Sunday, September 29, 2013

Justin's Mom Tells Their Story of Justin's Spondylolisthesis Journey

Justin's mom just sent me this blog entry to tell their story.  
My summary of Justin's surgery is found on previous blog.
Dr. Lloyd Hey -  Hey Clinic for Scoliosis and Spine Surgery
http://www.heyclinic.com
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In January of 2010 our son Justin was diagnosed with a grade 3 Spondylolisthesis. He underwent spinal fusion surgery at L-4 to S-1 on June 9, 2010. Although the doctor proclaimed the surgery a success our son’s recovery was plagued with complication. During a routine follow up exam in June of 2011 it was discovered he had a cracked screw and on April of 2013 the surgeon stated a second surgery was required to remove the cracked screw and a loss screw. The surgeon recommended an anterior and posterior approach to correct a now grade 4 Spondylolisthesis.
We didn’t want our son to have a second surgery but God opened our eyes to his daily struggles and limitations. He was experiencing limited movement, walking bent forward and his low self-esteem. Our son has not played sports for 3 ½ years.
Our Journey was not an easy one, who could we find and trust to care for our child as if he was their own? Our searches lead us to Dr. Hey at The Hey Clinic.  When we met with Dr. Hey his confidence and expertise was evident and we agreed upon a surgery date at that very first visit.  Dr. Hey also suggested that we feel confident with him by getting a second or third opinion. 
A wise man seeks councils from others and that is what Dr. Hey did he consulted with doctors from around the world and determined that the anterior approach was not required.
Our Son’s second surgery was performed at Duke Raleigh Hospital on September 26, 2013 his surgery consisted of removal of the Legacy hardware inputting of new hardware, posterior exploration of fusion mass, lumbar 4 to iliac wing.  The surgery lasted 9 ½ hours. Before surgery Dr. Hey prayed a prayer of thanksgiving.
 We were able to leave the hospital on September 29, 2013 and our son is walking upright with minimal assistance; he is almost three inches taller and will be returning to school in a few weeks.
Dr. Hey was a God sent to us; we pursued a third opinion and were given no hope of our son walking normally with a 25% percent chance of foot drop. If you are faced with decisions such as ours please contact The Hey Clinic, his staff is top notch and can answer any question you may have. When our son had surgery the operating room nurse Kelly came in on her day off.  I pray you get a second opinion from Dr. Hey it can change your life, it did for our family and now our son has hope for a brighter future.

Yours Truly, The Harper Family


16 yo Justin with Grade 4 L5-S1 Spondylolisthesis pseudarthrosis with flatback syndrome and 45 degree anterior tilt goes home today!

At Hey Clinic, we see many straightforward adolescent, early onset and congenital scoliosis patients, as well as  adult patients who had adolescent and/or childhood scoliosis now with curve progression and pain.  We also see many patients for second and third opinions for surgery, revision surgery and scoliosis bracing.  Some of the revision surgery consults we get can be quite challenging, and actually require me to do further research, and even touch base with some of my Scoliosis Research Society (SRS.ORG) colleagues around the world, as well as combing the literature to find the best, least invasive solution.  Some cases also require me to really use my engineering training and experience, carefully examining the loads, vectors, and translation and re-angulation forces, as well as rod/screw stresses to figure things out.

Justin's case definitely fit into this last category.  Justin had a high grade L5S1 spondylolisthesis, probably Grade 3, which means that his L5 vertebra was slipped between half and 3/4 forward on the sacrum.  He had an instrumentation and fusion done elsewhere at age 13 from L4-S1, fused in situ, meaning that they just fixed it in the position he was in.  Unfortunately, the hardware loosened and one screw broke, and the L5 vertebra slipped even further forward, and then started to fall off the front of the sacrum, tilting forward about 45 degrees.  One of the remaining sacral screws was poking out, tenting the skin on the left side.  Justin had quite a bit of pain, and really couldn't stand up very well, having to keep his knees bent with "flat back syndrome" posture.  In some sense you could say that Justin's top half of his body was not very well connected to the bottom.  Big problem.



There are several ways to approach this problem:  one way would be to go anteriorly and posteriorly (front and back), and jack up the L5 vertebra back on top of S1, with an interbody spacer.  That's pretty invasive though, and runs small risk of retrograde ejaculation, which could make Justin sterile.  Another way to do it is through a posterior approach, to try to pull the L5 vertebra back into position and tilt it back up where it belongs.  The problem with this approach is that it can cause a stretch injury to the L5 nerve roots.  To help prevent the L5 nerve root problem, you can do something called a "dome osteotomy", where you cut off the rounded off top of the sacrum, shortening it a bit, and give the sacrum a flat surface so the L5 vertebra can sit on top of it.  This shortening helps prevent the stretch on the nerve roots.

After much preop research, planning and discussion, including with several of my SRS colleagues at the SRS meeting last week, including Dr. John Emans and Tim Hresko from Boston Children's Hospital and Dr. Sig Berven from UCSF, a final surgical plan was developed.  I found several good articles out there through PubMed, and this article from Kan Min et al in the European Spine Journal had a very good discussion of the surgical technique for the decompression and reduction.

