Monday, September 10, 2007

Hey Clinic Sep 10 2007 Surgery: Severe collapsing thoracolumbar scoliosis after 2 laminectomies fixed with T10-Iliac Wing Instrumentation, decompress

Today we helped Craig, an 80 yo gentleman who had 2 previous laminectomies, who presented with severe back and bilateral leg pain, and trouble walking more than a few feet.

His X-Rays showed severe multilevel thoracolumbar degenerative kyphoscoliosis, and his MRI showed severe multilevel stenosis, including the levels that were previously decompressed, but had gone on to collapse further, with restenosis.

His surgery today took approximately 5 and a half hours.

His estimated blood loss (EBL) was around 2200 cc, with 1200 cc returned to him via Cell Saver, and no additional blood was transfused.

His bone quality was good, which meant that the spinal pedicle and Iliac wing screws held quite well. His deformity, especially the rotatory deformity was severe.

His stenosis was also very severe, with the decompression made much more difficult with the previous multiple laminectomies. One of his facet joints on the L around L3 was impaled into the dura with surrounding scar, requiring extra care, and dural repair.

As shown on the difference between the preop and intra-operative X-Rays, we were able to correct his scoliosis well from the AP (Front/Back) Coronal plane, as well as correcting his “flat back” and TL junction kyphosis with the instrumentation.

His family was very thankful after surgery, and he is doing well postoperatively.

He will spend the night in ICU at Duke Raleigh Hospital, and then start to get up tomorrow.

Right after his surgery, I saw a nice lady from Pinehurst with a similar curve, who has had no previous surgery, and has had increasing back and leg pain over past 3 years. She has lost 3 inches in height, and her walking distance has become quite short. We will complete conservative treatment for her this fall, but if her symptoms do not improve, she will have decompression laminectomies, and thoracolumbar scoliosis correction – but her surgery will be much easier than one this morning since we will not have to deal with the old laminectomies – fixing both the mechanical collapse / instability along with the nerve “pinch” lumbar spinal stenosis at the same time!

Lloyd A. Hey, MD MS

Hey Clinic for Scoliosis and Spine Surgery

1 comment:

Greg said...

Extremely grateful for they Hey group and the care they have given my father. Hopeful that his recovery will improve his quality of life and that I'll be able to take him fishing again.