Tuesday, July 22, 2008

62 yo nurse from South Carolina w/ New Quality of Life 9 months after Pedicle Subtraction Osteotomy (PSO) for Flat Back Syndrome

From: <“Betty”>
Date: Mon, 21 Jul 2008 20:39:19 -0400
To: "Dr. Lloyd Hey" <>
Subject: Re: Photos from Hey Clinic

I am a 62 year old nurse from South Carolina and I know that I am blessed to have found Dr. Hey. Before my spinal surgery with Dr. Hey I could not stand more than 1-2 minutes without support, and walking >25-30 feet left me totally exhausted. I had flatback syndrome with severe kypohosis and my legs were bent when I stood or walked. My back looked like a curved "C". I had been advised by two other surgeons to just accept this condition and apply for disability, that the surgery to correct it was too complicated and that almost no one had any experience with performing it. Then I found Dr. Hey and Duke Health Raleigh Hospital. They are both wonderful and made my surgery and hospital stay as comfortable as it could possibly be. I am now 9 months out from my surgery and am walking 2-3 miles every day and have returned to all my former activities, with some restrictions with weight lifting because my spine is still in the process of fusing. I have a lot of energy now that I don't have to expend it all trying to stand upright and I can once again walk my grandchildren on the beach and play with them in the pool. Dr. Hey is not only truly talented but he has tremendous enthusiasm and love for his work. Thank you again Dr. Hey. You cannot possibly know how much you have changed the quality of my life.


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

FW: Thanks. After L5S1 revision discectomy

------ Forwarded Message
From: Rick
Reply-To: Rick
Date: Mon, 21 Jul 2008 21:11:29 -0400
To: "Dr. Lloyd Hey"
Subject: Thanks

Dr. Hey,

My family and I want to express our most sincere thanks to you for restoring my life after my herniated L5S1 disc. You are a truly gifted surgeon and one of the finest human beings that I have ever had the pleasure of meeting. Your staff is also tremendously skilled and share your empathy and compassion for your patients. I hope that someday, I will be able to help you as you have helped us.


Rick _____
_____Law, P.C.
Raleigh, NC 27613

------ End of Forwarded Message

Monday, July 21, 2008

Molly's going home to Michigan!

Molly got her shower today, and was discharged from the hospital and just stopped by Hey Clinic next door so I could check her X-Ray, and see her new posture.
She walked in on her own, standing up straight and tall.
Our height check here showed she was 5 ft 4.5” -- an inch and a half taller than preop.
Her posture looks excellent, and her new X-Ray shows her kyphosis is in the normal range, with the hardware intact.

Molly and her mom Lysanne have been updating Molly's Blog throughout her hospitalization at Duke Raleigh Hospital, with photos along the way. You can see it at :


Have a safe trip home, Molly and family!

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

Saturday, July 19, 2008

"The Miracle Lady" One Year Out from Kyphoscoliosis Surgery with Dr. Hey

Yesterday, I saw Iona and her husband back for follow-up.
A year ago, Iona was a very, very crooked, suffering woman.
Her preop photographs shows her shifted way over to the side, and humped over.
I performed a T3-Iliac wing reconstruction, with multi-level laminectomies, and L5S1 TLIF all through a posterior approach.
She left the hospital standing up straight, and has done very well postoperatively.
She and her husband are both so thankful.
Back home, they call her “The Miracle Lady.”
Definite answered prayers for Iona and her family.

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

Friday, July 18, 2008

15 yo Taylor from Kodak, TN: Can scoliosis and kyphosis be fixed with an incision an inch long?

Here is a "Hey Clinic Puzzler" for you.
Is it possible to fix a scoliosis and/or kyphosis with only a 1 inch minimally invasive incision?

Your answer is tucked into the story below.

I just got a nice follow-up note from the mom of one of my recent surgery patients, named Taylor, who is from Kodak, Tennessee, about 343 miles drive from Hey Clinic. (5 hrs 35 minutes according to Google Map!)

