Sunday, June 26, 2011

Dr. Hey's past week in review. Biomechanical Models, Tinkering, and Adolescent Scoliosis at Age 40.

All 4 of our adolescent idiopathic scoliosis surgery patients went home by Friday this week, having had their surgery Mon-Wednesday! Great families, and all very pleased with the care they received at Duke Raleigh Hospital. My daughter actually helped film David's surgery, and provided a copy for him and his PreMed Sister as they headed home to Winston-Salem. She literally narrated the video, asking me lots of questions, just like they did when I was filmed for the Discovery Channel doing scoliosis surgery at Duke Medical Center years ago. What a joy it was to have my daughter with me psyched to watch me at work. I will never forget that day. It was like my "home world" broke into my "work world" -- it felt almost like a dream!

When my daughter was very young, maybe 4 or 5 years old, used to come on rounds with me at Duke University Medical Center, and used to make get well cards for every single one of my patients in the hospital. She would ask me as we were driving into the hospital "Daddy, how many patients do you have in the hospital?" I would say "7". She would carefully count out 7 pieces of blank paper, then carefully make up a card for reach one, with picture on front and inscription inside which would say "Get Well Soon. I love you. " After we finished rounds, we would always go for a ride on the electric train which connected Duke North with Duke South. She would ride up front and we'd pretend we were at Disney World riding the Monorail!

Well, now that little girl has grown up, and is getting a chance to see what daddy does in the operating room, as she considers serving others in the future in the healthcare field.

I spent a lot of time with a very nice 40 yo woman with a 56 degree long right thoracolumbar curve. She was at Hey Clinic with her husband seeking a second opinion regarding her painful, and possibly progressive scoliosis. She was diagnosed with scoliosis as a teenager, braced and never had surgery. She thinks her curve was around 25-30 degrees when she was done growing.

She did well for many years, but over past 8 years or so has noted increasing lower back and mid back pain. It has increasingly affected her quality of life, so she cannot kayak, take long walks, garden and do some household chores. She thinks her posture may have changed a bit with a bigger hump appearing on the right.

We spent a long time going over all of her films, and carefully measuring all of them and putting them into our database and special scoliosis electronic medical record (EMR or EHR for Electronic Health Record).

We talked about importance of tracking the curve over time. Her curve has progressed 8 degrees over past few years, which is more than the expected 1 degree per year for most curves if they are progressing.

She came into clinic very concerned about risks of surgery, but was also very concerned about the risk of doing nothing, since her quality of life now is not acceptable, and things seem to be progressing.

We answered all her questions, and she's going to think things over. We took over an hour with her, showed all her films up on big screen and discussed in detail what were the benefits vs. the risks of doing scoliosis surgery now as opposed to later, or not at all.

This couple really seemed to appreciate the time my physician assistant and I took to go over her particular situation, and equip them with the information they need to make an educated decision now, or sometime in future.

This also illustrates importance of screening for, and following scoliosis in younger people, especially during the adolescent and young adult years. If this woman would have had her scoliosis fixed years ago before the lowest levels of her spine became degenerative, we could have more likely fixed it with a shorter fusion, preserving the bottom 2-3 discs. As people get into their late 30's and 40's, often those lowest discs have degenerated so much that they must be included in the fusion -- not the end of the world, but it sure is nice to have "a stitch in time that saves nine!" - or that saves some mobile disc spaces.

Also saw a bunch of our smiling teenage scoliosis patients back for follow-up from the large group of adolescents we "straightened up" last summer! They all looked great, and were very happy and very smiley and VERY active with sports and camps and dancing.... What a joy it is to care for any patient, especially these younger folks.

Saw a 26 yo woman who has a collapsing scoliosis almost 90 degrees now 13 years after having her adolescent scoliosis surgery performed elsewhere, which was complicated by intra-operative loss of evoked potential monitoring and wake up test with paralysis. They took out all the hardware and just put in bone graft. She woke up paralyzed, but has made remarkable recovery since then, able to ambulate with cane but some remaining spasticity. Unfortunately now she has severe pain and deformity, since the curves have continued to progress since the fusions done without instrumentation have high likelihood of progression. We're getting CT scan to check quality of fusion, and to take closer look at cause of her progressive pain.

