Dr. Lloyd Hey's Blog: Scoliosis and Spine Care, Aviation Safety and Quality "Standard Work"
How can we care for scoliosis and kyphosis and spondylolisthesis better with conservative care like physical therapy, high-tech scoliosis braces, exercise and other techniques? What can be done to improve surgical care, and understand choices for surgery, learning from those around the world? How can we learn from aviation and from Deming's principles of "Standard Work" to constantly improve spine and all healthcare?
Using Schroth physical therapy and home exercises and 3D-CADCAM Rigo-Cheneau bracing, we are able to treat the very large majority of our scoliosis patients at Hey Clinic with conservative therapy, and life-long follow-up.
However, there still is a small percentage of patients whose curves progress and/or the patients have pain and/or posture issues where they want to hear more about surgical options for treating their scoliosis.
One of the most common questions I've received over the years caring for children, adolescents and adults with scoliosis is this: "Will I be able to bend after scoliosis surgery?" or "Will I be able to dance if I chose to have a spinal fusion?" Am I better off having my daughter or son have a tether rather than a spinal instrumentation and fusion to preserve spine mobility?"
Here is MaKenzie's answer, an AIS adolescent scoliosis patient now 9 months postop. MaKenzie and her mom voluntarily have shared this on YouTube, and Facebook and now here for you to see. Thanks for sharing your passion with all of us MaKenzie! Just beautiful!!
25 degree Angle Trunk Rotation (ATR) R Thoracic Rib hump
This is a guest post from Colleen Skeete and Jonathan Revoir, scoliosis patients and CareGuard Institute interns.
Welcome to Scoliosis Awareness Month! Our spine is the core of our body that holds us up for our lifetime, and we can take it for granted. Early screening in children and life-long monitoring in adults is important to take care of your spine, so that you can maintain a good quality of life.
4 degree Left Lumbar Angle Trunk Rotation (ATR)
It is easy to screen yourself, your children, or your friends from home by using a scoliometer or a bubble-level app on your smart phone to measure the degree of rotation. Simply have the person bend over, and measure the two greatest areas of rotation. If the angle of trunk rotation (ATR) is greater than six degrees, it is a good idea to get physician evaluation, and a full-length x-ray taken to see if scoliosis is present. If scoliosis is present, conservative methods such as Schroth therapy, a physical therapy technique focusing on elongating the spine, and 3D-CADCAM (Rigo-Chenau) bracing can help to stop and/or reverse the scoliosis. This may prevent later quality of life issues, and life-long curve progression. and possibly prevent the need for invasive surgical treatment. Weinstein found that curves under 30 degrees tended not to progress during adulthood -- so we want to FIND scoliosis under 30 degrees, and try to "KEEP IT IN THE GREEN ZONE" - under 30 degrees if possible, with conservative therapies.
Life-long monitoring of scoliosis, even after adolescent years, is just as important as early screening. Natural progression history research shows 68% of patients with adolescent idiopathic scoliosis (
(AIS)will experience curve progression as adults, as shown in the figure below. Curves under 30 degrees, shown in green, tend not to progress [Weinstein et al 1981, 1983 -- see figure below].
For more information about Scoliosis Awareness Month and the steps you can take to decrease the chance of life-long effects of scoliosis, watch this video from Dr. Hey and his team.
Jonathan Revoir and Colleen Skeete CareGuard Institute Summer Interns with Dr Lloyd Hey
http://www.CareGuard.org
Hey Clinic for Scoliosis and Spine Care
http://www.heyclinic.com
What a wild couple of weeks it has been here, and around the country and the world with coronavirus.
Here is a short video on how we are innovating to help give patients and families more choices to how to screen for scoliosis and other deformities, and be able to get the necessary imaging when necessary for initial diagnosis so that early treatment can be initiated, such as bracing and Schroth physiotherapeutic exercises and physical therapy.
Check out the video, and we'll have more innovations coming up to share, including how to screen yourself or your own children for scoliosis using a scoliometer or bubble meter.
Stay safe, but let's not forget to "take care of our core" with early diagnosis and treatment for spinal deformities and other conditions for a better quality of life for the long run.
There has been a lot of buzz in recent years about the Minimally Invasive Spine Surgery (MISS), and in some cases minimally invasive scoliosis surgery, using small puncture incisions, XLIF's, slipping rods under the skin, and/or going anteriorly with tethering through the chest.
But many people have not heard much about the LEAST invasive scoliosis "surgery", which really isn't surgery at all, which is Schroth Physiotherapeutic Scoliosis-Specific Exercises (PSSE), and 3D CADCAM bracing, also known as Rigo-Cheneau Bracing. Even I was not aware of these two techniques, that both emanated from Europe until about 3-4 years ago, which really has brought a transformation for the way we can manage scoliosis at Hey Clinic, especially in our new, much larger facility we moved into a year and a half ago on the Duke Raleigh Hospital campus at 3320 Wake Forest Road, Raleigh, NC, where we had the room to add physical therapy, and in-house brace measurement and construction, as well as put in an EOS X-Ray machine, and have a large open area for training and classes.
