Friday, September 5, 2014

What could happen to a small thoracolumbar curve with trunk shift as adolescent/young adult 40-45 years later?


Pam, Age 20 on left in red with trunk shift to right.
Pam, Age 60, 1 year after scoliosis surgery
Yesterday we saw Pam and her husband Gerry for her 1 year postop follow-up at Hey Clinic for her thoracolumbar-iliac wing instrumentation and fusion with laminectomies and osteotomies.  She is doing really well, is active and really enjoys her new posture.  She shared a very interesting story, which she also shares on YouTube video below:  Recently she went home to the house where she grew up and found an old photograph of herself with her college roommate at age 20.  Pam studied the photograph and noted that the picture clearly shows that she had a slight trunk shift to the right, although she was never diagnosed with scoliosis.  For her wedding pictures a few years later, the photographer made her stand in a very awkward way, which he said made her look "straight" but to Pam made her feel wierd and unbalanced.  In the years to come, she noted increased back pain, loss of height, and worsening humps on her back with posture/appearance increasing difficulty.

This is really a wonderful "Time Machine" look at why it is important to screen and follow-up for scoliosis, not only in children and teen-agers but in young adults and older adults as well.  In this day and age, Pam could have had her scoliosis fixed at age 16 or possibly even up until her late 20's with a much smaller operation, which would have preserved a good portion of her lumbar mobility, while centering the loads to help prevent those lowest discs and facet joints from wearing out prematurely, causing back pain as well as possibly sciatica, spinal claudication and leg pain and trouble walking.  Increased awareness by not only pediatricians, but OB/GYN's , family practitioners, chiropractors, physical therapists and others can help ensure that patients like Pam are diagnosed early, and followed regularly, so they potentially can choose less invasive options that could prevent issues in years to come.

Fortunately there is also hope for the older adults who have progressive deformity, and/or increasing pain and problems with quality of life, as Pam can attest!

Thanks for being willing to share with others on the blog, Pam and Gerry!

Dr. Lloyd Hey, Hey Clinic for Scoliosis and Spine Surgery  
http://www.heyclinic.com



Monday, September 1, 2014

Another interesting and busy week caring for kids, adolescents and adults with spinal deformity, spondylolysis, and spondlylolisthesis


All of us at Hey Clinic are catching our breath this holiday weekend after a good, but very busy weeek in the clinic and at the hospital caring for children as young as 4 years old, up through tons of teens with adolescent idiopathic scoliosis, and adults with old adolescent scoliosis deformity now concerned about increasing curves and/or quality of life issues.  Many folks got good news that their curves were small and / or have not progressed, while others learned that their curve had become quite large due to growth or degenerative collapse.  We heard from many of ALL ages worried about long-term consequences of their deformity on their posture, pain, quality of life, future pregnancies, need for future back surgery, and its affect on sports and exercise.


Mom of adolescent idiopathic scoliosis teenage girl shares before and after pictures from her surgery with us at Hey Clinic

16 yo young man 6 weeks postop from Scheuermmann's kyphosis surgery and his mom share their story on improved posture, quality of life and 2-3 inches of new height!!


Here's a sample of some of the folks we saw in last week or so back for follow-up telling their stories, which can be also found on our YouTube Hey Clinic channel, with their permission to share these stories with all of you!  

Our annual SRS meeeting (SRS.org) is coming up this coming month, and as Chairman of the Adult Deformity Committee, there is a bunch still to be done, working on some presentations, publications and reports.  I always enjoy this meeting though -- always plenty to learn and share with scoliosis colleagues from literally around the world!

14 yo returns to soccer during first few weeks and months after scoliosis surgery.  Patient and family share their thanksgivings, appreciating care at Hey Clinic and Duke Raleigh Hospital

When should I get a scoliosis evaluation as an adult? Should I get up the courage to go and talk to someone about my scoliosis concerns?

My PA Rachel and I spent a good hour with Diana, who is now 70, but looks and acts more like someone in her 30's or 40's!  Diana had adolescent idiopathic scoliosis, and had upper curve fixed with non-instrumentated fusion, and postop casting in 1957, before the Harrington rod instrumentation was done commonly.  She spent a month in the hospital, and a whole year recovering with a postop cast, then back brace, and lots of time in bed.

She is incredibly healthy, and does everything possible to maximize her spine health:  keeping her weight down, core strengthening, low impact aerobic exercise, and some physical therapy in the past.  We saw her back in 2007, and she came back for follow-up with concerns that her lower curve was collapsing, and some new symptoms.  This past week, she saw us back, and indeed her lower curve has progressed, and trunk shift has increased.