Did urgent/emergent surgery yesterday on woman with progressive spondylolisthesis above scoliosis fusion. Came up with a new technique for correcting kyphosis in both the cervico-thoracic junction and thoracic spine at the same time using a specially contoured "U-Rod" --- using technique similar to Luque Rod technique, but using Zimmer Universal Clamps. She got an excellent correction of deformity, excellent relief of pain, and went home today! In order to create this special U-Rod, I had to do a very special bend using my big vice I brought in from home, and a piece of pipe I bought from Lowe's Hardware Saturday morning that I used as a lever to help make the proper U bend that I needed to match the cervical spine. I then contoured the rod into the proper cervical lordosis and thoracic kyphosis. Once the rod was contoured, it was washed and sterilized and was ready for surgery! This single rod was then placed with the top of the "U" up at C4, and the 30 cm lengths coming down over the thoracic spine. It was attached using the Universal Clamps and the pedicle screw instrumentation.

The overall surgery took about 5 hours, with about an hour and a half setup time. I spend A LOT of time preparing for this surgery, doing drawings, talking to instrument reps, and mentally going over each step of the surgery in my mind. I learned this mental preparation from my Dad, who is a flight instructor, who encouraged me to mentally practice landings and other maneuvers in my mind even before I got into the airplane. It really helped. Friday evening though, at dinner, and even later that evening and night, I could tell that my mind was still churning, working out all the details, and "what if''s" --- woke up even that night going over things one more, until I had it just right.

Really appreciate my physician assistant Rachel staying all day to help, and the excellent staff at Duke Raleigh Hospital who worked together with me as well. We all had a good time together, and got a great job done and really helped relieve some suffering while preventing bigger problems that were brewing, including a spinal cord pinch at the level of the spondylolisthesis.

What a joy it was to see her this morning with her husband -- both with a big smile, as she showed off how well she could now move both arms up over her head without any pain.

As many of you know, I started "tinkering" at a very young age, fixing just about anything: lawnmowers, go-carts, outboards, inboards and more. That led to me "tinkering" with the Hoffman external fixator on my left leg which was not strong enough to hold my complex Grade IIIB tibia fracture still -- leading to new design using triangular structure which was much stronger and helped it to heal. This led to my desire to combine engineering with my patient experience to help future patients who had complex problems as I did, which set my course throuth MIT Engineering, HST Program at Harvard-MIT, and Harvard for Medical School, Residency, Chief Residency and Fellowship at Boston Children's Hospital.

This week we also helped out a young lady who had a pseudarthrosis of a scoliosis fusion. Using our biomechanics lab at NC State with Professor Andre Mazzoleni and his graduate student, we were able to create a finite element computer model using this patient's spine parameters, and were able to measure the relative strength of revising her fusion using anterior ALIF technique vs. TLIF technique. This interesting research revealed that we could get very close to the ALIF strength, but with the much less invasive TLIF technique if we focused on getting the TLIF as far anterior as possible. This would also have comparable strength to the XLIF technique. So, we were able to use the lab to help a physical therapist patient and her MD husband to make a very educated choice on which way to go with their surgery. The TLIF technique worked great, and she went home after just 2 nights in the hospital feeling great!

Many thanks to Professor Andre Mazzoleni and his grad student from NC State University Dept Mechanical Engineering who put in countless hours to create this new computer model to help us in our decision analysis. Look forward to further research together with you which will help patients and surgeons in the future.

After all this, I was pretty darn tired by last night. Got home about 6:30 pm, and had restful day today after rounding this morning at Duke Raleigh Hospital. Slept in til 7:20, Rounded at Duke Raleigh Hospital, had good church service with family and lunch out. Caught up on some things around the house, took a long walk, had a swim, and caught up on email and the Blog!

Hope you all have a great week and a great 4th of July.
We have a busy week coming up, and hope to send you an update later this week before the long weekend.