His surgery went very well this past Thursday.   I used a special operating room bed and 3D Navigation to help with the anatomy, and new hardware placement and correction.  I was able to get the broken screw out of the sacrum using special screw removal set and the 3D nav.  The L5 nerve roots were carefully identified and decompressed, including removing the disc bulges below both nerve roots, and ensuring nerve roots were freed up.  Then, I completed the L5S1 discectomy, identifying the large "dome" of bone of top of sacrum, rounded off by the spondylolisthesis over time.  Using the bur and osteotomes, coming at it from both sides, gently retracting the nerve root sac, I was able to remove the "dome", and create a shorter, flat surface.  I then used 2 very strong iliac wing screws combined with redirected sacral screws and carefully contoured titanium rods to form the foundation of the construct.  I then used my special "Pursuader" system to very slowly and gently pull L4 and L5 backward and into alignment, doing a few twists of the "corkscrew" tops then waiting, checking the evoked potential monitoring, and checking the L5 nerve roots bilaterally for tension and pressure.   "Cool" was the word at that point.  The L5 vertebra came beautifully back into position.  Very Cool.   Slowly, and steadily the L5 vertebral body, and Justin's entire top half of his body slid back into proper position, at which point I was able to lock the caps into position, put in the bone graft and close!!   No evoked potential changes and we were able to get a great correction.  This whole process took about 6 and a half hours!! Whew.  Aftwerward, Justin's folks were definitely thankful, and so was Justin as you can see below.  He has done wonderfully postop, standing up straight, and with his nerves all working fine.

So, Justin went home today looking and feeling well.  Many thanks to everyone who helped make his surgery so successful, including my spine colleagues, and even "Nurse Kelly" who came in on her day off to help.

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


Saturday, September 28, 2013

12 yo Madeline goes home from Duke Raleigh Hospital postop day 2 after her scoliosis surgery with big smile! Nice note from her parents to thank Hey Clinic and Duke Raleigh Hospital Staff.

 After getting back from SRS Sunday late afternoon from Lyon, France, it has been a busy week in the operating room and clinic, culminating with both clinic and surgery on Friday. Before heading home Friday night, I checked my texts and emails before hitting the road home.  In the stack of messages,  I found this very encouraging note from Madelene's parents:

Dear Dr. Hey,
I can only imagine that you receive many emails from extremely thankful parents just like us.  It has been almost 1 year to the day that we learned about Madeline's scoliosis.  I vividly recall being very overwhelmed and frightened at the onset of her diagnosis. Her curve was progressing quickly.  Those feelings were compounded when we were informed by another orthopedic about the possibility that she may have neurofibromatosis.  Once we were able to rule that out, it was actually a relief to be able to focus on the scoliosis. 

During those beginning weeks, I knew that I had to do more research and learn of other specialists in our area.  I wanted to be sure we had a Dr. who was exceptional in his/her field.  Thanks to Google, we found you!   I was immediately impressed with your website.  The expertise, knowledge, and compassion of your clinic was evident from the website--and it was quickly solidified the moment we had our first appointment with you.  My husband, a design engineer, was able to connect with you thanks to your background at MIT and the technical/design component that comes with orthopedics.  We appreciated your knowledge and kindness as we navigated through finding the right time for Madeline to have the surgery. Everyone in your office has been gracious, professional and helpful. Words cannot express how grateful we are to all who have played a part in Madeline's journey.  

I am also thrilled with our experience at Duke Raleigh. The level of care we have received at Duke Raleigh has been phenomenal.  Everyone from Holly, to Maggie the OR nurse who comforted Madeline as she was so scared right before surgery, to the nursing assistants has been so wonderful.  It's been another blessing to have you stop by our room each day.  Those few minutes of face time with you are reassuring to all of us.  Madeline's face lights up when she sees you.

God blesses each of us with a gifts and you have many for which we are eternally thankful.  Best wishes to you and the many pre-teen girls and their families who enter your office.  May everyone have a lifetime of hope for a "straight" future!

-Nancy and Brett W____

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I got a chance to see Madeline each day this week twice a day after her surgery at Duke Raleigh Hospital this past Wednesday.  She was in her private room Wednesday evening with her parents doing very well, just a little swollen in the eyelids.  She introduced me to "Sprinkles", her little stuffed animal, who indeed had very colorful sprinkles all over.  I showed her the X-Ray, which showed her spine all straight, and she gave me a big smile.  She then reached around her back and felt her back where one of her two humps used to be... and she said "The hump is gone!"  A happy day for Madeline and her folks.

 Postop Day 1 on Thursday, she was quite a trooper, getting up in the morning, and walking down the hall and back again with physical and occupational therapy.  Yesterday, Friday, she went to the homebound room, and got cleared going in and out of the test car, and climbed some stairs.  I got a chance to see her and her folks and get a couple quick photos together before she headed home.

Having the chance to serve families like Madeline's is a such a joy, that it energizes all of us at Hey Clinic and Duke Raleigh Hospital and WakeMed Children's Hospital to keep serving better in the future!

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

Wednesday, September 25, 2013

12 yo Madeline got her "straight wish" this morning at Duke Raleigh Hospital.


I just finished doing surgery on 12 yo Madeline, who had a double curve scoliosis progress to 52/48 this past July.  Dad thought curve has gotten bigger in the couple of months since then, and curves definitely looked a bit bigger with her in big growth spurt.  As shown above, we got a nice correction, and her lower 3 lumbar discs are now in much better alignment -- should last her a lifetime.  Her preop "humps" that we could even see under anesthesia on OR table are gone.  Time go to see the parents.  Surgery took 3 hrs 52 minutes, with no blood transfusions.

