Wednesday, September 19, 2007

Big Kyphoscoliosis and Herniated Disc Repair in 30 yo woman from Virginia. Hey Clinic Surgery Sep 19 2007

Today we helped a very pleasant 30 yo woman phlebotomist from Virginia who had a collapsing kyphosis and scoliosis combined with herniated discs at L45 and L5S1.
She had 2 previous laminectomies done down at L45 and L5S1, and actually had her symptoms get much worse after these surgeries, and also had worsening of the scoliosis. Laminectomies can destabilize the spine, and accelerate collapse of scoliosis when not combined with surgical fusion stabilization. Her pain was so bad down her R leg that she literally limped around the hospital.

Maggie’s surgery went very smoothly today. She had a combination of thoracolumbar scoliosis and a thoracic and thoracolumbar junction kyphosis. Because of her large symptomatic recurrent disc herniation at L5S1, I needed to fix this bottom disc level as a part of the overall reconstruction. We fixed her spine from T3 above in the thoracic spine, down to S1 and the Iliac Wings down at the lower spine and pelvis. I had to do a complex revision decompression of the nerve roots of L4, L5 and S1 which were all socked in with scar, and being compressed by herniated disc and enlarged facet joints. I replaced the herniated disc at L5S1 shown in the MRI axial view above with a TLIF transforaminal interbody cage and bone graft. This provides interbody support at the bottom of the construct, which is very helpful to promote fusion and stability when combined with the posterior instrumentation down to the iliac wings.

Her bone quality was excellent because of her young age, which made the pedicle screws more difficult to place, but will make the screws much less likely to loosen. That is one reason why it is better to get scoliosis or kyphosis corrected when the patient is younger, rather than older, since the quality of the bone (level of osteoporosis) is much better in younger people, and the bone heals more rapidly in younger people.

Maggie’s surgery took about 6 hours today, and required no transfusions intra-operatively. Her intraoperative radiographs show nice correction of her scoliosis and kyphosis. I did attach the bottom iliac wing screw on R after the X-Ray was taken, and added a couple cross-links for additional stabilityI did give her 2 units of PRBC’s postoperatively in PACU. She is doing very well postoperatively in ICU overnight. Her husband was extremely thankful.
Tomorrow she’ll get up and around. We had a wonderful “Gem” new nursing graduate named Brittany in observing surgery today on our “big screen” monitor hooked up to our special operating room sterile overhead light. Brittany learned a ton about scoliosis surgery today and spinal anatomy today, and did very well on the “pop quiz”! We hope Brittany will join our awesome inpatient orthopaedic spine scoliosis service at Duke Raleigh Hospital!

Lloyd A. Hey, MD MS
Hey Clinic for Scoliosis and Spine Surgery
Raleigh, NC — USA

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