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery

Flat Back Syndrome Young Lady Tells Her Story after Anterior / Posterior Reconstruction at Hey Clinic

This past week was a real busy and exciting one at Hey Clinic, after having a very nice week off the week before. We saw many thankful smiling faces in clinic on Thursday and Friday, including this woman and her husband. She had an anterior-posterior (A/P) reconstruction for flatback syndrome including L45 L5S1 ALIF, and posterior L1-Iliac wing instrumentation and fusion with bone grafting and osteotomies. She is now a few months postop, and shares what a difference the surgery has made in her quality of life. This patient is now I believe in her 30's, and had instrumentated fusion as teenager for adolescent idiopathic scoliosis (AIS), and then had hardware removed. She subsequently developed the flatback syndrome with progressive pain and difficulty walking.

She gave her permission for us to share this video with all of you!

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

Wednesday, June 22, 2011

Back from Vacation. Scoli Camp Week In Full Force!

I was on vacation last week celebrating 25th wedding anniversary.  Great break.
This week we’re doing “Scoli Camp” at Duke Raleigh Hospital, with 4 adolescent scoliosis and kyphosis surgeries already during our first 2 days!
Patients are doing well postop, getting up and around.  
One of my 15 yo patients who had very severe kyphoscoliosis gave me a big smile right after surgery since she could feel that her back was sitting comfortably on bed for first time in years!!  She had an 80 degree kyphosis, probably Scheuermann’s kyphosis, combined with 42 degree scoliosis!

Yesterday also fixed up a 17 yo young man with severe 68 degree progressive right thoracic adolescent idiopathic scoliosis.  His curve was SO MUCH STIFFER than the 15 yo girl I fixed yesterday afternoon, who had a smaller curve.  It really does help to fix the curves when they are smaller, and a bit younger to take advantage of the increased flexibility, less rib deformity, and easier/safer and more complete correction.  Sometimes people put off scoliosis and kyphsosis surgery due to concerns about playing sports.  With modern instrumentation and fusion techniques, we can get people back to sports fairly quickly, including golf, lacrosse, cheer leading, soccer, baseball, softball, and even highly competitive diving and swimming.

Had a real joy of having my daughter looking in on surgery for past couple of days — she’s been very enthusiastic student.

Have a great week!

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery

Wednesday, June 8, 2011

Jane's Flat Back Syndrome Story, and discussion of benefit of surgeon blogs.

I saw Jane back for follow-up this past Friday, 3 months after her anterior/posterior reconstruction for flatback (flat back) syndrome years after Harrington Rod scoliosis instrumentation and fusion.  

Here she shares a little with a local reporter writing article about physician blogging.  In Jane’s visit with me, she told me that she is a “walking billboard” for successful flat back surgery, and is very thankful for her new posture.   Take care Jane, and thanks for giving your permission to share our picture together on the blog.  Look forward to seeing you back in clinic.  Thanks also for helping Page with her article on blogs.

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

My name is Jane, and I am a patient of Dr. Hey's who just had surgery a little over 3 months ago.  He told me that you are writing an article for Raleigh's Midtown Magazine and thought I could give you a patients perspective about blogs.  Let me first give you a little bit of my history.  I was diagnosed with scoliosis about 33 years ago and had surgery to correct it a couple years later.  The surgery was horrible to say the least and to this day I still have nightmares about it.  The surgery was successful at the time but later I developed something called a "flat back" deformity caused by the original scoliosis surgery.  I have felt great until the past 3 years and this is when I decided to see Dr. Hey.  He diagnosed me with the flat back deformity and gave me options to try first before we considered surgery.  The past couple of years I tried the physical therapy and injections.  During this time I read his blog almost daily.  I was amazed that a doctor who's as busy as he is spends all that time writing this blog.  I hard for me to put in to words what that blog meant to me.  First, it was so educational.  Times have changed so much and I found it so interesting to see how they treat scoliosis patients these days.  The surgery, and recovery, for it is completely different from what I went through.  I especially enjoyed seeing the before and after X-rays that he puts out there.   Second, the life changing stories are so inspirational to someone who is suffering daily from back pain.  It really gives you some hope.  You see so many different cases and learn how their surgery changed their life. Lastly, I think you can learn a lot about the doctor, not only professionally but personally, just from reading his blog.  A doctor that takes the time to document all of these incredible stories has to be a special one.  You can tell from reading his blog that he really cares for his patients and their families.  The amount of success stories he has written about are just incredible.  I was able to tell that he was a very successful, well educated, caring doctor that truly wants to help people by improving their quality of life.  After my first surgery I didn't think I could ever get myself to go through back surgery again.  By reading his blog over the past several years it has really encouraged me and inspired me.  I knew I was going to be in the best of hands from everything I have read.  I had the corrective surgery done by Dr. Hey and all the pain I had before is gone.  He fixed my flat back and now I have a beautiful posture and shape.  I can't help but look in the mirror every time I go by one.  I am so grateful for all the time he spent writing on his blog.  I don't know if I would have had the courage to "go for it" if I wasn't able to read these amazing stories.  I can definitely say that it helped change my life.  
Hope this gives you a little patient perspective.  Please feel free to contact me if you have any questions.  Thanks.

