Response to Joanne from near Chicago trying to find spinal surgeon to help with possible revision Harrington Rod surgery.

I received this Blog Comment/Question today.

 

Joanne,

Thanks for your encouraging feedback on the Blog.

The Scoliosis Research Society (SRS) website is very helpful for identifying surgeons who specialize in scoliosis and reconstructive revision surgery. 

The website is http://www.SRS.org.

You can search it by region of the country.

 

Many patients still choose to see SRS surgeons from around the country, (our Clinic, for example in past 3 years has seen patients from 32 States and 4 foreign countries), but it is often preferable to find an excellent scoliosis surgeon closer to home.  Many will seek second or third opinions from surgeons in other parts of the country, learning and seeing which surgeon and approach is best for them.

 

Don’t forget: conservative treatment is usually your best first option before diving into revision surgery.  Some of my other Blogs and other education materials stress that.  There is a Midtown Magazine article which is found on my main website which outlines many aspects of conservative care.

Take care and best of luck.

 

Dr. Hey

http://www.heyclinic.com

Hey Clinic for Scoliosis and Spine Surgery.

Raleigh, NC – USA

 

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Dr. Hey,

Thank you for your blog, it is wonderful to be able to find practical information regarding scoliosis on the internet.

I had corrective surgery with Harrington Rods in 1983 at age 15, at 21 the rod came loose and I had it removed.

I have had chronic back pain for over a decade, can you suggest any Doctors in the Chicago, IL region?

Thank you.

Joanne

OB/GYN SPINE LECTURE TODAY @ WAKEMED. RECOMMENDED FOLLOW-UP PERIOD FOR ADULT SCOLIOSIS.

This morning I had the pleasure of teaching at Grand Rounds for the WakeMed Obstetrics and Gynecology (OB-GYN) service, including faculty, residents and medical students from UNC.  

I started off the lecture sharing a recent email I received from a 50 yo woman who I did scoliosis corrective surgery for in past couple of years.  She shared how tough her scoliosis was on her self-esteem, and how embarrassing it was to try to talk about it with her OB/GYN, or primary care doctor.  It was easier to just not bring it up, since the doctors never brought it up.  

I gave an overview of spine biomechanics, including explaining how loads over 290 pounds can be created across the L5S1 disc just lifting small objects slightly in front of you.  We also reviewed Five healthy habits for spine health, including the importance of checking and following up on potential spinal deformities.  We talked a bit about how the mis-alignment of scoliosis can result in premature wear on the lower discs, due to asymmetric loading   A couple of the slides are attached.

It is important to note that several articles have documented the continued progression of scoliosis and kyphosis curves during adulthood.  It is estimated that 25 percent of patients with scoliosis by end of skeletal maturity will progress during adulthood.  In Betz’ 1987 JBJS article, he recommends that adults less than 25 yrs w/ scoliosis should have a scoliosis evaluation every 2 years, and every 5 years after age 25.  We will often follow the adolescents every 3-6 months, depending on curve size and growth remaining, and follow the 16-25 yo once a year if curve is bigger.  Betz also recommended getting evaluate immediately after each pregnancy, minimizing the chance of exposing fetus to X Ray.  It is helpful if these X-Rays can be stored digitally, measured by same observer to minimize error, and kept for decades, since curves are often very slowly progressing.

We talked about the effect of scoliosis and kyphosis in several key areas:

1. Self-image and appearance.  Often the first big effect of spinal deformities.
2. Back Pain
3. Curve Progression during adulthood
4. Late pulmonary and cardiac effects, especially in those with severe hypokyphosis, or severely narrowed chest wall.
   

We had an enthusiastic group of residents who eagerly wanted to try out the scoliometer on each other, which is a great tool for pediatricians, OB/GYN’s and others to use to screen for scoliosis.  The residents and medical students were all measuring each other at the end of the lecture, and going over their quiz answers.  Strong work!!!

Ever since I was at MIT, I have always enjoyed teaching, and inspiring the next generation. The most important place we teach is inside the Hey Clinic and over at the Hospital with our patients and families.  We always find our patients and families eager to learn more about their spinal conditions, and to then better understand their treatment options.

