Thursday, August 18, 2011

14 young lady with adolescent idiopathic scoliosis straightened up Monday, home today postop day 3. Other updates.

So sorry for delay getting to the Blog.  Last week I enjoyed some time off with family and friends, including a family celebration for my in-law’s 50th wedding anniversary.  A good time was had by all, and it was great to sit around my folk’s pool up on Long Island and see everyone together.  

It was back to work, though on Monday morning, where I was greeted by Harper and her family.  Harper is a 14 yo girl who is a big time soccer player.  She also has a fairly big time right thoracic idiopathic scoliosis (AIS) which has been progressive and at times painful.  Her curve is now over 40 degrees and it has definitely become fairly noticeable.  She told me Monday morning that her soccer team won a big tournament this past weekend, and now she was ready to get her scoliosis fixed before going back to school in a couple weeks.

Her surgery went very smoothly.  Intraoperatively,  I got the pedicle screws in, and then pressed down over the right rib hump.  Her curve would correct a bit, but then quickly spring back to it’s original curved state.  While I am a big fan for chiropractic treatment for back pain, it really surprises me when I hear the rare chiropractor claim that they can actually correct scoliosis with manipulation.  Based on my tests, it seems to just go quickly back where it started off....

We obtained a very nice correction using a special double rod technique and gradual translation and derotation.  Her right rib hump gradually disappeared.   After locking everything down and inserting the bone graft, we did care plastic surgery subuticular closure and put on the Dermabond and SteriStrips.  Her estimated blood loss was around 300 cc, and she received no blood transfusions.  Surgical time was a little under 3 hours.  I then got a chance to meet with Harper’s parents who were so glad that everything went well, and were excited to see the postop correction of the deformity.

She was able to go to a regular orthopaedic private room after surgery where her parents were waiting for her and could spend the entire stay with her.  She is planning to start school on time on August 25th --- about a week --- which believe it or not is quite possible for return to school == 10 days to 2 weeks or so for many adolescents postop.  She’ll also be starting back to practicing soccer this fall semester with an accelerated exercise program.

During surgery I had a very special observer  --- Brittaney Swift — Hey Clinic’s latest hire.  Brittaney is a Family Nurse Practitioner, with extensive experience as a pediatric intensive care nurse in Winston-Salem.  She did her nurse practitioner training at UNC.  We are so glad to have her on our team, and she’s quickly getting up to speed with help from the rest of the Hey Clinic Team!  Welcome Brittaney!

In addition to a busy operating room schedule this week, I got a chance to see several very interesting families.  First thing Monday morning, I saw a 15 yo young lady and her mom for a second opinion for scoliosis which has become quite painful. There was a complex health history including possibly Hoshimoto’s Disease.  Curves were measured elsewhere over 45 degrees, but to our measure her double curves were in the mid-thirties.  Good news for her!  We’ll hold off on recommending surgery at this point, and suggest checking other X-Rays in a few months.

Also saw a 56 yo woman referred to me by Dr. Dan Albright from Raleigh Orthopaedics with a very painful scoliosis. This patient obviously had a adolescent idiopathic scoliosis, with right thoracic curve which was never treated.  40 years have gone by, and her thoracic curve has progressed a bit. But the BIG problem is that the lumbar compensatory curve below that curve has gradually degenerated and collapsed, causing increasing debilitating pain which has unfortunately limited her ability to work!  I added a green arrow to the picture to show the downward and to the right collapsing direction for her spine.  This is why I get so excited about the importance of early detection and early intervention for scoliosis --- it can help prevent big time problems later in life where the “fix” is a much bigger surgery at a time in life where the curve is bigger and stiffer, you don’t heal as quickly and well, and there is more chance for complications.  Also, we all know that life gets more complex as we get older, as people depend on us more, rather than being able to lean on our parents and others.

Today I saw a very thankful 50 “ish” woman back for follow-up who had surgery with me a year ago.  She had a multilevel XLIF fusion done elsewhere, and then developed a very severe proximal junctional kyphosis (PJK) at the thoracolumbar junction.  She was in a lot of pain and had a large hump on her back for this otherwise very attractive lady.  She was told that nothing could be done.  We did a thoracic pedicle subtraction osteotomy with extension instrumentation and fusion for her.  She’s done great postop, and now looks great and feels great!  I left her picture and video clip on my camera in clinic this evening, which she said I could share with all of you.   She actually runs, and exercises every day and is some sort of a dancing leader in a marching band!  She gave me a big hug, and we got a “graduation” picture of the two of us together with her X-Ray.  Great way to end clinic.

Was on the phone last night with John from California about his concerns about pain after thoracolumbar instrumentation and fusion for scoliosis a couple of years ago as an adolescent.  Differential diagnosis would include pseudarthrosis with loose or broken hardware, adjacent level failure / severe degeneration or pain related to hardware itself hitting muscle or other tissue.  Hope you get some relief John.

Our little girl Olivia we did Early Onset Scoliosis Surgery a week or so ago is doing very well recovering at home.  

Take care and have a great weekend.

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery


t.bass said...

Hi I had a couple questions about scoliosis surgery and I don't really.know how this blog thing works but yeah I am 13 and have been informed that I need surgery on my back I was just told Thursday but the guy could not tell me much cause he was not a surgeon I have started a blog on my scoliosis because my dad recomdemed that I should. Is there anythings I should know about it how long would it take to heal what would I be capable of doing after. Well thanks :)

t.bass said...

Hello I already left a comment but I.looked and it was not there so I was just wondering about scoliosis surgery well I'm 13 and was told I needed surgery and I have a bunch of mixed emotions and I was wondering if u could give me some advice about the surgery and how take to get better and things like that well thank you and reply :)