Little Maggie going home today!

Yesterday was Maggie's mom Lisa's birthday, and it was a great one!! Maggie got a full shower, walked 160 feet and loves her new straight posture.

This is Maggie and I on morning rounds early this am at WakeMed Children's Hospital. The care there was excellent many thanks to the excellent doctors and nurses there including Dr. Duncan Phillips who helped with the anterior approach before I did the Shilla Growing Rod technique posteriorly.

Tuesday, June 7, 2011

FW: Thank you, and a message for Brittany

------ Forwarded Message
From: Shelbi
Date: Tue, 07 Jun 2011 09:01:22 -0400
To: Lloyd Hey
Cc: Brittany Harris PAC
Subject: FW: Thank you, and a message for Brittany

This made my week.

------ Forwarded Message
From: <michelle>
Date: Mon, 06 Jun 2011 16:55:49 -0700
To: Shelbi
Subject: Thank you, and a message for Brittany


I am delinquent in thanking you for sending us copies of your last news letter with Caroline featured in one of the articles.  It was nice to see the story in print, and be able to share it with others.

About 2 weeks ago, I contacted the office with concerns about Caroline.  She was having severe pain in her back, which we believed (and hoped) to be a pulled muscle.  I talked with Brittany about my plan to monitor her and have her take naproxen, as prescribed once before by your office, and we discussed a "Plan B" if that didn't work, and a way to get her ready in time to perform in her dance recital this past weekend.  I told Brittany I would call if we needed the additional help or an appointment.  It was such a whirlwind, I never called....

...but as they say, "no news is good news!"  The plan for complete rest and naproxen DID work, and Caroline danced beautifully in 6 different numbers on Saturday!  I wanted to thank Brittany for her time in talking with me, her professional advice, and reassuring me with a contingency plan.  While Caroline continues to have some discomfort in the knots we discussed a couple of months ago, she is better, and will continue the exercises and stretches she learned in PT, and hopefully, in time, they will go away.

THANK YOU again for being so accessible in our time of distress!  You're just another reason we continue to refer friends to The Hey Clinic!!!


------ End of Forwarded Message

I am so thankful for our Hey Clinic Team that makes connections like this throughout the day for our guests that make a huge difference.

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery

------ End of Forwarded Message

Little Maggie Doing Well 6 days after Anterior/Posterior Scoliosis Surgery including Shilla Technique

Maggie, 8 years old, 108 degree progressive scoliosis, weighing less than 50 lbs, had her surgery 6 days ago with the Shilla Technique at WakeMed Children’s Hospital, Raleigh.

Maggie’s parents wanted me to send these photos and thanksgivings to everyone who has been keeping them in prayer.  They also wanted to thank all the caring staff at WakeMed Children’s Hospital, including Dr. Duncan Phillips who helped out with the anterior approach, the excellent pediatric intensive care unit physicians and nurses, and the floor nurses and others at the Children’s Hospital.  

I want to express my thanks again to Dr. Richard McCarthy and his staff for helping teach me how to do the new Shilla Technique as a wonderful alternative to growing rods for children with early onset scoliosis (EOS).  Janelle and her family from Raleigh travelled to Arkansas Children’s, where I met up with them in December to work with Dr. McCarthy and their team for Janelle.

