Thursday, April 30, 2009

Today's surgery: spondylolisthesis w severe stenosis, quickly losing ability to walk

Quality of life horrible, and getting worse. Forced to use rolling walker over past couple of months.
I met him and his wife and son yesterday for first time in clinic, doing all of the preop work over phone and email and mail.
Surgery: L2-Iliac wing instumentation and fusion, L2-5 laminectomy.
Surgical time: 3 hour 15 min
Blood transfused: none.
EBL: 640 cc.

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery

Wednesday, April 29, 2009

Todays's surgery: 17 yo kyphosis correction. Intraoperative and Preoperative xrays showing excellent correction

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine surgery

3 hours later: the 17 yo girl's kyphosis hump is gone!!!

It's a whole new posture.
This is her new side posture right after skin closure w head to left of picture.
Compare this to preop photo in previous blog.
She's gonna stand up pretty and tall tomorrow.
Surgical time: 3 hour 10 min.
Fusion: T4-L2 w pedicle instrumentation.
2 Smith-Peterson osteotomies
Blood transfused: none.
Complications none.

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery

This morning' kyphosis surgery: prep and drape

Her severe kyphosis is still quite evident when lying face down under general anesthesia.
We'll check this posture again at end of surgery today.

Dr. Lloyd Hey
Hey clinic for Scoliosis and Spine Surgery

This morning's surgery: 17 yo w 78 deg thoracic kyphosis w back pain.

Dr. Lloyd A. Hey
Hey Clinic for Scoliosis and Spine Surgery

Tuesday, April 28, 2009

37 yo gentleman w severe kyphosis and scoliosis and L5S1 disc herniation fixed today

Preop: severe back and R leg pain. Huge L5S1 disc herniation w 56 degree TL curve and 35 deg thoracic curve.
Proc: T5-Iliac wing instrum and fusion, L5S1 R discectomy and TLIF fusion.
Surgical time: 4 h 18 min.
EBL: 2700 cc
Cell saver 1100
Blood transfused: none.
Complications: none.
Correction: excellent.
Postop planned location: ortho floor (not icu).

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery

Monday, April 27, 2009

37 degree lumbar scoliosis w severe stenosis and flat back syndrome fixed this am

Preop status: barely able to stand and walk just a few feet w severe pain. Surgical time: 3h 40 minutes.
EBL 1100 cc.
Blood transfused none.
Surgical deformity correction: very good.

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery

Sunday, April 26, 2009

Joann and Chad head home today to complete 1,500 mile round trip journey to get her posture and life back after major thoracolumbar revision osteotomies and scoliosis surgery

A little over a week ago, I did a very complex T1-Iliac wing revision extension instrumentation and fusion for her, including upper thoracic pedicle subtraction osteotomy.
She did very well postoperatively, and her posture now is awesome.
Early this morning, after morning rounds I brought Joann and her husband Chad to Raleigh-Durham Internation (RDU) airport, which is 15-20 minutes from Hey Clinic and Duke Raleigh Hospital.
The nursing assistant helped her to get into my car with ease, and the folks at the airport met her at the curb with a wheelchair to take her through the whole check-in process (although she actually was walking great even without a cane or assistance!)
She does have a very long trip home, which apparently includes several airport stops, and a 3 hour drive on the other end to get her home to Potsdam NY. But she is definitely up for it, and we made sure that she was medically and physically ready to travel before letting her go. Is it possible to have scoliosis or kyphosis surgery out of state and travel on an airplane? The answer is "yes", but you need to plan ahead and take some additional precautions, and be a bit flexible on return flight especially for the very complex revision surgeries.
We had a nice chat on way to the airport, giving thanks for many blessings through the whole process.
Have a safe journey home Joann, and a very happy reunion with your children and whole family. Have a very speedy and complete recovery.

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery

Thank You Jaclyn Wagner, PA-C! You will always be a part of Hey Clinic Family.

Almost four years ago, a very spunky new physician's assistant graduate and triathlete named Jaclyn interviewed with me for a clinical position with me at Hey Clinic. She fit in great with our team, and came on board right away, and very quickly became a spine expert clinician, able to handle our very young scoliosis children and their families up through some of our guests who are grand parents and even great grand parents! Since then, Jaclyn has spent countless hours helping families in clinic, taking plenty of time to evaluate and explain the problems, and helping come up with solutions. She has done a great job working with me and the rest of the staff as we formulate and carry out care plans including surgery, and seemed to remember everything about everyone! But most of all, Jaclyn's compassionate heart has won over many families, and she has helped make a big difference in countless lives.