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

End of a Busy Week With Many Smiles

It’s been a really busy and tiring week @ Hey Clinic this week, but we had lots of great smiles to keep us going, including many during clinic today.
I gave a lecture this morning to a wonderful group of obstetricians and gynecologists @ WakeMed, as well, which I will share more about sometime soon.

Have a great weekend!

Lloyd A. Hey, MD MS
http://www.heyclinic.com

Back to Normal Flexibility Playing Golf 1 month after major scoliosis surgery

------ Forwarded Message
From: Alex
Date: Tue, 22 Apr 2008 18:47:53 -0400
To: "Dr. Lloyd Hey"
Subject: Golf

Dear Dr. Hey,
 I just wanted to touch base with you on my progress! It has now been one month since my surgery and for the first time today, I went to IMG academies and saw my coach for a golf lesson! I now feel like my back is extremely flexible and back to normal. Thanks again for all that you have done.
 
Alex

------ End of Forwarded Message
Dr. Lloyd Hey
http://www.heyclinic.com
Hey Clinic for Scoliosis and Spine Surgery
Raleigh, NC  USA

FlipFlops concern about preganancy and exercise after Harrington Rod Scoli Fusion

I received this Blog Comment today:

 

flipflops has left a new comment on your post "23 yo Iris with Scoliosis follow-up question":

Hello. I'm so grateful I stumbled upon your blog. I had a harrington rod/spinal fusion (bone grafted from both hips) to correct a 42 degree S shaped curve when I was 13 in 1983. I'm now 37. I'm worried since I haven't seen an orthopedist since I was a teen since I now have lower back pain. I worry that I was too ambitious in physical activity, running, swimming, dance, pilates and may suffer ill affects. Also terrified about family planning/pregnancy since recently married, if that is an option/if pregnancy weight will strain spine etc.. I had physical therapy re: strengthening back muscles two years ago. My primary care doc took xray and said that the x-ray tech said fusion looked ok. I do pilates, spin class and light jogging now. I don't want to lose my quality of life. Sorry this is so long.

-------------------------------------------

Dear flipflops,

I would not worry about your past activity – life is to be enjoyed, and there is no data I know of in the literature that suggests that decreased activity improves disc/spine condition later in life for scoliosis patients with our without fusion.  There is a lot of information that talks about the physical and psychological and emotional benefits of exercise.  So, be thankful for your active life, and have no regrets about the past.

In terms of pregnancy, and family planning issues, I don’t think you need to be terrified.

I would get your scoliosis checked, and get some conservative therapy for your back pain for starters.

 

You should get your scoliosis checked every couple of years to look for any signs of progression below your old fusion.  If you decide you want to have children, it should be quite possible, and it should even be possible to have an epidural anesthetic at levels below your old fusion.  You may have some back pain during pregnancy, but the end result is worth it!  If your back pain or leg pain was absolutely horrible despite conservative therapy, or if there was documented progression of your lower curve, you may wish to get the lower curve fixed before you have your first child.  But it is a fixable problem, fortunately.

 

I am trying to bring the issues of scoliosis and kyphosis to mind for OB/GYN (obstetrician and gynecologist) physicians, since these doctors frequently are the “primary care” doctors for young healthy women, and need to understand the importance off scoliosis follow-up through adulthood, as well as how the issues of scoliosis, previous scoliosis surgery and pregnancy planning all fit together.

If your OB/GYN would like some more info, she/he is welcome to email me or call me.

 

Take care, and thanks for your comments and questions.

 

Dr. Lloyd Hey

http://www.heyclinic.com

Hey Clinic for Scoliosis and Spine Surgery

23 yo Iris with Scoliosis follow-up question

Dr. Hey,Thank you so much for your feedback - that was a very pleasant surprise!!I wanted to add some more details about my situation: I was diagnosed at age 13 with a curve of 32 degrees (menarche had already occurred by this time). When I was first diagnosed, I started wearing the Charleston bending brace at night time. Four months later, my curve progressed to 38 degrees. This is when I started going to Shriners Hospital and started wearing the Boston TLSO for about 23 hours a day. Overall, I was very good at wearing the brace, and the brace successfully kept the curve from progressing.My last appointment was when I was 18 with the same degree of curvature. I am 23 now and have not been to an orthopedic doctor since that last appointment. Everything seems to be stable both physically and visually, but the only way to really tell would be to see a doctor. Thankfully, scoliosis does not affect my daily life, but the uneven shoulder blades bother me when I am sitting in a hard chair. I am currently finishing up my first semester of nursing school and am enjoying it. =) I hope that when I start my new career, my scoliosis won't be too much of a problem. I am slightly concerned, as I have heard from many nurses that they have bad backs, and I wonder if the duties of nursing would affect my scoliosis at all.Thank you again for your very informative post!- Iris

Iris,
You should not have a problem with your career as a nurse.
It is important, however, that you get careful annual follow-up at a scoliosis center, or with orthopaedic surgeon comfortable following you as an adult scoliosis patient.
Take care, and best wishes in your healthcare career.
If you would like to come and see some scoliosis surgery here in Raleigh, NC that can possibly be arranged.

Dr. Llooyd Hey
http://www.heyclinic.com
Hey Clinic for Scoliosis and Spine Surgery
Raleigh, NC  USA

Question from young adult who was braced as an adolescent with Boston TLSO: should she see orthopaedic surgeon as an adult?

Today I received this message from a young lady named Iris via my Blog:

Hi Dr. Hey!I found your blog when I was searching for blogs that mentioned scoliosis. It's neat how you are blogging about your patients and the treatment they are getting. I have scoliosis and wore a Boston TLSO for over a year. I was treated at Shriner's Hospital. My curve was 38 degrees at my last appointment. I currently do not have any major problems, but I wonder if I should go see an orthopedic surgeon sometime in the future to see if it is progressing at all. Perhaps I will, if I develop any problems.I will be continuing to read your blog!- Iris

Answer from Dr. Hey:
Iris, this is an excellent question.
Yes, it is important to be followed by a clinic comfortable taking care of adults with scoliosis.
As a young adult, you should probably have your scoliosis checked once a year through age 30 or so, and then every 2-3 years thereafter.
You should especially be sure to get your scoliosis checked before and after each pregnancy, since pregnancy may increase the curve dramatically, due to the ligamentous laxity caused by hormonal changes, and also the weight of pregnancy.

Sometimes a scoliosis curve can be stable over even many years, but then start collapsing during later years in 40’s or 50’s when degeneration causes especially the lower curve to destabilize.
It’s much better if possible to fix a progressive scoliosis during your early years since the curves are smaller and much more flexible, and the lower curve degeneration can hopefully be prevented due to the mis-aligned loading of the lower spine.

It is important for parents and adolescents with scoliosis to know that bracing can help slow down curve progression during adolescence, but it does not guarantee that the curve will not progress during adulthood, even if the curve when you finish growing is less than 50 degrees.  Meredith, who works in my office at Hey Clinic had a 30 degree curve when she was done growing, but the curve went to 45 degrees when she was a senior in college, at which point she had it fixed.  Many others have had similar experiences, and are often angry if they were not told about the potential for progression after they were “done growing.”

It is very important for you to have accurate scoliosis measurements made with proper scoliosis X-Rays, preferably by the same physician or physician’s assistant to decrease measurement error.
Keep copies, preferably digitally of all of your X-rays, since each of these data points, even a decade later may be important for verifying curve progression.
Curves during adulthood often only progress at a degree per year, so it often takes a few years to confirm the progression.
Scoliosis and Kyphosis are life-long conditions, and require life-long follow-up.

Take care, and I am glad you enjoy the Blog!!

Please send along other questions if you would like.

