As mentioned in previous blog, I did surgery at Duke Raleigh Hospital, and saw some patients at Hey Clinic. I then jumped on an airplane Monday evening, and then did an anterior release surgery with Dr. Richard McCarthy at Arkansas Children’s Hospital, on one of my patients named Janelle, who recently turned 6 years old. She has severe case of Early Onset Scoliosis (EOS) which has been very resistant to brace treatment.
Through my involvement with the Scoliosis Research Society, and combing the literature, I researched and presented several different treatment options to Janelle’s parents, after talking to several SRS surgeons from around the country that I know. Dr. McCarthy’s Shilla Procedure seemed like best option, since this procedure fixes the main deformity with a fusion around 3 disc levels usually at apex, but leaves the rest of the spine to grow in a guided way using rods that can slide through pedicle screws. Dr. McCarthy was not only willing to see Janelle, but allow me to come out for both the anterior portion of the surgery, and posterior portion to scrub in and learn and help.
The anterior release portion consisted of going in through Janelle’s side, and taking out three discs around the worst part of the curve. We found some benign neural tissue on the side wall of the vertebra and overlying the disc spaces that may have stimulated her unusual scoliosis, which we partially removed and sent for pathology. Bone graft from the removed rib was placed in those disc spaces.
A couple of days ago, on Friday, I was back out in Little Rock, and having breakfast with Dr. McCarthy at 6:30 am, who bought me breakfast and coffee as he reviewed a couple of talks on his laptop on the Shilla and other techniques. We went and talked to Janelle’s parents, discussing details of surgery. Dr. McCarthy shared how his first Shilla was done about 7 years earlier on a 2 year old patient, who has done just great, and has been able to get into little league baseball. The parents of this child have helped talk to other parents considering Shilla.
The posterior portion of the surgery went very well, doing fusion on the apical 3 vertebra and 4 vertebral bodies, placing bilateral pedicle screws in these vertebra.
Above and below this section, the muscle was preserved, and pedicle screws were placed percutaneously through the muscle using image guidance and special guidewires that went through the pedicle and into the vertebral body. The screws actually had holes in them, so they would go down the path of the guidewire. This prevented us from needing to dissect the muscle off the bone, which could cause unwanted fusion. These percutaneous screws above and below the fusion have holes at the top of them, so the 4.5 mm rods can actually slide through them as Janelle grows, allowing her chest and entire torso to grow more, but not needing multiple surgeries as is usually required with growing rod technology. Dr. McCarthy’s Junior Resident Eric was scrubbed in as well, and was great to work with. An excellent correction of the deformity was obtained, and she woke up and moved her legs well, and was extubated.
After the surgery, Dr. McCarthy and I got a chance to meet with Janelle’s parents, and show them the before and after X-Rays. They were so thankful.
And I was thankful too, for Dr. McCarthy’s excellent care of Janelle and her family, and for Dr. McCarthy’s excellent team at the hospital and in his office, especially his assistant Cindy who was very kind with all of the arrangements that were necessary to allow me to operate out of State, and at a whole new hospital!
I flew home Friday night as the sun was setting over the Mississippi River writing down all my notes from what I learned from this adventure. I learned a lot! I also feel like I made some new friends in Little Rock, Arkansas. I’ll be seeing Janelle back in Raleigh at Hey Clinic, and will do all of her postop care. I look forward to being able to share this new Shilla technique with some of our younger guests like Janelle who have severe Early Onset Scoliosis that does not respond to conservative management.
Many thanks again to Dr. McCarthy and his wonderful team for Janelle’s care, and helpful teaching and inspiration.
This is a great example how the Scoliosis Research Society helps to deliver better care to children, adolescents and adults around the world: surgeons and others working together to learn from each other, and research and develop better treatments with life-long learning. Learn more about SRS at http://www.srs.org.
Get well soon Janelle, and we look forward to see you back in Raleigh.
Lloyd A Hey, MD MS
Hey Clinic for Scoliosis and Spine Surgery
http://www.heyclinic.com
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