Collaboration, expertise leads to successful outcome for police officer facing high-risk surgery

Shannon Sampson recognizes the value of teamwork.

As a crime prevention and community outreach officer with the Cedar Rapids Police Department, and as coordinator of the Linn County Safe Kids Coalition, Shannon works closely with fellow officers, Cedar Rapids firefighters and other safety professionals, area schools, and community groups to help keep families safe and well-informed.

She also appreciates teamwork outside of her job—like the University of Iowa Health Care neurology, neurosurgery, and cardiothoracic surgery teams that collaborated to identify and remove a potato-sized tumor that could have left her paralyzed.

UI Health Care specialists discovered the tumor following an MRI of Shannon’s thoracic spine (upper back), more than a year after she first noticed symptoms.

“In January 2018, I woke up one morning, and the toes on my right foot were numb,” Shannon says. “Over the course of several months, my left toes went numb, then my feet. Eventually, the numbness worked its way up my legs, particularly my right leg.”

In summer 2018, Shannon’s family doctor in Cedar Rapids referred her to local specialists who performed a number of tests and scans of her brain, cervical spine (neck), knee, and lumbar (lower back) region. However, they could not pinpoint the problem. 

Meanwhile, Shannon’s symptoms grew worse—numbness and weakness in her legs and severe back pain that made standing and walking extremely difficult at times.

“I was trying everything—heat, ice, pain relievers, physical therapy. Nothing would work,” she says.

Shannon’s Cedar Rapids doctors referred her to UI Health Care. In late January 2019, she met UI Department of Neurology specialists Annaliese Bosco, MD, a fourth-year resident physician, and Christopher Nance, MD, clinical associate professor. The neurologists performed a physical exam, reviewed notes from Shannon’s case, and localized her problem to the thoracic spinal cord—an area that had not yet been imaged.

A dangerously pressing issue

Shannon had the MRI on Feb. 14. Right afterward, she was instructed to go to the Emergency Department, where she got the news: A large mass had developed in her thoracic region and was pressing against her spinal cord. The tumor also was dangerously close to Shannon’s aorta, the large artery that pumps oxygen-rich blood from the heart to the rest of the body.

“I immediately broke down crying, because I automatically thought ‘cancer.’” she says.

Shannon’s tumor was not cancerous, however, as tests would later confirm. Hers was a schwannoma, a benign mass that originates from the layer of insulation that surrounds nerve fibers. These nerve sheath tumors, which are typically slow-growing, can arise anywhere in the body. Treatment is necessary if they grow large enough to interfere with underlying nerves or, in Shannon’s case, the spinal cord.

Shannon was admitted to the Neurology/Neurosurgery Unit at UI Hospitals & Clinics. Her husband, Mike, who was out of town at the time, flew home the next day.

Over the next several days, teams of doctors, nurses, and staff met to discuss Shannon’s case and convened at her bedside during morning rounds to go over plans to remove the tumor and prevent permanent nerve damage or paralysis. Both neurosurgeons and cardiothoracic surgeons were part of the multidisciplinary approach.

“It was impressive the way everyone worked together,” Shannon says. “Every morning, the neurosurgery team would come in, then the cardiothoracic team. Each team would explain their plan, but they also stressed that they would coordinate with each other.”

Careful collaboration among surgical teams

While Shannon’s tumor was not rare, its location made surgery extremely risky, says John Keech, MD, a cardiothoracic surgeon and clinical associate professor in the UI Department of Surgery.

“This tumor was in a somewhat unique position, sitting between her chest space and her spinal cord space,” Keech says. “Any type of surgical plan was going to be difficult. This was not your typical bread-and-butter procedure—it required a multi-team approach.”

Collaboration and detailed discussions about tactics and strategy were extremely important to minimize risks to the patient, notes Satoshi Yamaguchi, MD, PhD, assistant professor in the Department of Neurosurgery.

“If we ‘chased’ the tumor too much in removing it from the spinal area, we might cause dangerous bleeding of the aorta or penetration of the lung,” Yamaguchi says. “We are not so familiar with operating in this area. That’s why we needed the expertise of cardiothoracic surgeons who are more experienced working in the thoracic cavity.”

The cardiothoracic surgeons, on the other hand, faced the challenge of removing the tumor from next to Shannon’s aorta while also not injuring the spinal cord. 

While the two surgical teams have worked together in the past on complex surgical procedures, they don’t often encounter cases like Shannon’s. Nevertheless, a plan came together quickly and seamlessly.

“We talked it through quite a bit,” Keech says, “determining what they were going to do, what we were going to do, and what order these things would occur—knowing this would be a long time in the operating room and with some significant risks involved. But we discussed it with Shannon, and she was on board.”

The neurosurgery team—which included Yamaguchi; neurosurgery department chair Matthew Howard, MD; chief neurosurgery resident Oliver Flouty, MD; and neurosurgery resident David Christianson, MD—went first. The operation involved a large incision on Shannon’s back to remove a portion of her thoracic vertebrae in order to take out the section of tumor that pressed against her spinal cord. Metal rods and screws replaced the removed vertebrae.

After the neurosurgeons closed their incision, the cardiothoracic surgery team, led by Keech, took over. Using a minimally invasive approach—three small incisions on Shannon’s side to access the tumor through her ribs—the cardiothoracic team removed the rest of the tumor.

The five-hour surgery went exactly as planned. 

In the intensive care unit the following day, Shannon was using a walker—a major step forward, because “my husband had spent a lot of days worried that I might be in a wheelchair for the rest of my life,” she says.

Five days after her surgery, Shannon was discharged from UI Hospitals & Clinics. She spent 10 days receiving inpatient rehabilitation therapy at St. Luke’s Hospital in Cedar Rapids, followed by months of outpatient occupational and physical therapy.

“It was a rigorous regimen, but I was up for it,” Shannon says. “Going back to work was my focus. I was determined.”

On June 21, Shannon returned to the Cedar Rapids Police Department. She’s working part-time but looks forward to full-time duties, possibly later this year.

“Being a police officer has been such a big part of my life. It was tough to think that I might not be able to get back to doing what I love, but here I am,” Shannon says. She celebrated 21 years as an officer in August 2019.

Expertise in complex surgeries

Shannon’s case is a “superb example of the special capabilities of a major academic medical center,” says Matthew Howard, MD, professor and chair of the Department of Neurosurgery and who also was part of Shannon’s treatment plan and follow-up care. “We have experts in every specialty who work together under one roof and have lots of experience taking on complex cases together.”

For Shannon, that breadth of experience and expertise showed.

“From that initial appointment with Dr. Nance, I felt confident that the team here was going to figure it out,” she says. “The morning after my operation, one of the surgeons noted that mine was a ‘very high-risk surgery.’ That really struck me after the fact—and it’s made me really appreciate what they did and how they helped me get to where I am today. I am so grateful to be walking and back to work!”