Sincerely,

Dr. Lloyd Hey
http://www.heyclinic.com
Hey Clinic for Scoliosis and Spine Surgery

53 you gentleman w/ 94 degree scoliosis from Mississippi. Wished he had gotten it fixed 10 + yrs ago! Getting on an airplane to see scoliosis specialist.

This past week, I got a chance to see a 53 yo gentleman from Mississippi who works as a river boat engineer.
He has a 94 degree thoracic curve, and has developed severe pain in his low back over the past 10+ years which has gotten significantly worse during the past year.

This is a good example of the long-term consequences of scoliosis.  Many scoliosis patients do well with smaller curves with no significant treatment.  However, there is a subset of scoliosis patients who have slow curve progression, which eventually becomes very symptomatic.  Correction of thoracic scoliosis curves at a younger age may help prevent this lower lumbar degenerative collapse which can cause spondylolisthesis, spondylosis (severe facet arthritis) and disc degeneration.  It can also cause spinal stenosis as the arthritis builds up, and the ligaments thicken in response to the collapse.  This can cause sciatica, and spinal claudication, with trouble standing and walking.

A couple weeks ago, I fixed a 16 yo  young man, who is a big-time golfer from southern Florida, who had a 68 degree preoperative curve.  He and his parents actually put off having the scoliosis fixed because of concerns about being unable to return to sports, including golf.  When Alex and his parents learned that people can now return to athletics including golf after scoliosis surgery, he was then willing to get it fixed.

By correcting Alex’s curve now, at age 16, rather than waiting to age 53, there are several advantages:

1. Less medical risk.
2. Better curve correction. Younger curves are usually more flexible.
3. More years to enjoy the improved posture and self-image and appearance.
4. Possibly help prevent the lower lumbar disc collapse and progression, by getting the spine into better alignment over the lumbar and lumbosacral discs.
5. Quicker recovery time
6. Stronger bone and faster/better spinal fusion rates.
   

Yet despite these advantages, I know many young, middle and older age adults are fearful or reluctant to have their scoliosis fixed, even if there is documented curve progression, and/or progressive back symptoms.  Some are even fearful or reluctant to get their scoliosis checked, or are unaware of the potential for progression of scoliosis or kyphosis during adulthood.

While it is always better to try to get spinal deformity fixed when you are younger, older patients can still do very well after scoliosis fusion.  I have actually helped patients up to age 96 who had significant spinal deformity.  The 96 yo woman I treated several years ago actually went back to work in the furniture industry, and actually walked with my wife all over huge furniture warehouses, successfully selling her a LOT of furniture and rugs, including our dining room set we enjoy frequently!  

However, it is important to have your scoliosis and kyphosis followed not just during adolescence, but throughout adult life.  Curves should be accurately measured every 1-5 years, depending on age and years of observed stable curve measurements.

If there is documented curve progression, or if symptoms from scoliosis or kyphosis are progressive, surgery should be considered.  However, it is always important to be evaluated by surgeons who have significant experience caring for people with scoliosis.  Many of my patients, including ones I have recently seen like Alex from south Florida (654 miles), this gentleman from Big Creek Mississippi (745 mi) , and Mary from Princeton NJ (468 miles) have found it  helpful to seek out more than one opinion, potentially traveling to different scoliosis centers around the country to find the right treatment and right doctor and team for you.  I’ve actually seen patients over the past 3 and a half years or so from as far away as northern California (2,700 miles) and  Stockholm Sweden (4,353 miles) and Honolulu, Hawaii (4,786 miles).  I think the Internet, and the ability for people to do more research on their own has really empowered people with spinal deformity, and their families to do a lot of research and communication, and then even get on an airplane to get things checked out, and possibly fixed.  Fortunately, scoliosis and kyphosis usually gives people plenty of time to research their options, unlike other more urgent medical conditions.  In a way I guess it really does make sense to travel sometimes, since we all travel often hundreds or thousands of miles for good vacations with family.  However, there may be a scoliosis expert that you will like closer to home, so you may want to check the http://www.SRS.org website for a scoliosis surgeon in your region.


