Tuesday, December 18, 2007

2 14 yo girls having scoliosis surgery 50 years (and 1 day!) apart. Exploring 50 yo time capsule of non-instrumented fusion.

Yesterday I operated on a lovely young lady who had a 50 degree thoracolumbar scoliosis with severe imbalance.
Today I did a complex spinal reconstruction on a 64 yo woman, who had a non-instrumented spinal fusion done 50 years ago, when she was 14, and now had severe collapse with an almost 90 degree kyphoscoliosis
The story these 2 women will be able to share later this week of their differing experiences would make good reading:
The patient who had scoliosis surgery 50 years ago spent a year or so in the hospital in traction, and in body casts.
Over the past 50 years, she continued to “shrink” in height, since the lower half of her fusion never quite healed.
She developed increasing back pain and leg pain, and trouble standing and walking.
Today, instead of a simple 3 hour surgery, which led to a near-perfect correction of the spinal curve in the adolescent young lady yesterday, I reconstructed the 64 you woman with a 7 hour and 45 minute anterior/posterior spinal reconstruction, and 5 level laminectomy and osteotomy.
Both patients did very well with surgery, but the 14 yo who had her original scoliosis surgery yesterday will have a much quicker recovery, going home tomorrow or Thursday, and a better long-term outcome with a solid fusion, and well-balanced solid instrumented fusion.

A lot has changed for the better in scoliosis surgery in the past 50 years, thanks to the efforts and innovation and research of many caring scoliosis physicians, many of whom have been involved with the Scoliosis Research Society (SRS) over the years, including my scoliosis mentor Dr. John Hall, from Children’s Hospital, Boston, and Dr. John Emans, also from Children’s Hospital.

The innovation and learning, however, is far from over.  Even in today’s surgery, I used some new innovations with stronger titanium alloy rods, and special buttressing techniques at the bottom of the construct which help to improve the correction, while decreasing chances for rod breakage and screw loosening.  The “upward spiral” of improving scoliosis care is never-ending.

I really do enjoy taking care of the full spectrum of scoliosis and kyphosis patients — from the  youngest toddlers, through the teen-ager and young adult, through the older adult.  Each group has it’s own challenges and rewards.

On evening rounds after my long day reconstructing Catherine’s very crooked spine today, I saw Layla, the 14 yo girl who had her surgery just yesterday with her dad.  She was eating, and resting comfortably, and had been up walking  a couple of times today with minimal assistance, and no back brace.

I wondered what it would be like to go in a time machine, back 50 yrs ago to Catherine’s first postop night, when she was 14.  How long did her surgery take?  When did they put her in the cast?  Why were parents only allowed to visit so infrequently, like once a week?  What did kids do on those long days and weeks and months in the hospital?  Were the cast changes painful?  What was it like to wear a cast for several weeks or months without a shower?  Over the years I have enjoyed talking to my scoliosis patients who had surgery done 20, 30, 40, 50 and even 60 years ago, and see how they described their experiences, through the eyes of the child.  

In surgery today, I felt like I got a glimpse of that time machine, through the “time capsule” that I got a chance to see looking at her old spinal fusion that was done 50 years ago.  The upper part of her thoracic spine had healed quite solidly, but was still very twisted and deformed. The lower portion of her curve never healed, and over the decades had collapsed into a very twisted and deformed spiral, crushing many of her spinal nerves in the process.  Her apex of the curve at the thoracolumbar junction was rotated almost 90 degrees, with severe kyphosis as well.  Her curve, now stiff with the years barely budged, compared to the fully flexible 14 yo Layla’s curve yesterday.

These two scoliosis ladies may end up meeting up on the Ortho/Spine Unit tomorrow or Thursday when we have our end of year “Thank You” lunch for the staff.
Layla’s goal is to go back to school in a couple weeks, and get back to all her activities almost right away.
Catherine will get back to her walking, and plans to ride on the back of her friend Tom’s motorcycle this spring!

One thing is for sure:  It is much better to fix scoliosis curves when people are younger and more flexible, and have more years to enjoy the improved posture and self-image.
Surgery is certainly far more effective now than it was years ago, and will continue to improve as we try to continually perfect the surgical techniques, hardware, biologic materials, and the process of care.

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

1 comment:

Bob Casey said...

Thank you Dr. Hey, for having this blog. I had scoliosis corrective surgery in 1982, I have had sciatica, and stenosis, and spondlytis in my lower spine - as per an MRI about 5 years ago, but no treatment was suggested. Is there any suggestions about who to see in the Chicago IL, area about this?

Thank you.