Dr. Lloyd Hey -- Hey Clinic for Scoliosis and Spine Surgery  -- http

Thursday, September 19, 2013

Are Scoliosis Braces Adolescent Idiopathic Scoliosis Effective for Stopping Curve and Preventing Surgery? New Weinstein Randomized Control Trial Published Today NEJM and Presented at SRS says "YES!"

I had the opportunity to hear Dr. Stuart Weinstein present the results of the BRAIST Randomized Control Trial for scoliosis bracing here at the Scoliosis Research Society (SRS) conference in Lyon France.  Also today, the study is published in the New England Journal of Medicine (NEJM) and you can read the whole article online by clicking here:  http://www.nejm.org/doi/full/10.1056/NEJMoa1307337?query=featured_home#t=article.

Dr. Weinstein was able to show that bracing was able to allow 75% of the children/adolescents who were braced were able to keep a curve below 50 degrees, with 50 degrees at time of skeletal maturity being considered a "failure" and all others considered a "success."

After the session was over, I got a chance to go up and speak to Dr. Weinstein, and to Dr. Lori Dolan, his co-author for U. Iowa to discuss the paper in greater depth.  Both were very gracious with their time, and I got a chance to talk to Lori at greater length. Several key points from our dialogue emerged:
1) Current indications for scoliosis bracing is far too broad and needs to be narrowed.  We are bracing too many children and adolescents who are not benefiting from treatment.
2)  Scoliosis Bracing does benefit a subgroup of patients, but the children/adolescents must be willing to wear the brace for 13-18 hours per day to have a reasonable chance to see any benefit.
3)  Lori agreed that we can't fully declare "success" with no surgery or curve less than 50 degrees at skeletal maturity, since some of those patients will continue to progress and/or have pain in adulthood and may eventually need surgery.
4) The emotional/family effect of wearing a brace during adolescent growth period should be considered when making the decision and personalized for each situation.

I also had some time this afternoon to see a couple of good science blogs talk about the article as well:
http://www.science20.com/news_articles/back_braces_work_adolescents_idiopathic_scoliosis-120784.

Here's an extended quote from the ScientificBlogging Site that gives a nice summary of the paper and some quotes from Dr. Weinstein:  For the study, investigators enrolled 383 subjects at 25 institutions in the United States and Canada between March 2007 and Feb 2011. Although the study began as a completely randomized clinical trial, the team eventually added a "preference cohort," where patients and families could choose their own treatment. About 40 percent of study participants were randomly assigned to bracing or to close observation without bracing. The remaining participants made their own choice regarding bracing or observation.
Patients in the observation arm received no specific treatment, while those in the bracing arm were instructed to wear a brace for 18 hours per day. Treatment was considered to be unsuccessful when a curve progressed to 50 degrees or greater – a point at which surgery is typically recommended. Treatment was considered a success when the child reached the age of skeletal maturity without this degree of curve progression.
In January 2013, the trial was stopped early after finding that bracing significantly reduced the risk of curve progression and the need for surgery, and that more hours of brace wear was associated with higher success rates. Among both the randomized and preference cohorts, 72 percent in the bracing group, and 48 percent in the observation group achieved success. In addition, the results suggest that the more a patient wore the brace, the better the results; wearing a brace more than 13 hours per day was associated with success rates of 90 to 93 percent.
"This study definitely shows braces work and are effective in preventing the need for surgery," Weinstein says. "Children who are at risk should be treated with a brace, and they should wear it at least 13 hours a day for it to be effective."
According to the researchers, the findings are clinically relevant to patients for whom bracing would typically have been recommended. But until now, that recommendation had not been based on solid data. "This study presents important evidence addressing the fundamental question facing families and clinicians dealing with the diagnosis of AIS – does bracing prevent the need for surgery? The answer is clearly 'yes'," Weinstein says.
The investigators also suggest that current bracing indications may be too broad, since 48 percent of patients in the observation group and 41 percent of patients in the bracing group who wore the brace infrequently also achieved success. "Further analysis will help us identify those AIS patients for whom bracing may be the most beneficial," Weinstein concludes.
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I liked Dr. Weinstein's comments in the blog above, but would probably be cautious about concluding that bracing prevents the need for surgery altogether, since the endpoint for their current study is only until skeletal maturity --- the game isn't over when you are done growing.  In our natural history study that we are preparing for publication now, as many as 38-40% of patients with scoliosis as a teen continued to progress during adulthood.  Lori did say that they are planning to do a 2 year follow-up on their cohort to see if there is any further progression.  We both agreed that even long-term follow-up would be helpful -- even lifetime!!  Certainly my hundreds and hundreds of adults over the years with progressive painful scoliosis would encourage us to consider such a long-term, full life approach.
In any case, it is a wonderful study and may encourage some of our guests to consider bracing, but it is a decision that requires dialogue with all parties -- especially the young lady or gentleman who needs to commit to wear the brace for at least 13 hours a day for possibly several years.
Getting new guidelines for scoliosis bracing will also be important to look for in the future motivated by this study.  