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

58 yo woman 7 years after major scoliosis reconstruction: visit back to Hey Clinic, doing well as Kindergarten Teacher

I got a chance to see an old friend this past week named Susan, who I helped 7 years ago back at Duke Medical Center (DUMC) with a T4-L5 instrumentation and fusion.  She has done just great over the years, returning to her very active life, including working with little children at school as  a teacher.  Unfortunately she lost her teacher’s aid recently, and has had to do a lot more lifting and bending, and has started to have some increased lower back pain, but it is manageable.  

Her X-Rays show her instrumentation and fusion looks great, with hooks up in the thoracic area, and pedicle screws in lower thoracic and lumbar area.  A year or 2 after her surgery, I went over to using thoracic pedicle screws all the way up the thoracic spine, which has been even more effective for curve correction and postop stability.

Her X-Rays show some disc degeneration of the L5S1 disc below her fusion, but it still likely has some more “miles” left on it.

We got Susan a high tech lumbar back brace, and our Level 1 conservative treatment program, including a home exercise program, weight maintenance, anti-inflammatory medications, etc.
I hope they get her a new teacher’s aid for next year, since she really didn’t have any problems at all until she had to do all the lifting and bending herself.
Most people can’t believe how well people can actually bend over and lift after long spinal fusions.  

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

66 yo woman from Princeton, NJ with severe progressive thoracolumbar scolioisis. Hey Clinic Surgery April 7 2008

Mary is a delightful woman from Princeton, NJ who has been suffering with severe progressive scoliosis for many years.  She had been told there was no hope / no cure for her problem, and her pain continued to increase.  She travelled 468 miles down from Princeton to see us a couple months ago, after hearing about Hey Clinic through a physician friend who heard one of my lectures last year.

Her X-Rays done at Hey Clinic showed a 56 degree lumbar collapsing scoliosis with a fairly large thoracic curve above that, and Lateral X-Ray showing fairly significan loss of lumbar lordosis.
This past Monday, I performed a posterior T4-Iliac Wing reconstruction, using titanium pedicle screw and rod instrumentation, multiple lumbar osteotomies and laminectomies, and bone grafting.
Surgical time: 5 hours 30 minutes
Estimated Blood Loss:  2100 cc
Cell Saver given back to patient: 875 cc
Blood transfused:  1 unit PRBC
Complications: none.
Scoliosis Correction:  55 degrees preop to 33 degrees intra-op. Lumbar lordosis also restored.
Postoperative course:  doing well with physical and occupational therapy.  Some intermittent nausea.  Her standing posture is excellent, and she walks well with small amount of assistance.
Discharge likely Monday, staying locally for a couple weeks before heading back to NJ.


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

Alex back to school and golf two weeks after idiopathic scoliosis surgery. Parent Update.

Dear Dr. Hey
     Just wanted to say thank you once again for all your hard work and touch base on Alex's progress. Alex just "drove" home from a "full" day of school. It is exactly 2 weeks post-op today (Tuesday April 8th) and our entire family continues to be amazed at his rapid recovery. Alex experiences no pain, is off all narcotics, back at the gym three times a week as well as putting and chipping! We are so thankful to you and your entire staff. Your confident, compassionate and caring attitude put us at ease immediately. You are truly a gifted surgeon that far surpassed any expectations we may have had. Alex is still in awe at the surgical video you made him! The new putter is awesome and is something we know Alex will always treasure. We sincerely wish you continued success!
 
Fondly,
Jill and Ray

 

 

-------------------------------------------

http://www.heyclinic.com

Hey Clinic for Scoliosis and S;pine Surgery

Can you play sports after scoliosis surgery? Yes, you can be athletic after spinal fusion. Playing Golf 13 days after scoliosis surgery.

I received an email from Alex today, who came up from Florida 2 weeks ago to have his scoliosis fixed.
He is back home in Florida, getting back into golf, and working hard with a trainer.
His email is below, along with some pictures from his time with us at Hey Clinic, and Duke Raleigh Hospital.
Using strong titanium alloy pedicle screw instrumentation, Alex can return to full golf as soon as he feels able. We have had other patients return to full competitive swimming, cheer leading, and basketball with excellent results.