Taylor was referred to me from a physical therapist in Tennessee.
He was lifting around 350 pounds doing squats about 15 weeks ago, when he had sudden pain going down both legs, and in his back, and found that he could not stand up straight.

He had seen doctors locally, and had some conservative treatment, but was told nothing more could be done.

I saw him a couple weeks ago, and found that he had a herniated disc with possibly a small endplate fracture at L45.  He stood with a severe scoliotic and kyphotic posture as shown in the photos above.  He could barely stand or walk.

My staff changed around my OR schedule for that week so I could fix his herniated disc and stenosis within 48 hours of our visit.  Interestingly enough, I fixed two other adolescents with scoliosis that same day -- the others had idiopathic scoliosis, which required the usual segmental spinal instrumentation with the several inch incision.  Taylor's was fixed with less than a one inch incision.

When I explored Taylor's L45 disc space, I found that he had actually not only herniated the disc, but had fractured off a piece of his growth plate, which is just below the disc.  This also contributed to his nerve pinch, and I trimmed this back as well.  His surgery took about an hour. Blood loss was minimal.

Taylor is shown in the pictures above standing up straight just the day after surgery, when he was able to drive back to Tennessee.

Her mom emailed me today the message below.  He is doing well.

So, the answer to the Hey Clinic Puzzler is "Yes - you can fix a spinal deformity sometimes with less than a one inch incision, if it is being caused by a pinched nerve, or disc herniation.  The person will then lean away from the pain, causing the spinal deformity.  Once the pinch and pain is relieved, they can stand up straight again.

The other thing we can learn from this is that weight lifters should be very cautious about lifting extremely heavy weights, with squats or dead lifts.  These lifting maneuvers, due to the biomechanics of the spine can put over a 1,000 pounds of force on the lower lumbar discs, potentially causing disc rupture, herniation, facet injury, pars fractures, and/or end-plate growth plate fractures.  

Fortunately, Taylor should do very well, but for his other similar lifting "buddies" out there, please remember that an ounce of prevention is worth a pound of cure.  Bench press is fine, but avoid extreme lifting with squats and dead lifts to help preserve your low back.

Here is Taylor's mom's email she just sent, giving her update.  

------ Forwarded Message
From: <cw.....net>
Date: Fri, 18 Jul 2008 16:18:59 +0000
To: <Dr. Hey>
Subject: Taylor ________ Surgery On 7-10-08

Dr. Hey,

You did surgery on my son Taylor __________ on 7-10-08.  Just to refresh you memory, he is 15 and had a injury from weight lifting for football. we are from Tennessee.

I just wanted to drop you a line to let you know how well he is doing and express how grateful we are to you for helping him.   He is walking completely straight and does not have any leg pain at all.  After 13 weeks of pain, he seems like a different person.  I actually have my son back and he is happy!!  

I can not put into words how to thank you.  All I can say is that God put you on this earth for a special reason.   Your compassion and your ability for helping others is a gift that your share.  To see a doctor ask God to guide his hands before surgery and to thank God for doing so after surgery is an amazing witness.   

You had mention that you were going to post something on your blog about this.  When you get time to do this could you please let me know where to find the blog.  His physical therapist wants to also read about it and keep it for future reference for his patients.   

God Bless You and Thank you so much!!    

Carl, Debbie and Taylor

------ End of Forwarded Message


Taylor and his parents gave their permission to share this story and photos on the Blog.

------ End of Forwarded Message

------ End of Forwarded Message

Our visiting medical student Evangeline, from Singapore and Dublin Ireland.

We have been blessed to have Evangeline Ng with us at Hey Clinic for the past 2 weeks.
Evangeline is from Singapore, but did her undergraduate premedical training at Johns Hopkins.
She now goes to medical school in Dublin Ireland.
She has done a rotation with us for 2 weeks, and has done a great job, rounding at hospital, seeing clinic patients with us, and observing surgeries. She has spent a lot of time with my two physician assistants, and with me as well
We will miss her!

Take care, Evangeline!