Jaclyn also now makes a big difference in her fiance's life, and will be joyfully starting a new life with him in northern Virginia this coming week. While all of us at Hey Clinic, along with our guests will miss Jaclyn, she knows that she is always welcome back, and will always be a part of our family.

We have been blessed to find a wonderful physician's assistant to replace Jaclyn named Jenny, who actually started with us a couple weeks ago to get trained by Jaclyn and Brittany and I. Jenny has a couple years of orthopaedic and spine experience already, and shares Jaclyn's wonderful qualities of eagerness to learn, compassion, service, and energy. She is also a triathlete, and actually has already gotten plugged in to the pool where Jaclyn used to train. We are excited to have you join our team, Jenny!

We had a beautiful going away party for Jaclyn last Friday including significant others that Shelbi in our office organized, which was a wonderful celebration of Jaclyn's contribution to Hey Clinic and our many guests. But I am sure many of our guests have not had a chance to express their thanks to Jaclyn, and might choose to leave her a quick message of thanks here as a comment, or on the Hey Clinic Facebook page. It truly takes a full team to deliver excellent scoliosis and spine care, and we've been blessed with a great one.

Thank you, Jaclyn, for pouring out your heart and mind and strength to serve our guests with excellence the past 4 years at Hey Clinic. We all wish you the best, and the door is always open. Come back to see us often!

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

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Wednesday, April 22, 2009

Huge L45 disc herniation now fixed!!

I just removed these 2 huge free fragments from a gentleman in his 30's who has been suffering severely for 2 months w severe left leg pain. His pain progressed, and led to weakness. Over past week, pain got even worse, and he lost ability to walk. Repeat MRI showed his small disc herniation at L45 had become monstrous, obliterating the nerve canal.
His wife, a nurse found me through internet searching, and then dropped me a call late yesterday when he could not walk.
They drove a couple hours up here today from the NC coast where they live this afternoon. We got him in late this afternoon, and took out the huge herniated disc which is shown in MRI image from previous "wow" blog.
I just saw pt in recovery room, and the facial expression of agony in preop is now the expression of relief -- his lg pain is gone.
Spoke to his wife after surgery and showed her the huge disc fragments which were sitting as a very prominent "crab meat" pebble pushing up on a very sensitive nerve bundle. Getting that "pebble out of his shoe" is usually quite a relief, like taking the thorn out of the lion's paw!!

The end of a good day at work.
Worth being a little late for dinner to ease the pain for this person and family.
Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery

Wow L45 disc herniation!

Severe L leg pain and weakness for this 36 yo gentleman w huge free fragment disc herniation.
Definitely fixable.
More to follow.

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery

Tuesday, April 21, 2009

AP view last surgery after surgery.

Dr.  Lloyd Hey

L5 severe radiculopathy caused by L5S1 spondylolisthesis w foraminal stenosis fixed today

This lady from South Carolina had L45 decompression and fusion w instrumentatin done yrs ago did well until recently. She then developed severe L leg pain in L5 distribution w scan and xray showinf spondy w stenosis. She as also tight a L34.
I just fixed this w L3 and L5 decompression and L3-iliac wing extension decompression and fusion w instrumentation. Her L L5 foramen was VERY tight, but now is completely free.
This is good example of adjacent level failure which is fixable by removing old hardware and extending the decompression and fusion.

Surgical time: 2 hour 15 min
EBL: 200 cc.
Blood transfused: none.

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery.

Monday, April 20, 2009

asymmetric pedicle subtraction osteotomy drawing for last surgery

Got a big hug from son of patient when he saw his mom's new shape!! 
I used this drawing to show where I removed the bone from L3 to fix both the scoliosis and lean and lordosis at same time.

Dr. Lloyd Hey

Today's surgery: L3 pedicle subtraction osteotomy to correct flat back syndrome, scoliosis imbalance and hardware failure

Surgical time: 4 hour 20 min.
Instrum levels: T4-iliac wing.
Lordosis and scoliosis correction: excellent. Post osteot lordosis 50 deg.
EBL: 2200 cc.
Complications: none.

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery

Saturday, April 18, 2009

Keith's 3 month postop visit with excellent pain relief and quality of life. Considering spinal surgery in the higher risk patient.