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



Wednesday, September 18, 2013

Are You Taller After Scoliosis Surgery? Duke Raleigh Hospital Blog Article ---- Adolescent Idiopathic Scoliosis Surgery Satisfaction -- Destination Medicine

Yesterday, this posting went up on the Duke Raleigh Hospital Blog, regarding one of our recent adolescent idiopathic scoliosis families.  I've copied the text below, or you can go to the link above.
The picture at the top of their blog is from the beautiful gardens and gazebo right next to Hey Clinic, which sits right next to Duke Raleigh Hospital.  We are so thankful for the excellent preop, operating room, and orthopedic floor staff from Duke Raleigh who work so closely with our Hey Clinic team and each patient family to deliver excellent care that is worth the trip --- even from Louisiana to North Carolina!!  Thanks to Benjamin and his family to share their encouraging story and word of thanks.

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



Growth Spurt; standing a little taller after scoliosis surgery, just in time for freshman year

Benjamin Hausmann grew two inches overnight.
The Baton Rouge, La., teen had a condition called rapidly progressing double thoracic curve scoliosis. After Lloyd Hey, MD of the Hey Clinic performed spinal surgery at Duke Raleigh Hospital, Benjamin’s newly straightened spine made him instantly taller.
“It was pretty weird,” recalls the 18-year-old. “The first difference I noticed was when I stood up and faced my parents. I could clearly see the difference as I was now looking down at my mom even more than before, and I was suddenly eye-to-eye with my dad! I was pretty excited about it. I mean, who doesn’t want to be taller?”
Benjamin’s scoliosis hadn’t interfered with high school. He says he experienced “occasional discomfort, but no debilitating pain” and “was able to fully participate in varsity sports, including football, wrestling and powerlifting.”
Benjamin’s parents, Rachel and Mark Hausmann, said their orthopedic spine surgeon in Baton Rouge told them Benjamin’s rapidly progressing condition warranted referral. Their friend, Dr. Dan Albright of Raleigh, referred them to Dr. Hey.
From the start, the family felt Dr. Hey was the right choice. “We were extremely impressed with Dr. Hey from our very first interaction with him,” says Mark.
He describes the process that led them from Louisiana to Raleigh: “After Dr. Hey reviewed photos of Benjamin’s back and his serial spine films and scans – but before ever meeting with us – he sent us a very detailed email regarding his impressions and followed that email with a 45-minute, in-depth telephone consultation.”
Based on their initial correspondence, the Hausmanns asked to schedule a clinic appointment with Dr. Hey during Benjamin’s February school break when they drove 14 hours form Baton Rouge to Raleigh.
The Hausmann family with Dr. Hey
The Hausmann family with Dr. Hey
Dr. Hey obliged. “Despite the fact that Dr. Hey’s usual clinic day is not on Mondays, he arranged for us to meet with him at the end of his long day in the OR,” Rachel explains. As Dr. Hey has privileges at Duke Raleigh Hospital where the surgery would be performed, he also arranged a tour of Duke Raleigh Hospital with Holly Bradicich, the orthopedic patient navigator.
“Holly familiarized Benjamin and us with the hospital and the general plan for his hospital stay,” Rachel continues. “We were also able to sit down and meet with an anesthesiologist who provides anesthesia services for Dr. Hey’s patients. Then after a long day in the OR, Dr. Hey met with us for almost three hours, answering all Benjamin’s and our questions. At the end of that meeting, we asked Dr. Hey to schedule Benjamin for the first available date after his high school graduation in May.”
Despite the miles between them, the Hausmanns remained in close contact with Dr. Hey and his staff. “We had numerous opportunities to correspond with Dr. Hey’s staff as we worked out the insurance issues and other logistics of Benjamin’s surgery,” Mark says. “And during each and every interaction with either Dr. Hey’s staff or the Duke Raleigh Hospital representatives, we were equally impressed with the friendliness and efficiency of everyone who helped us.”
Dr. Hey is quick to share credit with his team. He says, “Our whole Hey Clinic team works very hard to ensure that every patient and family have a positive outcome and good experience working with our team at the Hey Clinic and also during their inpatient experience with Duke Raleigh Hospital.”
Benjamin didn’t have time for back surgery to slow him down during his last summer before college. He graduated from high school four days before his surgery. And this month, he heads to the University of Texas at Austin to study chemical engineering.
When the Hausmanns were ready, so was the Hey Clinic team and the staff of Duke Raleigh Hospital. The familyflew to Raleigh on a Sunday. Monday was devoted to pre-op testing and an anesthesiology interview, followed by X-rays. Tuesday was surgery day. On Friday, the family was ready for their flight home. “Benjamin’s hospital stay was only three days,” Rachel marvels.
“Benjamin received excellent care during his stay,” she continues. “All the nursing staff was very professional and attentive. And the OT and PT staff helped Benjamin learn strategies to help him during his recovery. In addition, Holly Bradicich’s efforts on our behalf during our hospital stay provided us with a seamless experience.”
Recovery time was swift. Rachel says, “This past spring, Benjamin applied to be a camp counselor at an eight-week summer camp. When he was hired, we had our concerns about whether he would be well enough to work as a counselor only three weeks post-op. To our great delight, Benjamin drove himself three hours to the camp exactly three weeks after Dr. Hey performed his surgery.”
Benjamin teaching summer camp
Benjamin teaching summer camp
“We are so grateful to Dr. Hey for his efforts,” says Rachel. “And we want to thank everyone who works with Dr. Hey and those who work for Duke Raleigh Hospital to make possible the excellent experience we had at Duke Raleigh Hospital. We couldn’t have imagined or prayed for a better outcome for Benjamin.”
Benjamin can now begin his college career without pain and with renewed confidence. And with two more inches added to his height.

