with Children's Hospital, was called in. Dr. William Olivero, chairman of the department of neurosurgery at St. Francis who has a specialty in pediatric neurosurgery, was also a member of the team.
"Since the tumor involved more of the left side, the approach was through the left side above the hip bone . . . this allowed access to the entire spinal column - side and front," Dinh said.
The extracted tumor measured about 6 centimeters (about 2-1Ú2 inches), and was the entire width of the encased vertebrae.
"Now we have this empty hole right where we took the tumor and vertebral body. We had to put something there," Dinh said. A bone from the bone bank was cut to size, grafted and stabilized with a metal plate.
Then Logan was flipped over and the surgeons finished the procedure on his back. More bone screws were used to stabilize the area.
"Essentially, it was a 360-degree approach," Dinh said. In all, the complex surgery took about 12 hours to perform.
"His prognosis is very good. There's some risk of local growth, but the risk is very small because we took a lot out," Dinh said. Local pathology reports indicate the osteoblastoma to be benign. Further testing is being done at the Mayo Clinic.
Kaufman, the chiropractor Logan's parents credit for "getting the ball rolling," is thankful his friends were able to get the care they needed for their son.
"We have such phenomenal doctors in Peoria," Kaufman said. "I told Mark (Logan's dad) we have the best neurosurgeons in the state. It's pretty awesome we have that available right here and it's not necessary to drive to Chicago, St. Louis or Iowa City."
Mark Freitag, a manufacturing specialist for Caterpillar, and his wife, agreed.
"You see the telethons for Children's Hospital, and don't think too much about it," Mark Freitag said.
"This makes you understand what they're all about."
Dinh credits Logan's parents for remaining strong.
"I can't say enough about them. They're the most courageous couple I've ever seen.
Being a parent myself, I'd be a basket case," he said.
"Logan's case is an extraordinary case. It's one of those anti-Murphy's Law situations, whereas, everything that could go right in this case, went right."