Tuesday, October 18, 2011

Catching up. Young and middle aged adults trying to decide what to do about their scoliosis. "Black Clouds" and Preventive Interventions.

I have seen three patients from South Carolina within the past week, all of whom had scoliosis.  H
The last one I saw was a very nice 31 yo woman from Charleston, who came in for second opinion for possible surgery for her scoliosis.
She had X-Rays with her from 2004, 7 years ago. Since then, her curve has progressed 20 degrees and is now and is now 53 degrees.
She is starting to have some back pain, and is just a little self-conscious about her posture.
She’d like to start a family soon and have children, and she was at the appointment with her husband who is very supportive.

She had don a TON of research on the Internet, and felt very unsure going into our appointment what she wanted to do.
My nurse practitioner Brittaney and I went over her whole story, physical examination and imaging and answered all of her questions.

Given the large amount of curve progression she has had as an adult (5 degrees per year is a lot),  and the current curve size, I thought it made more sense to get the scoliosis fixed now when she is younger, and avoid issues down the road when life is more complex during pregnancy and after pregnancy with kids!  Her lower lumbar area right now looks quite good, and fixing the curve when she’s younger could result in a shorter surgery with less fusion.

We talked a little about the “Black Cloud” of decision and worry that seemed to be hanging over her --- which I’ve seen many times before.  Her husband definitely smiled and agreed with this assessment of his wonderful bride!  It is definitely worth the time to research your scoliosis, find out your options, and find a surgeon and hospital you are peaceful with.  But at some point it’s good to just decide what you feel is best for the LONG RUN (like through the rest of your whole life --- maybe 50+  more years ) rather than spinning your wheels and just being overwhelmed with worry.

One thing for sure this case illustrates is the importance of following your scoliosis over time, even after you are an adult.
That X-Ray she brought with her from 2004 from South Carolina was so helpful to prove that her curve is collapsing and progressing as an adult.

Today I did huge scoliosis surgery on a 55 yo lady, who has developed very severe progressive back pain til the point she can’t work.  Her X-Rays show that her lumbar area is collapsing and degenerative, even though her original adolescent idiopathic scoliosis was thoracic only.  I did T3-L4 instrumentation and fusion, which could have been fixed with 3 levels less if fixed before this lower curve became degenerative and collapsed. Sometimes I actually have to fuse all the way down to pelvis when there is severe collapse and stenosis below.  Her surgery went well, and we got a very nice correction, but I would have rather fixed this curve at age 15, 25, or 35 or 45 rather than 55.  But 55 is still better than 65 or 75!  Her bone quality was still quite good, and she only had 700 cc blood loss. Surgery was about 4.5 hours.  She was able to go to a non-ICU bed postop.

Just after doing her scoliosis surgery, I met a very nice 51 yo woman with a painful 38 degree scoliosis, who also has severe right arm pain with a C56 C67 disc herniation and foraminal stenosis.  Her scoliosis may be actually making her arm pain worse due to the angle of her upper thoracic spine, which might close down the neural foramen on the right side.  She’s in agony with her right arm pain and actually has triceps weakness.  After one more shot at conservative treatment, we will likely fix the C56 C67 disc herniations with an anterior cervical discectomy and fusion (ACDF), and then may end up needing to address her scoliosis which is also becoming painful for her, even though her curve is not huge.

This afternoon I fixed a giant lumbar disc herniation at L5S1 which a lady in her 20’s had been suffering with for over a year!  Yow.  That sucker was huge, and was tenting the S1 nerve root.  She looked great in recovery room.

Tonight talked to mom from Arizona about her 14 yo daughter with scoliosis who had sent me some films to look at.  Look forward to see them for consultation sometime this fall.

Now it is definitely time for bed.  Really big scoliosis in the morning to fix, then a guy with severe thoracic myelopathy with a T10-11 severe spinal stenosis.

Duke Raleigh Hospital had their Talent Show this evening.  I saw some of it, but missed seeing our Motorcycle Dan do his rendition of “Country Boy” on his guitar....  “People say I’m No Good, Crazy as a Loon.....”  I remembered most of the words to the song as we all sang along at end of surgery yesterday listening to Pandora.  Nurse Kelly was impressed with my singing as much as Dan’s!

Hope you are all doing well.  Will try to be more consistent with writing.....but it’s tough.  This is not my main job!  I met a blogger this past weekend who writes for 4.5 hours every day!!! Yikes!!! I would get no sleep period!  :)

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery

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