Janelle and her family has befriended Maggie and her family, and have been a real encouragement to them through the whole process.  We see that a lot — families helping other families through the whole process.  Awesome.

Here’s quick note from Maggie’s mom, Lisa, sharing about their experience at WakeMed Children’s Hospital this week:


From: William
Date: Mon, 6 Jun 2011 23:22:40 -0400
To: Lloyd Hey <>
Subject: Re[2]: Maggie

We would be honored to have Maggie's pictures on your blog.   There is a sweet peace among us as we are praying this new Shilla tech. can minister to other suffering children.  There are no words to describe God's presence through the last week.  She sat up in bed tonight and ate 4 pieces of Dominos pizza and we just finished watching a movie.  She is talking just like our Maggie.  Praise God!! We thank God for the wisdom He continues to give you for her treatment!!!!  See ya in the morning!!

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery

Monday, June 6, 2011

"Hey Dr. Hey!!!" TIMES THREE!! What I seemed to hear a lot in restaurants recently

So last week was yet another great, but very hectic week, which was completed with my daughter’s graduation from high school on Friday.
After the ceremony, we went over to the Carolina Inn, in Chapel Hill, NC — a very quaint and historic Inn and restaurant.
When we approached the hostess check-in spot, I was greeted with a big “Hey, Dr. Hey!!!” with a big hug from one of my former scoliosis patients from several years ago named Kristen.  I had performed revision scoliosis surgery for her when she was 25, and she tells her whole story on my old Blog-site, which includes picture of her in Paris!:

My wife, remembering a similar story just recently where the manager at Ruth Chris’ Steakhouse, also a former scoliosis patient of mine gave me this same warm greeting “Hey, Dr. Hey!!”  -- my wife assumed this must be the same young lady who took on a new job at the Carolina Inn.  Nope.  This is a DIFFERENT thankful young lady, former scoliosis patient, who also happens to manage a different restaurant!  (See story:

Well it was great to see Kristen again.  She’s looking and feeling great, and excited about her new opportunity at the Carolina Inn.
We did have an absolutely delightful meal there with our large party of family, including both sets of our daughter’s grandparents.  The service and food were excellent, and the price was a great value.  The valet parking was friendly, and included with the cost of our meal!  The UNC campus is just a few feet away, as well as the beautiful Chapel Hill campus.  If you need a nice place to have a special event, or just stay an evening, check out the Carolina Inn and say hello to Kristen at the restaurant.  I assure you, you will get excellent care!  

Kristen:  we wish you well in your new job! Can we have the Hey Clinic Christmas Party there this year?

I’ve been greeted with “Hey, Dr. Hey!!!” at one other restaurant this past week:  Sanitary Fish Market in Morehead City, NC.  Brittany, one of my adolescent patients yelled out across the restaurant, where she was working at the new coffee bar.  They’ve made a lot of improvements to the restaurant over the winter, including new outside deck seating and Jeff the owner told me how new floating docks are coming in soon, which will be great.  It was great to catch up with Brittany again.  She’s looking and feeling great, and told me how glad she was to get her scoliosis fixed — a real word of encouragement.  You can see Brittany’s blog from last summer at:  By the way: the Sanitary T-Shirts are the best!  Go for the Tie-Died if they have them in stock.  My favorite dish there is the Bluefish, broiled.

Here is Kristen’s story from the “Old Blog”, which may eventually go away I think — need to check on that with!

May 7, 2007


I first found out I had Scoliosis when I was getting a routine physical for track at age 14.  What started out as a 30 degree curve soon progressed to a 49 degree curve by the age of 17.  A month after my 18th birthday and the start of summer vacation before college I had my first corrective surgery. June 15th 2001 would be the beginning of a long journey for me.  My spine was corrected to 20 degrees with the help of one stainless steel rod along with screws and wires.  My ribs were broken and moved in order to protect them from crushing my lungs and to correct cosmetic appearances.  My life proceeded as normal.  I moved to Wilmington, NC and attended college on time and participated in regular activities.  