Yes, this has been a total "game changer" for us at Hey Clinic, and for now hundreds of our pediatric, adolescent, young adult, middle-aged adult, and older adult patients.
We had another example of a huge success in clinic this past Thursday with 14 yo Regan. 3 months ago, she got some very bad news... she had a 28.9 degree scoliosis. We recommended Schroth physiotherapy. She rolled her eyes. She was not psyched. This whole thing was a complete downer.
But she was willing to give it a shot, encouraged by one of our Schroth Therapists, Mariah, that we have seen many successes. She chose to do Schroth only for starters, and hold off on the 3D CADCAM Brace, to see what we could get. Over the last 3 months, Regan has come to Hey Clinic once a week to learn how to do the PSSE exercises, and started doing them at home for about 20-25 minutes a day, 6 days a week. She actually began to actually LIKE to do the exercises, and was faithful to do them.
Well, this past Thursday morning was the big reveal.....
Her mom and dad were there.....and the results were....29.5 degrees, down to 11.6 degrees.... 18 degree improvement in 3 months. And less pain!
At that point, there was lots of "hootin' and hollerin'" and celebration with Regan and her parents and also with Mariah.
Then there was time for a quick Team Win Photo
Then Regan shares her story to inspire other children and teens to consider Schroth PSSE
With Schroth and the 3D-CADCAM braces (when needed), we are seeing 90+ % success rates thus far with conservative management. However, some curves still do progress despite our best efforts, but especially when we can inspire the compliance, the success rate is very high. When the curves do get into the range where surgery could be considered, and when it is paid for by insurance, we also are happy to discuss that option as well so that the patient as well as the family completely understand and have the freedom to make their own personal choice. About 60% of AIS scoliosis curves will progress during adulthood, so we do also always recommend lifetime follow-up.
We do see many happy patients who chose the surgical route as well, especially for curves that are in the 40-50 degree range where scoliosis surgery may be considered, and over 50 degree range where it is usually strongly considered. Curves under 40 are sometimes considered for surgery if there is ongoing pain/quality of life issues that do not respond to conservative therapy. At Hey Clinic, we take a LOT of time to help our pediatric, adolescent and adult patients to fully understand your diagnoses, as well as your CHOICES, since it is YOUR BODY, and YOUR CHOICE... which will affect you for the rest of your life, since your spine is literally the very CORE of what has to hold you up!!
So for example, on Thursday we also saw Elizabeth, who was treated at age 12 for her scoliosis with Schroth and bracing, but unfortunately her curve progressed to 56 degrees, at which point her and her parents decided to have her scoliosis addressed surgically. Bracing and Schroth compliance was a bit harder for her, which may have contributed to her curve progression. She had her surgery a year ago, and recovered quickly, back to cheerleading, and now is taking up diving, and also showed me her new dress from Christmas which she is proud of, confident in her posture going into high school and beyond.
So maybe it's time to take a trip to Hey Clinic, and get a second opinion for bracing, Schroth, and possibly very very "minimally invasive" scoliosis care that could bring joy to your family too!
It was a beautiful sunny fall afternoon in our Hey Clinic Great Room today when I bumped into Andrea, one of my scoliosis moms. She had to show me something her daughter Leah made this week in school for Thanksgiving. She showed me the "Tbankfulness Tree" Leah made, and a long list of things she is thankful for. Take a look -- I'm the brown leaf toward the middle of the tree! How cool! I asked if it would be OK to share these thankgivings with all of you, and Andrea replied:
"Absolutely you can share it! Leah thinks the world of you and your talks with her have helped her immensely! Thank you for educating us and for your wonderful encouragement! We will see you on December 5th! Happy Thanksgiving "
Andrea pointed out that "Dr. Hey" actually made it onto the Thankfulness Tree, and in her list of thanksgivings explained why:
"... because he has helped me to have a more positive outlook on my scoliosis and to not give up on my ability to overcome scoliosis."
Leah also shared that she was thankful for scoliosis: "because though it has hindered me greatly, it has taught me a dedication to physical therapy and helps me appreciate things I wouldn't normally appreciate."
Wow. I can look back to my own teenage experiences as a patient and say "Amen", although it took me longer to figure that out than Leah!
Having a thankful spirit has been shown to be the key to resilience, which is why Remembering "Three Good Things" every day is one of the best suggested cures for burnout. There are definitely things that my physician assistants, physical therapists, orthotists, MA's and other staff do to really help patients and families through this difficult journey, and actually grow and thrive. There is much more going on here than a cobb angle or trunk shift changing -- there is a little precious person becoming a big person, with a growing foundation of compassion, strength and hope and confidence!
Strong work Leah for facing your scoliosis with courage, and thriving through it! I am thankful for you and your family, and the many other patients and families who bring life and light to our lives at Hey Clinic every day.
Happy Thanksgiving from all of us at Hey Clinic for Scoliosis and Spine Care.
--- Lloyd A. Hey, MD MS