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

Thursday, July 17, 2008

13 yo Molly from Kalamazoo, Michigan gets 88 degree Scheuermann's Kyphosis straight today

A few months I got a very nice email from Molly’s mom in Kalamazoo, Michigan very concerned about Molly’s severe Scheuermann’s Kyphosis, which had progressed into the low 80 degree range.  We exchanged X-Rays and clinical photos and clinical history via web, and talked on phone.  Molly and her mom and dad then decided to come to Hey Clinic for evaluation and then likely surgery the next day here in Raleigh, NC.

Last week, they made the 13 plus hour journey from Kalamazoo Michigan to the NC coast down in Wilmington NC for a few days to enjoy the beach, and then drove up to see me yesterday for first time at Hey Clinic.

Her kyphosis was indeed quite severe, and appeared very stiff.  
Our digital scoliosis X-Rays in Hey Clinic, measured accurately with digital on-line Cobb measurements measured 88 degree thoracic kyphosis with some wedging of vertebra.  We had a long talk about the surgery, and postoperative recovery, and Molly and her brothers and mom and dad left the clinic smiling late yesterday afternoon.  They stayed in one of the many hotels right nearby, and came back into Duke Raleigh Hospital this morning bright and early.  We got a nice team picture to start the day, and Molly went back for surgery after a family prayer.

Molly’s surgery today went very well.  Molly has her own Blog, and she wanted video and photos from surgery for her future documentaries and blog entries.  Her mom is a professional photographer, and I think Molly is following in her artistic foot steps!

Molly’s curve was very stiff, as shown in the photo showing how big her thoracic hump remained even under general anesthesia and lying on 2 rolls, prone.
Her surgery went very smoothly.  I performed a T2-L2 instrumentation and fusion using titanium pedicle screw instrumentation with multiple points of fixation.  Since her curve was SO BIG and stiff, I also performed 4 posterior thoracic Smith-Peterson osteotomies to help improve the correction.

Her surgery took approximately 4 hours from start to finish.
Our special laminar flow room was used, along with “moon suits”, and special preps and drapes for infection prevention.
Her estimated blood loss (EBL) was 750 cc, with most of this returned to her in the form of “cell saver.”
No blood transfusions were needed.
I had to do the spinal correction slowly, in a segmental fashion due to the severity and stiffness of the curve.  Fortunately, with patience, it gradually allowed me to push it down and into a normal-appearing kyphosis.
Evoked potential sensory and motor function was normal throughout surgery.
Her parents were kept informed of our progress throughout surgery.

Postoperatively, I met with Molly’s mom and dad, and Molly’s 2 brothers who were definitely “wowed” by Molly’s new shape on X Ray and intra-op photographs.

I went by to see Molly in the PACU, and then an hour later up on the orthopaedic floor where Molly was with her mom and dad and 2 brothers in a large private room, comfortable, and psyched to see the pictures of her new shape!

Here is info Molly’s mom sent me earlier today about Molly’s Blog, that Molly and her folks gave me permission to share, as well as sharing this information in my blog.

Dr. Hey,

Thank you very much for sending us the xrays.  I need to get my sleep for tomorrow but thought I'd send you the blog website as we promised.


It was so nice meeting you today. We were very much put at ease after talking with you and Molly is thrilled with you!  Thank you in advance!


Monday, July 14, 2008

29 years after scoliosis surgery, doing great after Harrington Rod Fusion with 3 preserved lumbar discs

Today in clinic I saw a delightful 42 yo woman, who actually was bringing her young adolescent daughter in for a scoliosis check.
The mom mentioned that she had scoliosis surgery done with a Harrington Rod by Dr. Ralph Coonrad when she was 13 years old, and has done great ever since.
She had not had an X-Ray in many years, so we offered to get her a screening X-Ray today.
Her fusion looks awesome, hardware is intact, and her 3 discs below the Harrington Rod fusion all are well preserved without flat back syndrome, or spondylolisthesis (slippage).
With her permission, I was able to forward her X-Rays to Dr. Coonrad, who seems to remember all 2,000 of the children he helped with scoliosis over the many years he worked out of Durham Regional Hospital.  We have seen many of these adult patients back for follow-up, who all remember Dr. Coonrad with great warmth and thanksgiving.

It is important for scoliosis patients who have had fusions as a child or adolescent or young adult to get periodic checkups every 5 years or so to check for deformity or degeneration/slippaged below or above the old fusion.  Finding a regional scoliosis center that can handle both children and adults is a good place to have this done.

It is great to see how well patients can do even decades after scoliosis fusion.
As mentioned in previous blog, trying to spare as many motion segments as possible is important to help maximize disc wear while also seeking to get best possible correction.

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

12 yo scoliosis surgery from June 23rd -- recovering well at home

Three weeks ago today on my first day back from Haiti, we “straightened up” a 12 yo girl named Brittany @ WakeMed in Raleigh.  She had a 48 degree upper curve and 58 degree lower curve, but fortunately had wonderful correction of her lower 3 disc spaces on bending films, so we were able to spare 3 discs below.
Brittany’s surgery took around three hours, and her evoked potential sensory and motor function was normal throughout surgery.  Preoperatively, she had 2 very noticable humps on her back, both of which were down to almost nothing by the time I finished closing the skin.  
She did not require any blood transfusions, but we did give her back blood from the cell saver.
Since she was only around 75 lbs, with a small thin frame, I used the pediatric low profile instrumentation, to lesson the chance of the hardware irritating her soft tissue, or being palpable / visible at the level of the skin.
Postoperatively, she did great in the hospital, not requiring an ICU stay, so her mom could stay with her in the hospital room both nights.
She is now recovering well at home, with a nice email from her mom and dad reminding me to post the X-Rays as I had promised.
Sorry for the delay, Brittany!  It’s been way busy!.  My scoliosis surgery and family life are interfering with my Blog and writing career!

Maximizing preserved motion segments, while still maximizing curve correction is key to long-term success.  In fact, today in clinic I saw a very pleasant 42 yo woman who had scoliosis surgery back in 1972 by Dr. Coonrad, who was here at Hey Clinic to have her young teenage daughter screened for scoliosis.  Dr. Coonrad saved 3 of the lower discs below her double curve, and now 36 years later her discs below look just great, and she has no significant back pain. Historically,  patients who had long Harrington Rod fusions with only one or two discs remaining preserved did not do as well as those who had 3 or more (3 doing better than 2, doing much better than just 1 disc remaining).  Having more shock absorbers is better than fewer.

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

"Jammin' and Feeling Strong, Looking Great" after Adolescent Scoliosis Surgery. FW: Photo from Hey Clinic

-----Original Message-----
From: Vicki
Sent: Monday, July 14, 2008 11:28 AM
To: Dr. Lloyd Hey
Subject: Re: Photo from Hey Clinic

Dr. Hey, thank you for sending this photograph. It was great to see you
and your
terrific staff a few weeks ago. Valerie is jammin' along, feeling strong
looking great. We appreciate the exceptional care you've given our whole

Take care,

Vicki ______________

Quoting Lloyd Hey:

> It was so great to see you guys recently @ Hey Clinic.
> Valerie looks just great!
> Here is Team Picture as promised!
> Take care,
> Dr. Hey

Friday, July 4, 2008

Busy first 2 weeks back from Haiti. Many younger adolescent/pre-adolescent scoliosis surgeries, Pedicle Subtraction osteotomies

I arrived home from 1 week medical mission trip to Haiti a couple weeks ago.
Haiti is a beautiful country, with beautiful people, but the needs there were seemingly overwhelming.
We had a wonderful medical team, and although I did not get a chance to do spinal surgery on this trip, I did get a chance to screen many children and adults for spinal deformities and other problems.  I did help cure a lot of kids of “worms”, and saw some osteomyelitis, and some non operative orthopaedic injuries.  I also treated a LOT of hypertension and diabetes, which is very common there.  Many people also need simple reading glasses.  Many have GI complaints, with reflux, and stress-related gastritis, as well as likely hunger.  Many complained of eye symptoms of burning and itching — there is a lot of smoke, and tons of dust flying around in the air — my eyes burned as well, but sun glasses helped to protect the eyes a bit.
There were many children with scoliosis at a special home we visited outside Port au Prince, which cared for children with severe cerebral palsy.
Family Health Ministry (FHM) does a really wonderful job with their medical ministries, working with, and supporting Haitian physicians and other healthcare workers.
They are also helping out with an orphanage and school up in Fondwa in the mountains of Haiti.  We would like to see the orphanage and school combined into one upgraded “boarding school”, and are in the process of raising funds and plans for this group.  The existing orphanage is very dark, and small with dirt floors and cinder blocks, no electricity, and very little water, and a tiny kitchen.  It is also located way down the side of the mountain, down a small footpath — a hard place to get to, and a very hard place to do construction.

