Visiting Synthes Spine, West Chester PA. It takes a Team Effort. Getting excited sharing ideas.

Thursday this week, I took a “field trip” to West Chester, PA to visit Synthes Spine along with Craig Browning, my local spine instrumentation support person.
I had a series of wonderful meetings with their design engineers, metallurgists, and mechanical testing experts.
What a wonderful experience to be able to get the surgeon who uses these products every day to interact with the engineers who design and test this equipment!
It was a “two-way” learning day, with several new projects and solutions in the works, including follow-up research in collaboration with NC State’s Department of Mechanical Engineering.
In my studies of Deming and Quality Management, Quality Improvement over the years, it has always proven to be true that it is always better for manufacturers and suppliers to work TOGETHER to come up with better combined solutions to serve the ultimate customer.  Companies like Toyota have done this very well for over 50 years, initially inspired by Deming.  
Hey Clinic tries to do the same thing by developing strong working relationships and quality improvement efforts with our instrumentation vendors, hospitals, information technology companies (SpringChart, MedStrat and others), and local universities including Duke and NC State.

In order to improve, you need to LEARN, and SYNERGIZE with others even outside your own company, strengthening the interdependent relationships that lead to better care across the entire continuum.

Many thanks to everyone at Synthes Spine for sharing your day with me on Thursday, and for everything you do to help create solutions to help patients.
An extra special thanks to Caryn, who even drove Craig and I to the airport, including a side-trip to see my sister and her kids who live nearby.

Lloyd A. Hey, MD MS
http://www.heyclinic.com
Hey Clinic for Scoliosis and Spine Surgery.

Ashlyn comes back to Hey Clinic for 2 yr follow-up for scoliosis surgery she had when she was 10 years old

It was great to see Ashlyn and her mom and dad back for follow-up at Hey Clinic.
Ashlyn had a severe scoliosis, and a severe seizure disorder which she has had since birth.
I performed her surgery at WakeMed, here in Raleigh, given her severe seizure disorder and size to use their Pediatric Intensive Care Unit (PICU).
Ashlyn received excellent care in the PICU and on the pediatric floor there, and the family remains thankful to this day for the wonderful team who cared for Ashlyn.


Lloyd A. Hey, MD MS
Hey Clinic for Scoliosis and Spine Surgery
Raleigh, NC  USA
http://www.heyclinic.com

Clinic on Wed and Friday this week. 15 yo twins with scoliosis.

We had 2 full clinics this week, on Wednesday and Friday, and saw many wonderful families.
On Friday afternoon, I saw a delightful family with 15 yo twins, both with scoliosis, and one with cerebral palsy.  Both of their curves were in the 30 degree range, and will need further follow-up.
While both of these children had scoliosis, and could easily have shared genetic factors which led to their deformity, their curve types are different, with the one young lady having a standard R thoracic curve, while the other had a longer curve more typical in people with cerebral palsy.
Bracing would not really be helpful for either of these young ladies, since they were done with skeletal growth.
However, they are both still at risk for curve progression, and need scoliosis follow-up every 6 months for next couple of years, and then annually thereafter.

Lloyd A. Hey, MD MS
http://www.heyclinic.com
Hey Clinic for Scoliosis and Spine Surgery
Raleigh NC  USA

Hey Clinic Wed Jan 22 afternoon surgery: 64 yo Virginia from Florida with adjacent level "failure" above fusion done 30+ years ago

Tuesday afternoon, we helped Virginia, who is a 64 yo woman, who came up to see us from Florida (near Sarasota), with severe back pain and trouble walking.  She had a previous L4-S1 noninstrumented fusion done 30+ years ago, and had done well for many years.  Over past few years, however, she developed increasing low back pain and trouble walking.  Her studies show severe adjacent level failure with degeneration and stenosis.
Tuesday, I took the pressure off the nerves at L34, (laminectomy) and extended her fusion from L5 up to L2, with instrumentation and bone graft.  The intra-operative photo shows a piece of the old fusion mass that I had taken from her fusion.  You can see how solid her old fusion became, now as solid white cortical bone on the outside shell, and cancellous bone in the middle of the fusion mass, similar to what you would find in the middle of a vertebral body.  It is truly amazing how the body heals, especially bone, since bone heals without the scar found in other tissues like skin.  In about a year (or less in children), the bone graft that I put along the spine from the local spinal tissues, and from the bone bank (allograft), turns to this very solid normal human bone, providing long-term stability along the fused segments.

Virginia did VERY well during her visit here to Raleigh, NC and Duke Raleigh Hospital.
She drove home to to Florida, leaving early Saturday morning, with plans to make one overnight stop on the way home.
She planned to sit in the passenger seat, semi-reclined, and to make stops every couple hours to avoid getting stiff and blood clots (deep vein thrombosis –DVT)

Lloyd A. Hey, MD MS
http://www.heyclinic.com
Hey Clinic for Scoliosis and Spine Surgery
Raleigh NC  USA

Hey Clinic Jan 22 Surgery: 17 yo Jillian with double curve scoliosis has corrective surgery with excellent correction

Jillian is a delightful, small-framed 17 yo girl with a severe double-curve scoliosis.
On Tuesday, I performed a T5-L4 spinal reconstruction for her.
Unlike 22 yo Ashley Monday, Jillian’s upper and lower curve were still nice and flexible.  Her ribs were also fairly flexible.
As a result, I was able to get a near 100% correction.
She has done very well postoperatively.
Her younger sister is very interested in medical things, and I think Jillian is a bit too, so I recorded portions of her surgery in High Definition (HD), with our new improved camera and sound system.
We also showed the HD video real-time on the big screen monitor in the operating room so the whole OR team could keep an eye on the surgical field.
As time permits, I will try to post some portions of that surgery video to the Blog, and YouTube.
Jillian did very well in the hospital, and went home Friday after 3 nights at Duke Raleigh Hospital with her family in a large private room.
She is at least an inch taller now that her scoliosis is corrected, and her posture looks just great.

Lookin’ good Jillian!

Lloyd A. Hey, MD MS
http://ww.heyclinic.com
Hey Clinic for Scoliosis and Spine Surgery
Raleigh NC  USA

Mon Jan 21 afternoon surgery: Revision surgery for broken rods in woman who had severe fall 10 months after scoliosis surgery. Developing better solutions for future scoliosis surgery through biomechanical research.

Monday afternoon we helped Mary, who I had corrected a huge scoliosis 10 months ago.
She did very well until a month or so ago, when she took a very severe fall, falling down several stairs.
She subsequently developed increasing back pain.
Her X-Rays and CT confirm that she broke both of her rods near the base.
I revised her instrumentation and fusion on Monday, with a new triangular construct, and improved biological healing using bone morphogenic protein, (BMP).
She subsequently did very well, and went home at the end of this week.

As many of my patients and readers know, I have a background in engineering, and have had a long-term interest in reconstructive surgery with a high emphasis on biomechanics.
I work closely with our instrumentation vendors, to ensure that we have the strongest materials available.  However, having strong materials is not enough: we need to continually figure out better and better CONSTRUCTS, and to improve the biological healing properties of the fusion.  We also need to help our patients to understand what to do, and not to do after surgery, especially in the older patient, who has a large surgery: “Avoid Bending, Lifting and Twisting.”  However, even with all of the right surgery and precautions, things like severe falls do happen, which can push the spinal constructs beyond what they were meant to handle, during the critical first year of bone healing.

Hey Clinic is working with the Department of Engineering at NC State on developing better computer models for guiding spinal instrumentation, and also on lab testing for new scoliosis constructs that should improve corrections and fusion rates, and provide solutions for tough revision deformity cases with proven mechanical strength and longevity.  Associate Professor Andre Mazzolini, one of our academic collaborators, has a deep interest in the spine, scoliosis and spinal instrumentation, with some direct family experience with scoliosis.  We are also working with instrumentation companies, including Synthes Spine, in order to evaluate and develop better solutions for spinal surgery.

Lloyd A. Hey, MD MS
Hey Clinic for Scoliosis and Spine Surgery
Raleigh, NC  USA
http://www.heyclinic.com

Mon Jan 21 Hey Clinic Surgery: 22 you Ashley with the 78 degree stiff R thoracic curve and pulmonary problems.