Lookin’ good, Alex!

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

------ Forwarded Message
Date: Mon, 7 Apr 2008 20:40:26 -0400
To: "Dr. Lloyd Hey"
Subject: Golf Pictures

Dear Dr. Hey,
    My mom took some pictures of me putting in chipping in the putting green behind our house as well as at the golf course. They are attached. Also I began going to the gym for rehab and can almost touch my toes!
Thanks again for everything,
Alex

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Early good word from grateful patient from South Carolina after revision lumbar surgery

Yesterday I received this note from a patient today, who had a failed microsurgery laminectomy performed elsewhere several months ago, and had severe postoperative pain and leg weakness.

A week ago yesterday, I performed a 2 level revision decompression and fusion, here at Duke Raleigh Hospital.
Intra-operatively, it was interesting to see that the amount of scar tissue in the area of the spine was actually larger than the skin incision.
Therefore, although surgery may look less invasive at the skin level, it is more important how successfully things can be fixed at the deeper spinal level.  
His one week report is below.

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

Dear Dr. Hey,
 
Although it is premature for a full evaluation of my condition, I do want to thank you for allowing me to get the first several nights’ sleep I have had in almost a year!  What a blessing!  I have not had any of the “old” pain in my leg since the surgery. Of course I have pain from the surgery, but the pain medication keeps that to a minimum.  I am walking every day, and am getting stronger.  You have given me hope and an optimistic attitude about my situation.  
 
I also want to thank your staff for their kindness and efficiency.  You have an exceptional team!  They are all very professional, and couldn’t be more pleasant to work with.  We have found the “Surgery Education Manual” most helpful.  We refer to it often.
 
You had stated that I would be well taken care of at the hospital, and you were certainly correct about that.  Everyone there was terrific. I have never had better care (and from my medical records, you know I have been in several hospitals over the years).  The nurses were all very attentive and personable.
 
Thanks again, Dr. Hey.  I will keep you posted regarding future results of my healing, and hopefully in a few months, I’ll have a great report for your “testimonials.”  
 
Best regards,
 
Jim

Lacrosse (LAX) Neck Injury: C67 cervical fracture with severe arm numbness and pain, fixed today C67 foraminotomy and instrumentation/fusion

Last Thursday, this 18 yo senior Varsity lacrosse player at local school had a severe blow to his head while checking another player in his chest, using his head and shoulder (possible “spearing” injury).
He had immediate severe pain and numbness and some weakness in left upper extremity, and came off the field.
His arm pain and numbness down into middle 3 fingers continued post-injury, but he did not complain of neck pain.
X-Rays of cervical spine were normal.
Physical exam showed sensory deficit in L hand in middle 3 fingers, and weakness in L triceps.
MRI showed possible facet fracture on L C67 with foraminal nerve root encroachment, but no spinal cord injury.
MRI flow through the adjacent vertebral artery was normal, although there was fracture of bone around artery.
CT Scan, shown here shows the facet fracture with foraminal narrowing.
He presents today for surgery, for C67 foraminotomy, to remove the broken bone fragments pressing on the nerve, followed by C67 plate fusion with a small titanium plate and screws, and bone grafting using local bone. An intra-operative photo, showing the plate and bone graft is shown.
Surgical time 1 hr 50 minutes.
Estimated Blood Loss 25 cc.
He will spend the night in hospital with his family, here at Duke Raleigh Hospital and go home tomorrow.

LEARNING/LESSONS: Lacrosse coaches, trainers and players should seek to prevent spearing injuries, which can cause severe cervical spine fractures, and spinal cord / nerve root injury. “Spearing” occurs when the head is driven into another football or lacrosse player, and then the cervical spine buckles under the high load, causing fracture and possible disclocation with cord and nerve root injuries common. Spearing has been outlawed in football, but is less well known in lacrosse and other sports.

Fortunately this young gentleman should have complete recovery.
He just woke up from anesthesia, and is moving his arms and legs well.


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