Here is email interchange with my PA Rachel responding to her email below.  It does take courage to go and see a scoliosis expert regarding your curve, but we do try very hard at Hey Clinic to use it as a time to educate, track the curves and quality of life and other factors carefully, and just let you know what your options are moving forward.  We also try to let you know what to look for as "warning signs", or "red flags" that might indicate when/if more serious trouble may be brewing due to severe spinal stenosis, disc herniations and/or cauda equina symptoms which may make surgical intervention more necessary and immediate.  From Diana's email below, you can tell that she was glad to make the trip and learn more about her current state, changes over time, and options moving forward.

In general, remember that it is good to have your scoliosis checked every year through age 25, and every 3-5 years thereafter on X-Ray, even if you have had a previous fusion, since there can be degenerative curve collapse, and this X-Ray measurement data over time can help you to know if you are dealing with a progression.  Carefully checking your height each year is also a good check --- any height losses more than an inch is worrisome sign of potential significant curve progression.

Dr. Lloyd Hey, Hey Clinic for Scoliosis and Spine Surgery

----------------------------

Diana,
I'm glad you had a good visit yesterday.  We enjoy being able to take the time to educate patients and clearly convey all options.  The blog is an excellent resource for real life stories too, for patients who were once in your shoes.  We also have some patients who have said they would be happy to talk with anyone who is interested or considering he surgery.  If you would like to pursue this, let me know and we can arrange this.  Please let us know if we can help you with anything else.  We look forward to hearing about your therapy and following you.

Thanks for the encouragement and I will pass this along to Dr. Hey as well.

Rachel

> On Aug 30, 2014, at 9:25 AM, "Diana> wrote:
>
> Rachel,
> It was a great pleasure to meet you yesterday, although we didn't talk much.  I appreciated your input into my reevaluation.
> Please let Dr.Hey know that although it's very hard for me before the fact to  think of talking to an orthopedic surgeon about my back, Dr. Hey makes it a very good experience when I actually have the appointment.
> I appreciate his sensitivity and understanding, and I am so grateful   he took the time to listen to me, reassure me, and give me hope.  I have been looking at his blog this morning, reading the stories and looking at the pictures and xrays.  When it comes to the scoliosis I have, I usually swing from keeping my head buried in the sand to feeling doomed.  I felt so much better about my future when I left your office yesterday.  I'll continue to do all the things which keep me healthy, but I am conforted to know that there is medical  help for me if I need it.
> Thanks Rachel, and please thank Dr. Hey for me, and for my husband.
> Diana
> PS
> ALL of the staff is wonderful! 

Sunday, August 24, 2014

Is adolescent scoliosis surgery worth it as a young adult? Angela's surprise visit this past week to Hey Clinic

9 years ago this past week, I met a young lady named Angela from North Raleigh, NC who was about to start high school.  Her pediatrician noticed a hump on her back, and sent her to me for possible scoliosis.  It turned out that she had thoracolumbar curve over 50 degrees with a very large hump and trunk shift. Mom and Angela were like deers in the headlights -- what a shock!!  She was a cheer-leader, and was afraid she would have to give it up.  She was glad to hear that we get our athletes, including gymnasts, cheerleaders, swimmers, lacrosse players, soccer and basketball players, climbers ... and much more back to their sports quickly after surgery.  They decided to go ahead and get Angela's curve fixed right away.  I rearranged my OR schedule for the following week.  She went to her first day of high school on Monday, had her scoliosis surgery on Tuesday at Duke Raleigh Hospital, went home from hospital on postop day 2 on Thursday.  The day after that on Friday, she went to school for a few hours, and the following Monday went to school and her first cheer leading practice!  Her mom was so psyched, that she videotaped Angela at practice and drove it over to show me at Hey Clinic that afternoon!  Angela continued to do well, very happy with her posture, and gradually returned to full cheer-leading as a "flyer."  Her mom gave me the picture shown below which is on our Hey Clinic wall showing Angela AFTER her scoliosis surgery up on top of pyramid with one leg directly over her head!!

