Thursday, March 18, 2010

Severe kyphosis in 41 yo woman who had previous kyphoscoliosis surgery fixed today

Well, I am definitely back from my week off last week!  It was a great week off seeing family, touring NYC, visiting Florida, and going to New Orleans for the AAOS national Orthopaedic meeting.  I saw a bunch of my old resident and faculty friends at the Harvard Orthopaedic Reunion, including Dr. Mike Millis from Boston Children’s, Mark Umlas from Miami, Kevin Schrock, and several others.  

It’s good to be back home, and at Hey Clinic and the operating room again.

Today we did a complex revision kyphsoscoliosis surgery, which involved fixing an over 45 degree acute deformity.
Patient had acute angulation at one disc space that was toward bottom of fusion. She had some hardware removed elsewhere, and some hardware also revised, but her kyphosis and pain progressed.
Today I revised this by removing all of the old hardware (two different types), and put in new hardware from T4 down to ilium.  I then decompressed the nerves at several levels, then did complex osteotomy, similar to a pedicle subtraction osteotomy, but actually through the acutely angulated disc space of L23!  Even under general anesthesia, she had a huge hump in that lumbar area, which did not reduce even after removing all of the posterior elements (Smith Peterson osteotomy).  After removing a good portion of the disc from both sides, I could gently lever the kyphosis out with the 2 cobalt chrome rods.  The finished “product” is shown, with a lateral photograph of her whole spine tilted 90 degrees to match her preop photograph I took this morning.  The hump is gone.  The X-Rays also show hump is gone, with complete restoration of the original disc spacing and posture.

Her surgery took around 4 hours and 30 minutes.
Her EBL was 2600 with 960 cc cell saver returned.
1 unit of PRBC’s were transfused at end of surgery.
Her evoked potential monitoring was normal throughout surgery.

After surgery, her family was thrilled to see her new posture.
This young lady has a chance to stand up straight tomorrow, and start new life getting over significant pain and deformity.

Yesterday we did a complex T23 laminectomy and extension fusion for a gentleman with progressive myelopathy above a long fusion due to osteoporosis and adjacent level failure.
Next week we are helping several teenagers with adolescent idiopathic scoliosis.

A great day, and a great week back!

Hope you are all doing well.

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery


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