Keith is a 68 yo man who had a lumbar scoliosis and spondylolisthesis and severe spinal stenosis at multiple levels with an extremely poor quality of life.  He was referred to me by Dr. Kittelburger at the Pain Clinic here at Duke Raleigh Hospital.  Keith was in agony with severe back and leg pain and trouble walking, that was getting worse. 
While it was clear that Keith had a fixable surgical problem, and a very poor quality of life which was getting worse, and also had failed all conservative treatments, his decision for surgery was complicated by the fact that he only had one lung, having one lung removed for mesothelioma.  
Keith had heard that I was capable of doing the surgery much more efficiently than other surgeons with less experience, which he and his referring anesthesiologist knew would be critical for him to get through the surgery. 
After getting an extremely thorough evaluation performed on Keith with the help of pulmonologists, and many others, we had a heart to heart talk reviewing all of the risks and benefits, and he and his wife decided they still wanted to move forward with surgery, and I agreed to do it.  The pulmonologist helped to maximize his pulmonary function preoperatively with steroids and other medications to get him in tip top shape.  I must admit that there are times it takes me extra time to weigh the pluses and minuses for surgery, and there are times where I have to decide that I can't help someone with surgery if their medical condition makes the surgery too risky, and I most certainly never want to do harm.  But it's sometimes a tough decision that I often need to work through with the help of other consultants, prayer, and follow-up visits.  

His surgery three months ago went very smoothly, taking only around 3 hours for a 7 level instrumentation and fusion with 4 level laminectomy.  He was extubated right away, and had no pulmonary or other complications, and only spent a few days in the hospital.  I never rush through surgery, but I have learned how to become more and more efficient in the operating room, and have built a team around me that works with me doing hundreds of surgeries together each year.  I view doing surgery like a military mission:  you need to decide when and if to "attack", plan out mission well, pull together your best team, and carry out the mission rapidly and effectively, with backup strategies already in place for "what if's" that may occur during surgery. In a sense, whenever you do a surgery, you are "invading" the body, so it is important to get in there and get the job done, but get out as soon as possible!  As a result, our team often performs scoliosis and kyphosis surgery and reconstructive surgery in about half the time as predicted by our patients who have seen other surgeons.  That helps decrease blood loss (which is often half of predicted), decrease chance and amount of blood transfusion,  decrease risk of infection, as well as other perioperative risks.  This is often important whether you are 12 years old, 22, 32, 42 or 62 or 82.

Seeing Keith in clinic yesterday reminded me that it is most definitely worthwhile helping patients that are higher risk.  He was back in clinic walking without any assistance, standing up straight with both he and his wife smiling and very thankful.  He looked like a different person!!  His wife looked better too!  He and his wife share their story, and send "thanks" to all of the nurses, doctors and others who helped care for him before, during and after this surgery which has given him back his quality of life.

Fortunately, most of the patients I get to care for are adolescent and young and middle-aged adults, who do not have significant comorbidities.  We have advanced computer systems and preoperative evaluation tools at Hey Clinic that helps us do an extremely thorough preoperative assessment, that helps to direct our preop workup.  However, there are a few percentage of people where the decision for surgery is tougher, where the surgeon, as well as the patient and family has to weigh the potential benefits vs. the risks involved moving forward with the "journey" of spinal surgery.  It takes "Two to Tango":  The patient and family AND the surgeon need to decide that they are all willing to go through the journey together, in close partnership.  If you are a patient or family considering a major surgery, it's important to realize that your surgeon is a person too, and has a tough job sometimes weighing all of the risks and benefits, along with you to decide when he/she thinks it is appropriate whether or not to do surgery.  Doing surgery on someone is a long-term commitment on both sides -- not always just a simple "just fix it" and move on.  

When facing a tough decision about surgery, I am often reminded of the risky case my orthopaedic surgeon took on to piece together my crushed left leg, which ended up taking 11 surgeries to fix, with me almost dying a couple times with sepsis, and spending over 3 months in the hospital.   His fellow surgeons and hospital administrators and nurses  probably wondered why he took these risks, and used all of these resources and hospital time, and whether or not it was worth it:  He could have done a simple 30 minute amputation the first night, or just not taken on my surgery at all and be done with it.  Instead, because he had so much experience successfully piecing together mangled extremities during the Israeli war, he knew he had a shot at saving my leg.  He took on my surgery, and persevered through multiple surgeries and lots and lots of complications and tons of visits.  The end result was that I was able to walk again on my own two feet, and even run and bike again.  

Now, 31 years later, that left leg has held me up without any trouble for over 5,000 surgeries that I have performed, and allows me to enjoy exercise every day.  I stand on that left leg all day long, sometimes for 7+ hours straight, helping others, and thankful that my orthopaedic surgeons were willing to take some risk to help me.

So, I prayerfully made decision to help Keith over 3 months ago, and now he is doing great and very thankful.  I do thank all of the people who helped me preoperatively assess Keith, and the excellent anesthesia and postoperative physicians, nurses, respiratory therapists, physical and occupational therapists, and Hey Clinic staff who helped.