Lloyd Hey, MD blogs regularly about his work with patients with scoliosis and other spinal conditions. Learn more about his practice and read his blog at www.heyclinic.com.

Tuesday, September 17, 2013

Surgery Video: 19 yo Amy's Revision kyphosis and scoliosis

I saw Amy recently after her recent revision kyphoscoliosis surgery with me -- she is doing well, and her posture is looking great.  She said it would be ok to make her YouTube video public and share with all of you!  I haven't had a chance to do the voice overlay, but it still might be helpful to explain the special craft of restoring Amy's posture through advanced revision scoliosis techniques.  Enjoy!



You can also see Amy's other pre and postop photos and surgery photos with the blog I did on her story a couple days ago:   Click Here To See Amy Revision Kyphosis Scoliosis BlogPost

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

Sunday, September 15, 2013

Harrington Rod Adjacent Level Failure Years After Scoliosis Surgery. Revision Surgery for Pseudarthrosis.

We saw Charyl back in clinic Friday doing really well. She had failure below her old Harrington Rod fusion that she had for adolescent idiopathic scoliosis.  She shares her story on YouTube video below and thanks the Hey Clinic and Duke Raleigh Hospital Staff for their help and her ability to return to quality of life with her family.




We also saw Eric back for follow-up yesterday, doing very well after revision surgery where he had a pseudarthrosis at his sacrum and an adjacent level failure after surgery performed elsewhere about a year ago.  He shares his story below on YouTube HeyClinic Channel.



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


Saturday, September 14, 2013

Revision Kyphoscoliosis Surgery for Proximal Junctional Kyphosis and Residual Deformity in 19 yo young lady


This week we helped Amy, a 19 yo who had kyphoscoliosis surgery done elsewhere complicated by proximal junctional kyphosis (PJK), and residual scoliosis and kyphosis deformity.  This week we revised her previous surgery, removing the old hardware including the sublaminar hooks, doing multiple osteotomies, and a special proximal fixation technique using innovative sublaminar fixation.  
In preop area, you can see her neck is forced forward, as Amy says, "Like a Turtle", with hardware prominence also at top

Here is her upper thoracic spine on operating room table, still with severe deformity and hardware prominence.

Here I am contouring the cobalt chrome rods setting her new shape.  This is where some of the "art" and scoliosis "craftsmanship" comes in --- metal sculpture to help restore shape and balance.

 Here I am contouring the rod some more, in my "moon suit" -- very helpful for infection prevention.


 This shows multiple "pursuaders" being used to slowly and gradually mold her spine back to the correct shape, by very gently tightening each of the pursuaders a millimeter at a time.  Slowly Amy's spine comes back into proper alignment.  
 Here is Amy's intra-op and preop X-Rays up in OR Room 12, showing good correction of both her original kyphosis, proximal junctional kyphosis and scoliosis
 Here is Amy and I on her day of discharge, 2 days after her surgery standing up straight and tall, with normal posture and no more "turtle" neck.  She's standing taller as well!

We've got some video that we can probably share on our YouTube HeyClinic channel sometime soon when I have a minute to finish editing.  

Get well soon Amy!!
Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery
http://www.heyclinic.com

Monday, September 9, 2013

Minimally invasive scoliosis surgery from Georgia. When to get a Second Opinion for Spinal Deformity, Including Revision Surgery

I saw this lady in her 50's this past week who drove all the way up from Savannah, GA who had minimally invasive surgery for her thoracolumbar scoliosis done in Georgia.  This was performed after a lumbar laminectomy surgery was performed in the first round, but that surgery only gave very temporary relief as her collapsing spine collapsed back down on the spinal nerve.  She was not interested in having a "big surgery" to help with her scoliosis and kyphosis, so  she had about a 5-6 hour minimally invasive surgery, focusing on her lower back.


Unfortunately, her posture continued to collapse, and her pain has gradually worsened with a quality of life which is now intolerable.  Her kyphosis with proximal junctional kyphosis is almost 90 degrees.

This will be a tough fix.  Minimally invasive surgery can be an effective treatment for some spinal disorders, but it probably makes sense to seek out second and third opinions from surgeons with significant spinal deformity experience, perhaps located through the Scoliosis Research Society (http://www.srs.org) website when considering deformity surgery.

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


Sunday, September 8, 2013

More Patient And Family Stories from this past week







As promised, here are some more patient stories that have recently been shared at Hey Clinic.

Ashlee is an adolescent who had scoliosis surgery for her idiopathic thoracolumbar curve 6 weeks ago with Dr. Hey, and is doing well.  She shares how she is already getting back into her drama with tryouts for the Wizard of Oz for this fall!

We saw Sheila for her 1 year postop visit doing very well after her T3-Iliac wing instrumentation and fusion for her large double curve scoliosis.  She had adolescent idiopathic scoliosis (AIS) that progressed as an adult, causing her severe pain and poor quality of life, and had it fixed in her mid-60's and has done well postop.  


Charlie had really severe back and leg pain and trouble walking, and shares his story postop after L3-Iliac wing instrumentation and fusion, and his very positive experience at Duke Raleigh Hospital with the nurses and a particular CNA who went the extra mile.





Tomorrow morning we'll be helping Patty, a woman in her early 50's with a collapsing thoracolumbar scoliosis that she has had since her teens, but had become symptomatic in recent years.  I got a nice email from her friend Steve, from eastern North Carolina, who has sent me many of his friends and relatives with scoliosis and kyphosis after I got him straightened up years ago.   Need to get to bed soon to rest up, and get up early to exercise and see her in preop area by 7:15am at Duke Raleigh Hospital.  We have 4 big scoliosis and kyphosis surgeries this week, including a revision scoliosis / kyphosis surgery on an adolescent treated elsewhere initially.  We will also be seeing several consults and second opinions coming in from out of town.It should be another interesting and exciting week.  Hope you have a good week as well.
Dr. Lloyd Hey -- Hey Clinic for Scoliosis and Spine Surgery
http://www.heyclinic.com

Saturday, September 7, 2013

The Special Families We Meet and Serve.... Lots of Patients and Families Sharing Stories Returning to Hey Clinic

Many years ago, when I was hit by a car as a teen, I spent over 3 months in the hospital, having 11 reconstructive surgeries on my leg, and undergoing countless wound treatments and therapy visits from many caring doctors, nurses, and therapists.  It was a very painful, frightening and often depressing journey, but God worked through many caring people to encourage me and heal me. Eventually I was able to walk again, and even run again, and for several years after that experience, I would go back to that nursing floor at Glen Cove Hospital to thank the nurses and therapists who cared for me, and let them see that I could actually walk again!  I also enjoyed going back to see my Doctor Mark Pitman back for follow-up to share how his "investment" in my life, taking on a very tough case made a huge difference not just in my physical life to save my leg and allow me to walk and stand without pain... but also made a difference in my life as a whole.

Each week at Hey Clinic we get a chance to see many families often coming back after major reconstructive scoliosis and kyphosis surgery --- from little children, teens, young adults and older adults --- sharing their story of recovery.  Meanwhile, the hard-working nurses, and nurses aids, therapists and many others at Duke Raleigh Hospital, WakeMed Raleigh Children's Hospital, and at Hey Clinic -- have not had the chance to see the healing that has occurred.  These hard-working folks, some behind the scenes, only see our patients at their "worst", yet continue to care with compassion and excellence.

Since it is not always practical for many of our patients to just pop in on the orthopaedic floor, (and they aren't allowed to "pop in" to the operating room or PACU/recovery room!), we've set out to use modern video / YouTube and blogging technology to allow these thankful families to share their stories here.  Hopefully this will help all of us to continue to serve with even greater compassion for those who are truly suffering, and to lend relief and comfort.

These stories can be found on the HeyClinic YouTube Channel, and we'll try to add some each week.  I discovered this week that some of our preop and postop patients have already found some of these stories encouraging as well for their motivation and progress!  It is a total blessing to just have the opportunity to be a part of a web of caring relationships that brings joy and encouragement and healing in many ways.  --- Dr. Lloyd Hey -- Hey Clinic for Scoliosis and Spine Surgery.  http://www.heyclinic.com


We saw Tiffany and her husband Dewayne in clinic this past Friday.  Tiffany is in her 30's, and works for one of the other excellent hospitals here in Raleigh, NC.  She had scoliosis surgery with us here at Hey Clinic at Duke Raleigh Hospital, and shares her scoliosis story going all the way back to when she was initially diagnosed as a teenager.  She shares how this summer was the first time since she was in middle school that she was able to wear a bathing suit to the beach now that her posture has been restored -- an important part of a holistic quality of life for many of our guests.  


















We saw Matthew and his mom Kristen, who are from the Charlotte, NC area about 2.5-3 hours away back for Matthew's 6 week postop visit this past Friday.  He is doing well, and actually shares how he had a 2 inch growth spurt on the day of surgery at Duke Raleigh Hospital!!



Darlene, like Tiffany up above, also works in the healthcare field at another major North Carolina Hospital where she serves as a Patient Navigator.  She suffered for many years with progressive degenerative scoliosis which made life pretty intolerable by her early 50's.  She is now back for her 6 week postop visit with her husband Tommy sharing about her experience before and during the first few weeks after surgery, which are usually always the toughest.


Little Emma was in with her early onset scoliosis with her dad, who had a revision lumbar discectomy decompression with us 6 weeks ago.  



Marilyn was back to see me August 23.  She had a lumbar-sacral iliac wing instrumentation and fusion, and then developed proximal junctional kyphosis with a fracture above her fusion.  She then underwent an extension instrumentation and fusion up to T3, and talks about her recovery from revision scoliosis / kyphosis surgery now doing very well with an erect posture and very good quality of life.


I have several more left to share.... but it's time to call it a night.  Thanks to everyone who shared these past couple of weeks, and I will share this blog link tomorrow when I go into round at Duke Raleigh Hospital with the weekend staff.  I am sure it will bring many smiles.  

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

Week of Aug 25 2013 Hey Clinic Scoliosis Round Up at Hey Clinic and Duke Raleigh Hospital and WakeMed Children's Hospital

We started off  the week of August 25 at WakeMed Hospital helping little 11 yo Kaitlyn, who has spinal muscle atrophy (SMA), and a nearly 90 degree progressive scoliosis treated elsewhere with VEPTR.  We got her straightened up with some unique engineering using special sublaminar fixation, since her osteoporosis / bone strength was very weak.  She can now sit up straight in her wheelchair, and this is also helping her with her breathing already.  Her mom is just awesome, and is basically a "super nurse" for Kaitlyn, who was able to take Kaitlyn home on postop day 3 back to Fayetteville!

Tuesday I did scoliosis surgery for a 19 yo young lady who had syrinx surgery at age 9, and developed a postlaminectomy kyphosis and scoliosis which was very painful.  Her surgery went very well, and she headed home with a great new posture, probably a couple inches taller.

Wednesday and Thursday were two back to back huge scoliosis surgeries --- the first one was for a woman in her 70's from Franklin, NC -- about 6+ hours away.  Jerry met one of my scoliosis postop patients from Franklin over this past year named Pam, who has actually helped Jerry through the preop process and continues to pray and care for her now with Pam's husband, Fred.    Jerry was really suffering badly with her deformity, shifted about a foot to the side, and about 2 fee forward.  She is now doing well, off to rehab here locally before we get her back home to Franklin in a couple weeks.

Thursday was a similar surgery for a nice lady in her 50's, who was also quite "pretzel-like" , having suffered for 10+ years with progressive deformity.  Both of these adult patients from Wed and Thu had adolescent idiopathic scoliosis, but then developed progression and severe pain and quality of life issues later in life.  This emphasizes the importance of life-long follow-up for scoliosis and kyphosis and to not assume that everything is OK at the end of growing.   She went home 4 days after surgery doing very well

Friday clinic before Labor Day was quite busy, seeing several of our teen and young adult postop patients back for follow-up.  Things really got interesting when the power went out in our section of North Raleigh --- shutting off all our lights, computers, and X-Ray machine!  The large group of patients we had in the waiting room and clinic rooms actually took it all in stride, and ended up creating a party atmosphere with a bunch of my long-term patients then turning to their neighbor and striking up a new conversation --- creating actually a festive family atmosphere.  Luckily Hey Clinic has large windows on 2 sides of the building, so the waiting room was well-lit, overlooking the park next door, and we actually used several of our offices as exam rooms.  We really appreciated everyone's patience during the power outage.  One interesting coincidence:  exactly 6 months earlier, we had to evacuate the building for a couple hours, also on a clinic day due to some smoke in an air handler.  One of our scoliosis guests and her mom, up from Wilmington, NC was there that day for her 6 month postop visit!   As shown in the link, we ended up seeing her and several other patients that day out in the beautiful gardens that are adjacent to our clinic building, on a beautiful sunny day.  

Labor Day weekend was a nice break, getting a chance to catch up with family and visit the North Carolina coast for a couple days with the dogs.  We came back to work this Tuesday and did scoliosis surgery Tues, Wed and Thu.... more on that later!  Have a great weekend.

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


Friday, September 6, 2013

Tim, postop from lumbar discectomy revision surgery is back today with daughter with Early Onset Scoliosis

I saw Tim and his daughter, both of whom are patients of ours here at Hey Clinic.  He just sent us this note that he wished to share with all of you!  Dr. Lloyd Hey

From: Tim
Date: Fri, 6 Sep 2013 11:20:55 -0400


My first encounter with Dr. Lloyd Hey was during an initial visit for my 8 year old daughter's s
coliosis condition nearly two years ago.  Going into the appointment, my wife and I were on edge about the pending news about our daughter’s diagnosis and path forward.   From the moment we entered the office, we immediately realized that the Hey Clinic was an exceptional place and that our daughter was in the best hands.  Unlike most doctor’s offices, the Hey Clinic is decorated with success stories of those who have conquered spinal deformities.  The Clinic also contains a significant  amount of literature and hands on demos aimed at educating patients in a very clear manner about common spinal disorders and the actions often taken to address them. 

It was no surprise that the aura of the clinic is the product of its people.  From that first visit to now ~2 years later, Dr. Hey and his staff have been extremely professional and cordial.  Each member seems to have a strong sense of pride in what they do, possess a genuine compassion for improving lives, and coincidentally wear a big smile on their face each time you see them.  From a clinical standpoint, Dr. Hey and his staff are top notch – very technical, knowledgeable, and highly skilled at taking complex information and distilling it down into a simple, layman’s description.  Dr. Hey also routinely has taken extra time to make sure all our questions are answered and is careful to weigh in our opinion about what we think is the best treatment for our daughter.  Moreover, he is a very empathic doctor which speaks volumes.  Overall, my wife and I have been extremely pleased with our daughter’s experience with Dr. Hey and his clinic; HOWEVER, my review doesn’t end here.

Little did I know that two years after first meeting Dr. Hey that he would treatment me too.   Jokingly, during one of my daughter’s appointments I mentioned to him that maybe he should check me out given my own bouts with degenerative disk disease.   He casually said sure, but at that point in time I had no issues.  We were simply letting my daughter know that she’s not alone in dealing with challenges of the spine.   Unfortunately though, my back woes returned with vengeance earlier this year.  I eventually learned from an MRI conducted by my Orthopedic physician that my L4-L5 disc, the same disc on which I had surgery 12 years ago, had severely herniated.  The herniation caused me an immense amount of pain, weakness, and numbness in my right leg and foot.  This was also compounded by a smaller than average disc thickness.   My physician recommend trying a directed steroid injection to help calm the nerves down.


Knowing that relief that injections bring is often temporary, I gave Dr. Hey a call hoping that he would provide some consultation even though my condition was far less complicated than most scoliosis conditions.  Dr. Hey kindly agreed to see me.   Within minutes of viewing the MRI Dr. Hey identified numerous issues that were the likely reason for my intense pain and discomfort. He immediately mapped out a game plan.  He also took the time to greatly ease my high anxiety stemming from the thought of battling my disc issues at such a young age and throughout the rest of my life.   Rather than rushing into surgery, he recommend taking the conservative route and proceed with a steroid injection by my Orthopedic physician.  His recommendation was backed by data he cited on the rate of success for different situations.  He also said if the injection did not improve my situation within 7 days to come back and we’ll talk surgery.


Seven days passed with no relief.  I immediately scheduled a follow-up appointment with Dr. Hey.  He and staff were able to squeeze me into a surgery the following week.  Dr. Hey carefully reviewed the planned surgical procedure to be done and answered numerous questions.  Surgery was an absolute success!!!  Dr. Hey performed a microdiscectomy, laminectomy, and removed a portion of ligamentum flavum ( I think) that had coarsened over time due to my degenerative condition.  The culmination of this work led to the freeing up of an immense amount of space.  The end result, was a night-and-day difference with my conditions.  Immediately after surgery I had no pain and virtually no numbness in my right leg except for some minor tingling in my toe.   Now six weeks later, the numbness is miniscule and I have re-gained significant strength in my back.  More importantly, I have a normal life again – free from the physical and emotional drain of pain. 


Overall my experience as father of a daughter with scoliosis and a patient with the Hey Clinic has been nothing short of superb.   What’s been very unique is that my daughter and I have gained many life lessons together through this clinic. (We are also Back Buddies!)  My daughter now has less fear and tons more confidence that the future surgery to be conducted by Dr. Hey will be well worth it.   I think she kind of enjoys going to see Dr. Hey.  Lastly, I’d like to emphasize that there have been very few people that I've met in life with the unique combination of qualities that Dr. Lloyd Hey possesses – humble, caring, empathic, super smart, funny, passionate, and firm believer in God.    Dr. Hey is truly fulfilling God’s plan for him by making the lives of his patients and doing it the Right way!  Thanks Dr. Hey!   

Sunday, September 1, 2013

How long after adult scoliosis surgery are patients glad they had it done? Ever?? Dealing with the Emotional Side of Scoliosis Surgery Decision and Recovery.

Tina is a 46 yo woman who had adolescent idiopathic scoliosis which progressed as an adult, with severe pain and deformity.  She had he surgery with us at Hey Clinic / Duke Raleigh Hospital a little over a week ago.  
She shares her thoughts below about her decision to have surgery, and the emotional side of the decision and the support she got that helped her through.  Thanks for Sharing Tina!!
Dr. Hey
Hello Dr. Hey,
I just wanted to thank you so much for all you and your staff have done for me and my family. Im sorry I was so emotional that last two times youcame by to check on me . I dont know if you remember me just sitting there crying. This whole process has been so stressful on me but your clinic and the hospital have made it so much easier and Im so thankful I went through it. Im still having some pain of course but Im doing so much better. I wish I  could have found you sooner ! I dont understand why so many doctors have pushed me off ? Im guessing because its such a complex surgery ? I dont feel like a twisted pretzel any more. Im so ever in your debt.  The Lord has guided your hands to help so many people and I know he will continue to. Now I think of my huge pillow that my Mom has given me as a a great comfort . It use to be my grandmothers pillow(shes no longer with us now nor is my too loving grandfathers )and whenever i lay on It I think of it as there arms comforting me as i sleep assuring me its ok now and things are only going to get even better.
My daddy laughs that Im much taller than I use to be and I laugh that now I can reach Tony easier now if i want to smack him . "just joking of course  "He has helped me so much also  especially with quite smoking again this time with me,  I hope I never start back up ever again.  I have a family i love so much and life was getting too hard to do anything just to take care of the little things around the house I always tried to do .Scoliosis is a dreadful disease that so many people dont understand and dont know about. A lot of unknowledgeful people was thinking I am going to regret the surgery in the long run but I dont think so, I had the best on my side ! Thank you again !

One More Thing:
I have two grown children also who have support me non stop . Daniel , 19 who has stood behind me even when he was scared for my life to have so a major surgery he never l left my side. He has been so supported of me making sure his mama was taken care everyday. he helped me learn how to get in and out of bed and reassured me it was going to be ok when I cried I couldnt handle it that i didnt have the strength like I thought I did. Calling his daddy when he saw new things he
was under assure if it was nornal or not making sure I had everything i needed, Hes reassurance as my son let me know we raised him right, and he surely loved me every morning checking on me and waking me up smiling/kissing my forehead asking me if I thought I was going to have a better day.  Knowing he loved me enough to check on me helped me out a lot .  My oldest daughter is going to school to be a nurse but  surprisingly she let her younger brother take care of me while she cleaned the house.We did a good job raising our two children, and the Lord has Blessed Tony and me  and letting us see this as a family each day as we go through this.

--- Tina


Tina S and Family.