 February 2005, I was having quite a bit of discomfort and decided to see a local orthopedic doctor since my surgeon was located in South Carolina.    As he came in the room with my x-rays and put them on the wall to show them to me He said, “the two rods look fine”.  As you can imagine the horror that came across my face considering I only had one rod placed against my spine.  The rod had broken clean in half.  As I explained this to the doctor he requested I contact my surgeon immediately.  Needless to say the next day I was on my way to see my doctor in SC.  After a long trip and much panicking he informed me that the fusion was stable and that everything would be fine.

 As much as I wanted to believe my surgeon I felt the need for a second opinion.  I found out about Dr. Hey through a family friend that works in the Duke community.  He ensured me he was the best of the best.  

 June 2005, was my first consultation with Dr. Hey.  He put me at great ease.  He informed me that there was no need to panic, but he would like to keep a close eye on my back and requested I keep a pain log everyday.  If my pain progressed he wanted to know!  I left feeling a great relief knowing that someone cared about my condition and knew the appropriate steps to take.  

 August 2005, I moved to Charlotte, NC to start my new life and a new job.  A fresh college graduate I was ready for anything.  Anything but this.  About 2 weeks into my new job I was on a sales call with my boss, As we were entering an office building I came to a sudden halt.  I knelt to the ground in great pain.  I immediately called Dr Hey.  He directed me to come to Raleigh as soon as possible.  It was a Tuesday, August 23rd.  Dr. Hey showed me my x-rays.  He didn’t have to say a word.  I am not a doctor, but I knew when I saw the staggered placement of the rod I was having surgery.  What I wasn’t ready for was Thursday.  Dr. Hey didn’t hesitate when he said we are having the surgery Thursday the 25th.  I could not believe my ears.  But I knew there was no other choice.

 August 25th, the day of surgery.  I was hungry!! My surgery was at 2:00 in the afternoon, and if you have ever had surgery you know you can’t eat or drink before hand.  Even with my stomach growling Dr. Hey made me and my family feel relaxed.  He took our hands as we stood in pre-op and said a prayer for my family and me.  I will never forget that prayer.  After a long wait my family rushed in to see me and see my new hardware.  I thought all of my surprises were through.  Dr. Hey came into my recovery room, informed me that the surgery was a great success.  He had replaced the broken stainless steel rod with two titanium rods along with 12 screws.  He also informed me the fracture had been stabilized.  Fracture?  What fracture?  Apparently, not only had I broken my rod but I had also broken my spine.  

 It has been almost 2 years since my surgery with Dr Hey and I cannot express enough the endless amounts of gratitude and appreciation I owe Dr Hey and his staff. Dr. Hey is truly a unique doctor.  I am a better person inside and out and he is the reason for both.    

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery

Hey Clinic's Version of Street Art

Back in January 2010, we shared with you the cool doodle drawing left behind on the tear-away exam table paper cover, which portrayed me (Dr. Hey as a Rapper -- :

Well, this young man from South Carolina is now back, a year out from his scoliosis surgery doing well.

When he left this time, more “Street Art” was left behind, and captured here.  He gives his permission to share it with all of you.
He was real happy with his new posture, which he expressed in person, but also through his art!

Hope you are all doing well.

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery

Sunday, June 5, 2011

Still thankful 33 years later for the surgeons, nurses, therapists and family who cared for me

Thirty-three years ago today, I was hit by a car, and had a very severe crush injury to my left leg.
Still to this day I remember that day when my life was turned completely upside down, then spent 3.5 months in hospital, 11 surgeries, 2 bouts of sepsis, and the constant threat of amputation.
It was painful, scary, lonely.  Would I ever get out of the hospital?  Would I ever walk again?  Would I ever go back to school?

I am so, so thankful for all of the caring people who took care of me, including Dr. Mark Pitman, the captain of the ship, and his brother Charles, Barbara Bader – a physical therapist.  Not sure what her name is now, but would love to thank her if anyone can find her.

I am confident that the passion I have for helping people these past many years as an orthopaedic spine surgeon began (and continues every day) out of thanksgiving for the care and healing I received, and will never ever forget.

Thankfulness is a great motivator to return the favor.

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery