Tuesday, February 26, 2008

Hey Clinic Feb 25 Surgery: Bob with Degenerative Scoliosis and Stenosis and Todd with L45 disc herniation for microdiscectomy

Yesterday we helped Bob, who had a degenerative scoliosis, spondylolisthesis and spinal stenosis.
He is now doing great, postoperative day 1.
His son is out in Seattle, and I wanted to send special greetings to you.
This Blog is for you!

In the afternoon, we helped Todd, who is a 29 yo gentleman with a several month history of severe left leg pain.
His MRI shows a large L45 disc herniation.
I performed microsurgery for him yesterday afternoon and removed a huge disc fragment.
His L5 nerve root looked like it got a huge instantaneous “AHHHH” relief.
Surgery was 40 minutes.
In the recovery room an hour later, Todd’s leg pain was gone.
He went home this morning a happy camper, getting ready for wedding 3 weeks from now in Arizona.
Best wishes, Todd on your marriage and your healing!

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

Friday, February 15, 2008

Does Motion Sparing Surgery Work to fix flat back syndrome and back pain below Harrington Rod Fusion? Hey Clinic Revision Deformity Surgery for Susan with Flatback Syndrome and Dynesys. Feb 14 08 Surgery

The answer: “Not Always”.
Yesterday we helped a young lady from western NC who had Harrington Rod fusion done years ago for idiopathic scoliosis.
She developed back pain and flat back syndrome, and had a surgeon in Tennessee  try to help her with a Dynesys motion-sparing stabilization posteriorly.
She really did not improve after that surgery, and her pain actually got worse and worse along with her kyphotic posture.
Yesterday I performed an anterior/posterior revision reconstruction for her.  
Step 1:  ANTERIOR: removing the 2 lowest discs anteriorly, and “jacking them up” using ALIF titanium cages with bone graft.
Step 2: POSTERIOR:  removed the Dynesys hardware which had actually loosened, and then did 2 posterior osteotomies, so more lordosis could be created.  I then did instrumentation connecting Harrington rod down to the iliac wings bilaterally and then placed bone graft.

This was all performed on one day, under one anesthetic.
Estimated blood loss : 1200 cc.
Blood transfused: 1 unit PRBC.
Total Surgical time:  6 hours.
Postop Location: PACU and then to Orthopaedic Spine Unit / Private Room with family.

Lordosis Correction:  from 20 degrees preop to 56 degrees intra-operatively.

We have developed some special instrumentation techniques which have improved the lordosis correction while creating stronger constructs to improve fusion rates.
Additional research is being performed in cooperation with NC State Dept Mechanical Engineering to develop better constructs and insertion technniques for complex scoliosis and revision surgery.

While there is a lot of enthusiasm right now for motion-sparing spine surgery, its use in spinal deformity and flatback deformity is probably fairly limited, since it is not necessarily fixing the deformity, nor the pain generators.

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

Jane 1 year Postop Scoliosis Thank You Note after Scoliosis Surgery , Hey Clnic. Adults can have successful scoliosis surgery, as well as adolescents.

Yesterday I received a very nice hand-written note from Jane, who I had helped with a complex scoliosis correction surgery a year ago.
Her reconstruction went from T3 down to the iliac wing, with a multi-level lumbar laminectomy.
I was able to perform her surgery through one skin incision, and she had no significant complications during her 1 year recovery.
She is a good example of our efforts to continually improve our surgical techniques and clinical processes, including learning from our own clinical outcomes databases.
She is also an example how adults, and even older adults can have successful long-term outcomes from scoliosis and kyphosis surgery, although the risks are certainly higher in the older groups.  It is always better to try to fix scoliosis and kyphosis when you are younger, and to get the best possible repair on the first surgery if needed.
There are some orthopaedic and even some neurosurgical and orthopaedic spine surgeons who tell patients that adult scoliosis is not fixable.  This used to be true years ago, but is no longer true.
At Hey Clinic we treat both children and adults with spinal deformity (kyphosis and scoliosis) as well as other spinal conditions, including disc herniations, spondylolisthesis, fractures, and revision surgery.

We had recently seen her in clinic and gotten her “graduation” photo together.

Her note and photo are viewable above, and the note says:

“Dear Dr. Hey,
This is written to thank you and let you know how much I appreciate your expertise in surgical repair.
I am grateful for you and for my significant improvement.
Henry and I wish for you and your family continued blessings.
Jane S_____

February 9, 2008”

Thank you, Jane for taking the time to write this note.  It is an encouragement to me and the staff of Hey Clinic and Duke Raleigh Hospital where you had your surgery!

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

Thursday, February 14, 2008

Can you be physically active and run and play sports after fusion surgery for spondylolisthesis or scoliosis?