After arriving back in Raleigh on the 22nd of June, the past 2 weeks have been very busy caring for many younger adolescents with scoliosis, and adults with deformity and other spinal problems.
Kids definitely come in all sorts of different shapes and sizes!  My first scoliosis surgery when I got back was on a 12 year-old with a severe double curve, who weighed only 70 pounds.
Yesterday I fixed a 10 yo old girl’s large R thoracic curve who is 100 lbs heavier than the 12 year-old from last week, much more mature.
This difference between skeletal age and chronologic age is something we take into consideration when examining children and adolescents with scoliosis.

Also this week we helped a lady who had a spinal fusion done 8 years ago who had horrible flat back syndrome, with 17 degrees of lumbar KYPHOSIS!
I performed a pedicle subtraction osteotomy (PSO) at L2, and got her back into excellent lumbar lordosis.
She is now getting up and around, standing up straight for the first time for many years.

On Tuesday this week we “straightened up” a 56 yo woman who had a pseudarthrosis at L5S1 with painful kyphosis.
She had previous anterior surgery L1-5 done elsewhere, but they did not put anterior cage in L5S1.
That level developed pseudarthrosis with painful kyphosis.
We were able to dissect out that L5S1 disc through the adjacent scar through anterior approach, and then “jacked up” the space to give her more lordosis.  After this, we turned her over, and did a posterior osteotomy with decompression of the neural elements, and then revised her instrumentation from L1 down to the pelvis.
She is doing very well now, standing up much straighter with less pain.

In the morning yesterday, we “straightened up” the 10 yo girl who had a 51 degree R thoracic scoliosis.  Her pre and postop films are shown toward the bottom.
Her surgery took approximately 2 hours, and the estimated blood loss was 500 cc, requiring no transfusions and 250 given back in cell saver.
Her correction was approximately 90 percent, and she has done great postoperatively, going home likely tomorrow.
Our adolescent scoliosis patients rarely if ever require blood transfusions, and have not had to go to ICU postoperatively, except for children with severe disabilities (cerebral palsy, seizure disorders, etc).
Yesterday, also did a simple L45 microdiscectomy for a lady who had a HUGE free fragment disc herniation on the R side.
She went home today feeling much better.

We’ve seen a bunch of surgery postop patients in clinic with their families, as well as seeing a lot of new scoliosis patients for second opinions, and initial evaluations.
I saw one of my 1 yo congenital kyphoscoliosis patients back for follow-up, who has actually very nicely grown out of most her kyphosis! Mom was definitely psyched!
I saw a very nice lady from Vermont, as well as a couple people from Florida, and several from South Carolina.

Our premed summer intern, Chris, is working hard on his “spine growth” paper, which we will be publishing on the Blog here shortly.    This will address some questions several families have asked recently, regarding the concern about limiting spine growth with spinal fusions.  More on that later.   Chris, an engineering graduate from NC State is also helping with our biomechanical research this summer.  He also takes his MCAT’S in a couple weeks.  Work hard, Chris!  We’ve had a bunch of other summer students so far, who have all been great, including a couple who are former Hey Clinic patients, now going into the medical field!

Our biomechanical research with NC State is coming along nicely, with new computer models for spinal deformity and spinal instrumentation constructs.
Some new constructs are also being tested with “real” (not just computer) testing this summer as well.

Never a dull moment!
It’s good to be back @ Hey Clinic.

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery
Raleigh, NC  USA