9 years have gone by since then, and lo and behold, almost 9 years to the day since I did her surgery, Angela dropped in to see me this past week!!  Here we are at Hey Clinic in front of her picture on the wall as the cheer leader in high school --- now she's all grown up, graduated from college and has a great job in the Triangle working with local universities.   Above you can also see a short YouTube clip with Angela from her visit.   Thanks for dropping in Angela!! So glad you are still looking and doing awesome 9 years after scoliosis surgery!!  
Dr. Lloyd Hey, Hey Clinic for Scoliosis and Spine Surgery http://www.heyclinic.com

Saturday, August 16, 2014

Back from vacation…."She Looks AWESOME" text from Bree's Mom correction of 110 degree Early Onset Scoliosis (EOS)

This Wednesday I got back from a wonderful two and a half week vacation with family, which included some phenomenal time out in the Pacific Northwest, including Glacier National Park --- breathtakingly beautiful!!!  If you ever get the chance to go there, GO!!  Also got a chance to see San Juan Islands, Seattle, and Helena, Montana.  We were also part of my brother's wedding celebration out in Seattle, which was just wonderful with lots of family gathering together.  It was a good break, although I did have to spend some time on my break working on some research papers and committee work for Scoliosis Research Society, which has a big meeting coming up in September.  I flew back into town Tuesday evening into RDU, glad to be home. I actually met 2 of my surgical scoliosis patients at the airport, and got a couple of hugs as I went through baggage claim!  So good to see some folks I haven't seen for a while doing well, enjoying travel.

The next morning, I was back in the scoliosis crafting "shop", and glad to be back.   I performed 2 scoliosis surgeries at WakeMed Children's Hospital, in Raleigh on a 9 yo Michael and 12 yo Jackson, both of whom had rapidly progressing right thoracic curves.  Both surgeries went very well, taking about 3 hours each, with very nice corrections, and no blood transfusions.  Jackson went home today  -- (he gave me a big green balloon before he left) on postop day 3, and the other will be going home tomorrow.  Both were up walking postop day 1 with one night in the PICU, extubated in the operating room.

Thursday we helped a girl at WakeMed Children's Hospital named Bree who just turned 10 who had a 110 degree early onset scoliosis (EOS).  Depending on the size of the patient, chest wall size, and other factors, we consider 3 options for treating such curves in younger children:  Growing Rods or Shilla Technique for a multistage surgical approach vs. a definitive instrumentation and fusion, possibly anterior/posterior and/or with posterior osteotomies, or possible larger vertebral body resection (VCR).  In the "old days", we used to worry about "crankshaft phenomenon" when performing definitive fusions in kids under 10, but with the dawn of stronger segmental instrumentation with thoracic and lumbar pedicle screws, this no longer appears to be an issue even for younger kids, down to even 6 or 7 in some cases.  We often do second opinions to help families decide which is best approach, and the best timing to optimize growth, minimize surgical risk and number of surgeries needed, and maximize curve correction.  the other issue that has to be addressed is when to use preop skeletal traction.

Over the years, I have been working on figuring out less and less invasive ways of trying to get better and better scoliosis curve corrections with less surgical risk and surgical time.  Bree's surgery this week gave us ample opportunity to hone this "craft" of curve correction in a very severe 110 degree curve.

Bree was totally psyched for her surgery Wednesday morning and let me know how straight she wanted to be!  She did not have preoperative skeletal traction.  Using some less invasive, but multiple osteotomies over several levels, and some creative instrumentation engineering leverage, we were able to get a really nice correction for Bree without any changes in her evoked potential monitoring, and no blood transfusions, and about a 5 hour total surgical time, extubated at the end of surgery.

I also used some new twists on a pedicle screw insertion technique I have been perfecting that worked very well, helping to direct the screws in her incredibly twisted and deformed spine in a very safe and efficient way bilaterally.

Bree was extubated in the OR, spent a short time in PACU, and one night in the PICU off the ventilator.  On postop day one, she was transferred to the floor, got up and walked around, and was 3 inches taller!!  Around lunchtime I received the "before and after" picture below texted to me by Bree's mom which said

 "She looks AWESOME!"


Get well soon, Bree!  You do look Awesome!!!

The learning never stops, learning every day -- day after day -- year after year how to serve and "straighten" children, adolescents and adults better and better.  This job is never ever gets boring.  The families are awesome, the people I get to work with in the clinic and hospitals are awesome, and it is just so great to see how together, as a team we are literally able to change a life for the better -- a change that will benefit children like Bree for the rest of her life -- even her first day back to school.  Her smile, and her mom's smile seeing her X-Ray and new posture after surgery makes us smile too!

Friday I did another scoliosis surgery on a 13 yo and made his "hump" that was painful and on right side of chest go away.  His preop curve was 53 degrees.

While it was great to be on vacation, my passion, and our passion at Hey Clinic and with our team members at Duke Raleigh Hospital and WakeMed Children's Hospital is definitely helping kids like Bree, Michael and Jackson, as well as some older teens and adults as well.

It's good to be back.

Lloyd A. Hey, MD MS
Hey Clinic for Scoliosis and Spine Surgery
http://www.heyclinic.com