The short answer is “yes.”
In some cases, such as the adolescent with R thoracic curve correction with pedicle screw instrumentation, kids and young adults can go back to very active sporting activities very rapidly, often within first 2-4 weeks.  We have had high-performance swimmers back to diving and swimming within 2 weeks of scoliosis surgery.
In the older adult, sometimes we have to go a bit slower, but many return to a very active lifestyle during the first year, including golf, tennis, walking, cycling, and even some running and mini-triathalons.
My father-in-law, Richard, had his L45 spondylolisthesis and stenosis fixed 2 and a half years ago.  He was back playing tennis in Florida within 6 months, and was doing his first mini-triathalon 1 year after surgery.  He has run several races since then, including the Komen race this past summer with his daughter and my wife Lori.  He called me last month and told me that he took 3rd place in his age group for a 5 k race in Florida.
My mother-in-law had her L45 spondylolisthesis fixed 5 years ago.  She was back walking 1.5 miles by 6 weeks, 3 miles by 3 months, and now walks 5 miles every day, and gardens, and dances for her retiree stage show!
She hiked the Grand Canyon with us 6 months after surgery, and the Grand Teton National Park 1.5 years after surgery.
I have seen it have a dramatic effect on their quality of life.

My friend Lou, who is a 70+ yo golfer from Pinehurst had his thoracolumbar scoliosis surgery about 10 years ago.
He plays golf 3-4 days a week, as well as bicycles and travels on a regular basis.

We do limit extreme lifting, bending and twisting especially in patients with weaker bone and longer fusion/instrumentations, but most should be pretty solid by 1 year.

Yes, most people can be quite active after spinal decompression and fusion.

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

Does Scoliosis Ever Get Better On It's Own?

Last week we saw Olivia, a delightful 5 yo young girl for follow-up for her scoliosis.
She was sent to us 4 months ago with a scoliometer reading of over 7 degrees.
Her X-Rays in our office, measured very accurately on our digital scoliosis X-Ray system showed a 28 degree scoliosis 4 months ago.
This last set of digital X-Rays taken in our office showed that her curve had decreased to 20 degrees!
Great news for Olivia and her family!
We often see scoliotic curves especially in this younger age group actually improve with growth.

Olivia was so happy with the news that she was going to sing for us, since she plans to be a “rock star” some day, but then she got a bit shy, and told us that we would have to wait until her next visit to Hey Clinic!

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

Hey Clinic Feb 12 '08 Surgery: L45 decompression and fusion for L45 spondylolisthesis with stenosis after laminectomy

2 days ago, I helped the wife of a former NC plastic surgeon who suffered with severe back and leg pain.  She had a previous laminectomy at L45 that gave her only limited and temporary relief, but now her pain and trouble walking and standing grew consistently worse.
Her X-Rays showed a Grade 1 anterolisthesis at L45, with severe lateral recess and foraminal stenosis at L45 with severe facet hypertrophy.
On Tuesday, I performed an L45 revision decompression and fusion with instrumentation.  On mechanical testing of her L45 level, there was significant instability.  Therefore, a TLIF interbody spacer was used to help add additional stability with interbody support to enhance fusion healing, and to jack open disc space slightly for the neural foramen.
She is now doing well, recovering in hospital, and would like to go to a rehab most likely, but is considering also going home with home services.

Lloyd A. Hey, MD MS

Hey Clinic for Scoliosis and Spine Surgery
Raleigh, NC USA

16 yo with painful idiopathic scoliosis, fixed yesterday

Yesterday we helped a 16 yo young lady named Sammantha who had a painful idiopathic scoliosis.
Her lumbar had a large compensatory curve, that was fortunately not rotated and was very flexible.
I was able to get an excellent correction, nearly 100%, and her rib hump is gone.
Her estimated blood loss was 500 cc (0.5 liter), and she did not receive any blood transfusions.
Surgical time was under 3 hrs.
Her mom was able to stay in her orthopaedic room the very first night, and each night thereafter, in a large private room with 2 full beds, at Duke Raleigh Hospital.
She did well today her first day after surgery.

Years ago I was taught that idiopathic scoliosis should not be painful, and if it is, there must be another cause for pain.
Since then, there have been several articles that have documented that idiopathic scoliosis is painful in many adolescents and adults with scoliosis, and may motivate some to seek treatment.

Lloyd A. Hey, MD MS
Hey Clinic for Scoliosis and Spine Surgery
Raleigh, NC 27609

Kyphosis older and younger!

This past week I saw 2 of my severe kyphosis repair patients back for follow-up.
The younger one is 9, named Zachary, who had a 90+ degree kyphosis secondary to multiple thoracic fractures, and severe cerebral palsy secondary to shaken baby syndrome.  He now is able to sit upright in his wheelchair, and actually function in a comfortable position.  Preoperatively, he needed someone to hold his head up, and would drool all the time on his clothes.  Now he sits upright, and can interact with his teachers and caregivers.

The older gentleman, was affectionately known as “Pretzel Man” -- had a failed surgery elsewhere, and fell into such a severe kyphosis that he actually walked around on his hands and knees in severe pain.  He is 72 years old, and otherwise healthy, but his life was incredibly limited.  Now he stands up very straight, and has his life back

We care for the full age range of patients with scoliosis and kyphosis and many other less serious spinal conditions like disc herniations and spondylolisthesis.  We have treated one year-old toddlers up through 96 year-old ladies with spinal deformity.

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