Monday, we helped a 22 yo young lady who had a 78 degree thoracic scoliosis, with some breathing difficulties secondary to decreased pulmonary capacity, exposure to her grandmother’s smoking, with chronic bronchitis, and possibly a mild cystic fibrosis condition.  She had known scoliosis as a teenager, but her parents did not arrange for ongoing follow-up after she finished being followed by her pediatrician.  Over the next 4 years, her scoliosis continued to progress even though she was skeletally mature.  She then experienced increasing back pain, and pulmonary difficulties.  We actually had to postpone her surgery for a couple of months to try to improve her pulmonary function prior to surgery.  She sailed through surgery without difficulty on Monday, with her surgery taking about 3 hours, and no blood transfusions.  Her curve, however, was quite stiff, which took more intra-operative effort to improve her curve.  Her postoperative curve is definitely improved, but her rib deformity is still evident, but may improve a bit over next few months.  However, we definitely would have gotten a better correction if we had fixed this when her curve was smaller, and she was younger and more flexible.  

In fact, on the day following Ashley’s surgery, I corrected a 17 yo young lady’s double curve which was 60/48 degrees, which was still very flexible, resulting in nearly a 100% correction of the curve and elimination of the rib hump.  Just 5 years earlier than Ashley’s surgery.

Parents and other family members, along with pediatricians, OB/GYN physicians (gynecologists and obstetricians), and family physicians can all help to ensure that all children and young adults and older adults get:

1. Screened for scoliosis and kyphosis, including using the scoliometer as an accurate method for determining whether X-Ray is necesssary, and
2. Ensure that all patients identified with scoliosis or kyphosis  receive life-long follow-up, since curve progression can occur at any point either before or after skeletal maturity.
   

Ashley did very well during her short hospitalization, and went home glad to have the surgery behind her, after many years of dealing with this growing problem.

Lloyd A. Hey, MD MS
Hey Clinic for Scoliosis and Spine Surgery
http://www.heyclinic.com
Raleigh, NC USA

Sarah comes back for follow-up after kyphosis correction @ Hey Clinic

This past week at Hey Clinic was filled with many wonderful interactions in clinic, and the operating room, and on the hospital floor, and even some travel up to visit Synthes, the instrumentation company that supplies much of our our spine hardware.

Last Friday, we saw one of our teen-age patients named Sarah, and her family back for follow-up.  I had performed a revision kyphoscoliosis surgery for her a few months ago, and she came in looking just great, with excellent posture and X-Rays.  Her photo with her family was the title photo for our weekly Hey Clinic Learning Conference.

Sarah was originally braced for her severe kyphosis, which really did not do very much.  Her original kyphosis was approximately 80 degrees.  Because of her slender frame, her kyphosis was quite evident to her and to others, and affected her self-image and appearance.  Now her kyphosis is normal, with an excellent appearance from all angles, and marked improvement in her own self-image.

Lloyd A. Hey, MD MS
Hey Clinic for Scoliosis and Spine Surgery
Raleigh, NC USA
http://www.heyclinic.com

Dr. Hey Discusses Revision Extension Instrumentation and Fusion with young woman who had motion-sparing Dynesys Instrumentation below Harrington Rod

Motion-sparing spinal surgery, using things like the Dynesys system have become somewhat popular with some patients and physicians.
This young woman had a Dynesys system put in her lumbosacral spine done elsewhere, below a previous Harrington Rod instrumentation and fusion. She did not get any relief, and now her pain is much worse.
She has failed conservative therapy, and now we are discussing fixing her flat back syndrome, spinal stenosis, and spondylosis and disc degeneration below her previous Harrington Rod fusion by doing an anterior L45 and L5S1 Anterior Lumbar Interbody Fusion (ALIF), followed by a posterior L2-S1-Ilium revision instrumentation and fusion with removal of Dynesys system, and multilevel lumbar laminectomy to take the pressure off the nerves.

Lloyd A. Hey, MD MS
http://www.heyclinic.com
Hey Clinic for Scoliosis and Spine Surgery

Peter gets the use of his right hand and arm back after ACDF cervical decompression surgery of his spinal cord with Dr. Lloyd Hey

Peter had a severe pinch on his spinal cord caused by a cervical disc herniation in his neck. He had progressive muscle atrophy and weakness in that hand and arm, and had to stop playing golf, and had increasing trouble with fine motor function, including writing with a pen.
He is now a few weeks out after his anterior cervical decompression and fusion (ACDF) with anterior plate, and is now doing very well. His strength, including pinch strength began to get better immediately in the hospital, which he showed us on rounds on postop day 1 at Duke Raleigh Hospital.
He gives a brief video interview here.

Lloyd A. Hey, MD MS
http://www.heyclinic.com
Hey Clinic for Scoliosis and Spine Surgery
Raleigh, NC USA

Hey Clinic Successful Adult Scoliosis Surgery Interview

We saw this woman back for follow-up on Friday who had a complex kyphoscoliosis reconstruction that we performed several months ago.
Her posture now is excellent, and quality of life restored.
She tells her story briefly via video.

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

Hey Clinic Postop Visit for Gentleman sp complex revision lumbosacral surgery

This gentleman had several previous surgeries elsewhere, including a pain pump, and still was in severe pain with very poor quality of life.
He came back for his follow-up visit at Hey Clinic after his revision lumbo-sacral iliac wing reconstruction instrumentation and fusion with multilevel complex decompression. He is doing so much better, and has tapered off his major pain medications.
As much as I prefer working with the children and adolescent deformity patients (kyphosis and scoliosis), the older patients are often just as thankful, if not more so.

Lloyd A. Hey, MD MS
http://www.heyclinic.com
Hey Clinic for Scoliosis and Spine Surgery
Raleigh, NC USA

1 year f/u appointment for teenage dancer after scoliosis surgery with Dr. Hey

I saw a bunch of people back for follow-up appointments on Friday, including this young lady for whom I had performed scoliosis surgery around a year ago.
She is doing great, returning to full dance within a few weeks of surgery, and now still looking great and feeling great.

Lloyd A Hey, MD MS
Hey Clinic for Scoliosis and Spine Surgery
http://www.heyclinic.com

Email from my mother-in-law, reading Hey Clinic Blogs as opposed to watching football

I received a nice note from my mother-in-law, Sharon, who I performed an L45 decompression and fusion with instrumentation for a L45 spondylolisthesis with stenosis over 5 years ago.
6 months after her surgery, Sharon and her husband Richard toured the Southwest with us, and hiked the Grand Canyon.
The following summer,  Sharon and Richard joined us for a trip hiking through the Grand Tetons.
She walks 5 miles per day, and does gardening and dance.

As a funny coincidence, Richard developed similar symptoms to Sharon a few years later, and after several years of conservative therapy had to have the same surgery as Sharon.  His surgery was 2 and a half years ago now, and he called me a couple days ago to tell me that he took 3rd in a mini-marathon down in Florida for his age group.  Sharon also finished the race, but did it walking with her friends!

Lloyd A. Hey, MD MS
http://www.heyclinic.com
Hey Clinic for Scoliosis and Spine Surgery.
Here is her note she sent me earlier today via email:
-----------------
Dear Lloyd,

I have just spent the first 3 quarters of the football game reading your web site and am more amazed today than I was with your abilities and concerns years ago.  Wow..................  you have done and continue to do such amazing feats.  So many people owe you so much for their pain relief and new self-confidence.  I am one of those.  

 
I will have to go back onto the site.......... time now to cook.

Thanks for all you do for so many.

Love , a very proud M.I.L.
Mom

Flexibility differences between younger and older patients who have scoliosis, and it's affect on curve correction during scoliosis surgery

We perform scoliosis and kyphosis surgery on a wide age range of people. For example, over the past 2 weeks we have treated people from 9 years old, to 75 years old.
In this video, I actually show a comparison of the spine flexibility between a 74 yo retired nurse who had surgery on Wednesday, and a 29 yo jewelry retailer yesterday.
Which one do you think ended up with the better correction?
Age alone is not the only factor.
In general, the children and adolescents are the most flexible and easily correctable, but there are exceptions, including congenital scoliosis, which is very "stiff" since there is an extra piece of bone, which acts like a wedge. This wedge can be removed in many cases, allowing for curve to be corrected.
However, there are other genetic and other factors that affect flexibility. I have treated relatively stiff teenage curves, that required some extra work to get an excellent correction. However, I have also found some 50 or even 60 yo people who had flexible curves.
Bending films, and supine films (X-Rays) can give you some indication of flexibility, as well as some observations on clinical examination.

In general, however, you do get a better scoliosis correction, and an easier recovery, with less risk if your scoliosis or kyphosis is corrected when you are younger, rather than older.

Factors that make scoliosis/kyphosis surgery "easier" in the younger group:
1. Flexibility
2. Curve size
3. Often shorter fusion needed, since long-term degeneration due to asymmetric loading does not collapse lower discs.
4. Better bone quality (less osteoporosis), which decreases chance of hardware loosening or pseudarthrosis (non-union)
5. Less medical risk (younger heart/lungs)
6. Faster recovery time
7. Less need for decompressive laminectomy surgery for stenosis, which tends to occur in older group.
8. More years to enjoy improved self-image, appearance and posture, and possible better quality of life with less pain, if pain is already an issue.
9. Fewer surgical and post-surgical complications, including wound infection, DVT, pseudarthrosis, adjacent level failure, major medical complications (stroke, MI)
10. Less stressful for surgeon!

As the spine surgeon, I always enjoy the younger scoliosis and kyphosis surgeries a bit more than the older cases, for some of the reasons above. However, the quality of life improvement that I have seen in the older group, (even up to age 96!) can be so dramatic that it is worth it to see them getting their life back, and standing up straighter, and be able to get out of some of the severe pain, and to be able to function better, and walk better.




Other big differences between the older an

Tiffany's "Teamwork" talk for weekly Hey Clinic Quality Meeting

Teamwork

by

Tiffany, Hey Clinic

One of the many definitions of teamwork is, a cooperative or coordinated effort by a group of persons acting together as a team or in the interests of a common cause.  Teamwork is used and applied in a variety of different settings including sports, corporations, marriages, law enforcement and the list goes on.  In order to achieve success in these, and several other areas, working together and using effective teamwork is imperative.

Everyone has heard the statement, there is "no 'I' in the word 'Team'." This is more true today then it has ever been. In researching teamwork, I discovered that many businesses now rely heavily on creating an atmosphere of teamwork.  They have found that the key to successfully completing and accomplishing projects is often through the development of teams. In the past, teamwork was used only for special projects.  However, in today’s society it is often the norm (Castro, 1994). Teamwork has become an essential element for the success and survival of a business.

The hardest part in achieving successful teamwork is true collaboration of each individual.  This is difficult to achieve because people are often rewarded on individuality more often then team participation.  Team players are encouraged to learn how to grow and develop as a team. 

In my opinion, a team player is someone who is willing to ask for help and at the same time always available to assist others.   A good demonstration of teamwork is an individual who communicates effectively and helps others/co-workers in need.  It is also the ability to accept advice from other people and to have the flexibility to adapt to any role within a team environment.  Being a team player means collaborating your efforts to help the “team” complete the tasks at hand.  Teamwork creates an atmosphere of mutual appreciation and respect towards co-workers.  It eliminates competition and strengthens the bonds between different people striving towards a common goal. 

“Simply stated, it is less me and more we” (Unknown).

 

 

Hey Clinic Jan 7 '08 AM Surgery

Patricia had L2-S1 instrumentation and fusion done 10 yrs ago, and now has terrible spinal claudication and back and leg pain with severe degeneration, spondylolisthesis and stenosis above her old fusion.

This morning I helped her by decompressing the compressed nerves, and stabilizing the spine 3 levels above the old fusion with instrumentation and bone graft.  The old hardware and bone stimulator were removed.

 

Her preop studies and intra-op X Ray are shown.

She did well with surgery, and will be up and around tomorrow.

 

 

Lloyd A Hey, MD MS

http://www.heyclinic.com

Hey Clinic for Scoliosis and Spine Surgery

Raleigh, NC USA

Ehlers-Danlos Syndrome as cause for back pain. New Diagnosis from a grateful patient.

Email received yesterday to Hey Clinic PA Brittany, and physical therapist Rob, from “Mare”:

Hey Rob and Brittany,
 
I just returned from my appointment with Dr. Evans (UNC geneticist) and he confirmed that I do have Ehlers-Danlos Syndrome, type 3 (hypermobile). First, I want to thank Brittany for taking my concerns seriously and being proactive. You referred me to Rob, who then immediately pinpointed the hypermobility issue, thus setting the course for the diagnosis I’ve been searching for…for soooo long! This diagnosis now frees me to work on core strengthening with Rob (let’s keep it gentle!!!) and to receive proper long-term medical treatment. Dr. Evans gave me the names of two internists there at UNC Chapel Hill, who I will use as my “medical managers”, for lack of a better way to say it. I don’t want to come off as schmultzy, but I do want to thank you both for being the key players in getting me on a track to wellness. I feel as if a huge burden has been lifted…and wanted to share my joy with you both! Once I get to a point of feeling stronger and having adequate pain control, I think I’ll get involved in patient advocacy or supporting the EDS foundation in any way I can. I was involved in a similar fashion with the ACS after I recovered from all of my breast cancer treatments some years ago, and it was very fulfilling and meaningful work. If I can help others struggling to get a diagnosis, or needing help in any way, then that’s what I am going to do. I realize that EDS is a rare condition, but please keep in mind, if another “Mary” walks through your doors, with clean x-rays and MRI’s, complaining of diffuse, debilitating joint pain, he or she may just have this condition, or one similar to it. (see? I’m already at work!) Thanks again to you both…Rob, I’ll talk to you later, and Brittany, I’ll call you if any more back issues arise.
 
Big hugs to you both….
 
Mare

Jan 3 2008 Hey Clinic Surgery: 28 yo woman with 43 degree painful progressive scoliosis

Vera has had 3 children, with progressive back pain and noticable “shift” in her posture to the side over past 10 years.
She had 43 degree mostly lumbar curve.
Today, she had her curve corrected nearly 100% with a T11-L5 instrumentation and fusion with L45 TLIF.
Her surgery took approximately 3 hours.
Her estimated blood loss was 1000 cc, with most of this blood returned to her with cell saver.
She is doing well this afternoon, very pleased with the photo of her new posture!
Vera wanted this fixed now when she was younger, not only to get relief, but to prevent the curve from getting larger in future, when it would also be stiffer, and harder to fix, with a higher complication rate, and harder postoperative recovery.
Her wonderful curve correction shows how some 20-30 and even some people in their early 40’s can get phenomenal curve corrections if the curve is relatively flexible.
I have even seen some 50 and 60 yo patients with flexible curves, but most older patients have much stiffer curves.
Osteotomies can also help get better correction in the younger and older groups


Lloyd A. Hey, MD MS
http://www.HeyClinic.com
Hey Clinic for Scoliosis and Spine Surgery
Raleigh, NC USA

Jan 2 2008 Hey Clinic Surgery (PM Case): 61 yo executive from Tennessee with severe myelopathy with severe thoracic stenosis, with falls, clumsiness and weakness

This gentleman had several month history of progressive lower extremity weakness and numbness and clumsiness, with falls.
This began after doing a lot of lifting when moving to new home on a golf course.
His MRI and CT scan showed severe stenosis T89 and T9-T10, mostly from posterior ligamentous and facet hypertrophy, and some disc bulging.
His surgery went very well with CT-guided level confirmation, and intra-operative evoked potential motor and sensory monitoring, and intra-op ultrasound that confirmed an excellent decompression of the spinal cord.
His preop evoked potentials showed no motor potentials, and weak sensory.

Postoperatively, he has done just great.
He was up walking around with a stable gait several times today, with much improved balance, and improved sensation and strength.
He goes home to Tennessee tomorrow, looking forward to play golf later this spring/summer as cord recovers.

Lloyd A. Hey, MD MS
http://www.HeyClinic.com
Hey Clinic for Scoliosis and Spine Surgery
Raleigh, NC USA

Jan 2 2007 Hey Clinic Surgery: 65 yo woman with severe back and leg pain, trouble walking with degenerative scoliosis, spondyolisthesis and stenosis

This woman had severe progressive difficulties standing and walking with a collapsing lumbar scoliosis and stenosis.
She did very well with her surgery yesterday, with almost immediate relief of her severe sciatica in L leg postoperatively.
Her surgery took a little over 3 hours, with 3 level laminectomy, and T12-Iliac Wing instrumentation and fusion.
She did not require blood transfusion, and was able to spend first night on our spine/ortho unit at Duke Raleigh Hospital with her husband in a bed next to her in a large private room.
She was up walking around today, doing very well.
She will likely go home to Pinehurst on Saturday morning.


Lloyd A. Hey, MD MS
Hey Clinic for Scoliosis and Spine Surgery
http://www.heyclinic.com

Dec 31 2007 Hey Clinic Surgery: Extension Instrumentation and Fusion for 9 yo with severe cerebral palsy and kyphosis with osteoporotic lumbar fracture

This young boy with severe spastic quadriplegia and history of thoracic fractures did very well after kyphosis surgery several months ago, but then developed increased pain and deformity due to a compression fracture in his lumbar spine.
I revised and extended his instrumentation and fusion down to the iliac wings bilaterally.
His surgery went very well, and his pain is now relieved, and he will be going home to his rehab Saturday.
Osteoporotic fractures are rare in children, but are more common in children who are non-ambulators, or who have chronic nutritional deficiencies, chronic steroid use, etc.
This young boy should do well now, with nearly his whole spine supported and straightened with the hardware.
This chilid’s guardian, Jeannie is an absolute loving angel, and has helped to look out for this little boy for the past 8+ years he has been under the care of the State.

Lloyd A. Hey, MD MS
Hey Clinic for Scoliosis and Spine Surgery
Raleigh, NC USA
http://www.heyclinic.com

Best Christmas Gift and a Happy New Year! A Thank You Letter to Dr. Hey, from Carolyn S., Alpharetta, Georgia, after corrective revision scoliosis an

Jan. 1, 2008

Dear Dr. Hey,

This time last year, I had never heard of you or the Hey Clinic. One year later, if I were asked to list the very best Christmas gifts I have ever received, the gift of good posture would be at the top of that list. This most wonderful gift was from you! Your incredible understanding of the angles of the spine combined with your very capable hands is nothing short of a miracle to me.

I am thrilled anew each morning when I check in the mirror to make sure I am still straight! I am also able to walk again which had always been one of my most enjoyable activities but one which had become so hard for me I had given it up. After my first spinal surgery in 2005, I had become bent forward at a very uncomfortable angle. I would try so hard to straighten up (my family was constantly reminding me) and would think I was perfectly straight but if I checked I would see an old bent-over woman. When I walked, it was no longer something I could do spontaneously but seemed to require thought to put one foot in front of the other. This feeling is the hardest for me to describe but I can tell you that walking was no longer pleasurable.

My family and friends recognized my distress at this most unfortunate change in my posture so not one photograph was ever taken of me in profile that would show how really terrible I looked. My husband, who photographs absolutely everything that goes on in our life, admits now that he refrained from filming my posture because he feared it would upset me. Everywhere I went, I would watch everyone around me walking so effortlessly and so straight and would think that I had lost this ability forever. Now my husband and I are once again “mall walkers” and getting faster and walking further each day.

We had talked with several fine spine surgeons in the Atlanta area about my back problems which did include a lot of lower extremity pain and not one had ever addressed the posture problem nor offered any suggestions when I commented on this most important issue. I was unwilling to undergo surgery a second time with only the hope that some of my pain could be alleviated. The memory of the slow, painful recovery plus the possibility in my mind of still more deformity was something I wasn’t interested in. Then friends of ours put us in touch with a former patient of yours, Dr. Cecil Bendush. My husband spoke with him extensively by phone and a small ray of hope began to emerge. I was still prepared to be disappointed once again as we made the trip to Raleigh for our consultation with you. How very wrong I was!

You and Jaclyn explained so thoroughly everything concerning the spine: then you examined me and said those magic words, “I can solve all three of your problems and you will once again be straight……in one operation”. After a thorough discussion, I trusted you completely and I never once wavered in the weeks before my surgery. And you did what you said you would do! I AM straight again and I can never thank you enough. The only thing I can do is offer advice to others in similar situations to know that there is help for this problem. Already a friend of one of my sisters is keeping up with my progress through second-hand reports and I’ll be talking with her soon. She lives in Texas, but like me, would be willing to travel any distance to be properly treated. Thank Thank you so very much for your gift to me and I hope you and your family had a most wonderful Christmas with lots of time to relax with no emergency surgeries or similar interruptions.

Sincerely,
Carolyn
Alpharetta, Georgia

--------------------------------
Carolyn’s Nov 1 2007 Blog Entry with X-Rays:

http://drlloydhey.blogspot.com/2007/11/hey-clinic-surgery-nov-1-carolyns.html



Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery
Raleigh, NC - USA
http://www.HeyClinic.com