Lloyd A. Hey, MD MS
Spine Surgeon
Hey Clinic for Scoliosis and Spine Surgery
Raleigh, NC  USA
Member, Scoliosis Research Society (SRS)

Mary, from Princeton NJ comes back for her one year anniversary scoliosis surgery visit and tells her story

Last Friday we were so glad to see Mary back for follow-up.  She travelled the 468 miles back to see us from Princeton, NJ to let us know how she was doing a year out from her scoliosis surgery I performed for her in April 2008.  Mary is 67 years old, and still works full-time administering a "think tank" where Einstein used to work years ago.
In the video clip below, Mary describes how bent over to the side she was preoperatively with severe pain and weight gain, and how the surgery got her standing straight up again, got rid of the pain and has allowed her to return to an excellent quality of life.  She also takes a moment to thank all of the caring staff at Hey Clinic and at Duke Raleigh Hospital who helped her through this process -- some of whom saw her at her worst in those first few days after surgery!  She wanted to be sure that all of these staff could see her successful final outcome, and to encourage them to keep helping others who also need help.
This summer Mary looks forward to gardening, and exercise, and a bright future which is now continuing to get better and better, rather than worse and worse.

Mary was kind enough to bring me a hat from "IAS" -- the Institute for Advanced Study -- which I proudly wore for her team photo.  I felt smarter as soon as I put it on!

Mary, thanks for making the trip back to see us, and for sharing your story. You look great.
Lloyd A. Hey, MD MS
Hey Clinic for Scoliosis and Spine Surgery
Raleigh, NC  USA
Member, Scoliosis Research Society (SRS)

Wednesday, April 15, 2009

L45 spondylolisthesis w severe spinal stenosis and facet arthritis fixed this afternoon

Surgical time: 1 hour 52 min.
Est blood loss: 150 cc.
Blood given: none.
Room aura: excellent. Good tunes classic rock.

This morning's case was a revision L4-iliac wing instrumentation and fusion w bmp for a woman from Asherville 5 hrs away who had fusion for L5S1 spondylolisthesis. She smoked a lot after surgery, which increases rate of nonunion dramatically (over 10x risk).
She did very well w 3 hour surgical time.
She plans to quit smoking now!! 

Our young lady who had thoracolumbar scoliosis surgery on Monday went home today doing great, taller, and loving her new posture. She actually asked her dad to take her picture w me standing in the hallway on rounds this morning!  She had a very big smile!!

A good day.

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

Monday, April 13, 2009

L3-iliac wing instrumentation and fusion w 3 level laminectomy for stenosis and spondylolisthesis

Surgical time: 2 hrs.
Est blood loss: 350 cc.
Complications:  none.

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery

15 yo wo 37.3 degree adolescent idiopathic scoliosis (AIS) thoracolumbar fixed this morning w 4 level fusion

Surgical time: 2 hours.
Estimated blood loss: 100 cc.
Correction: excellent.
Complications: none.

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery

Wednesday, April 8, 2009

This morning's scoliosis surgery: 12 yo young lady w 43 degree R thoracic adolescent idiopathic scoliosis

Surgical time: 2 h 15 min
Levels: T5-L1
Correction: excellent
Estimated blood loss: 350 cc
Cell saver: 125 cc
Complic: none.
Postop location: PACU x 1 hour then private room w parents waiting. Extra bed for mom to sleep w her.
Parent satisfaction w preop experience:  excellent. Including answering follow-up clinical and insurance questions via email.
Parent satisfaction w surgery day and correction:  excellent!

Other updates:  boy from monday who had scoliosis fixed is doing great, going home today. 47 yo woman w scoliosis and kyphosis and T11 fracture doing well. Rheumatoid arthritis cerv spine reconstruction from yesterday w posterior cervical recnstruction and laminectomy for severe instability, spondylolisthesis and myelopathy w cervical stenosis was in great spirits this morning and using his arms and legs better already! 

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery.

Monday, April 6, 2009

15 yo young man w 44.6 degree right thoracic adolescent idiopathic scoliosis (AIS) fixed this am

Surgical time: 2 hour 15 min
EBL:  1,250 cc.
Cell saver 500 cc.
Blood:  none.
Complications: none.
Correction excellent.

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery

Wednesday, April 1, 2009

55 yo sp multiple laminectomies w degen scoliosis and severe stenosis w severe pain fixed this am

L3-iliac wing instrumentation and fusion w complex revision decompression laminectomy.
Surgical time: 2 hour 40 min.
Est blood Loss: 500 cc.
Blood transfused: none.
Complications: none.

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery