Sunday, January 8, 2012

Hey Clinic Week In Review: From Urgent Calls at Gas Stations on days off, through smile-filled clinic. Physician Assistant Opening.

After a very busy couple of weeks around Christmas focused mostly on surgery for our adolescent idiopathic scoliosis patients who were out of school and needing surgery, I took a few days off after New Year's to recharge, and get some projects done around the house.

On Wednesday this week, I was on my way to Lowe's Hardware, and fueling up my little diesel Jetta when a call came in from neurosurgeon from Rocky Mount. He had a woman that he saw with progressive severe weakness in both legs to point where she could not walk. I had done scoliosis surgery for this woman years before, and she had done well. Now she had a new problem with a likely severe thoracic spinal stenosis with myelopathy. As soon as the neurosurgeon started to describe her symptoms, a "switch" went off in my mind, which flips me into emergency triage mode. My home repair projects were now off the list: emergent spine repair goes to top of list. From the gas station, I got in touch with patient and family, had them run to pick up the MRI and X-Ray discs, and get on their way to hospital without eating or drinking anything. Call then to the hospital to book surgery, and to Hey Clinic to give them heads up. I arrived at the hospital and switched out of my home project jeans and flannel shirt to my other work clothes: the blue scrubs, size medium, with the blue Crocs. I get to preop just as the patient arrives. I examine her quickly. She can just barely stand on her right leg, and her left leg is completely weak. This is serious. Her husband hands me the discs, which I load into my laptop there in preop. The image to the right pops up on my screen and I see the "villain" -- an extremely tight stenosis crushing her thoracic spinal cord a couple levels above where her scoliosis fusion was done.

We get her back for surgery, and her evoked potential monitoring shows really no signals in either lower extremity. In surgery, I find a HUGE facet cyst coming off her left T10-11 facet joint, which formed a huge egg-like mass over 2cm in diameter, crushing in on her cord. This is by far the biggest facet cyst I have ever seen, at a very dangerous location. I decompressed the two tight levels, and her evoked potential monitoring started to show some signs of life in both lower extremities. Cool. I then extended the fusion up 3 levels to stabilize this zone. Postop she started to improve right away, regaining her feeling and strength over her few days in the hospital. She was discharged to rehab yesterday with nearly full strength in both legs and walking well! A great start to 2012.

I did 2 elective surgeries on Thursday, which included a lumbar scoliosis on a gentleman from Florida, who also had severe multilevel stenosis. He did very well postop, and went home to stay with his sister who lives in Beaufort for a couple weeks. I also did 2 level ACDF on Thursday on a 38 yo with severe neck and arm pain. She did well and went home Friday after staying overnight.

In clinic Friday, I saw a bunch of postops, including several adolescents and young adults who had spinal deformity surgery.

This young lady with severe spastic quadriplegia cerebral palsy is now several months postop from a thoraco-lumbar sacral-iliac wing instrumentation and fusion. She was ALL smiles in clinic, in part because of her new erect sitting posture and much improved comfort and appearance, but also because of her new boyfriend! Love is great. Apparently she got to go to a Duke basketball game recently, which was a lot of fun.

This young lady was back with her family after her adolescent idiopathic scoliosis (AIS) surgery with a beautiful posture. It is definitely a family effort and journey to go through scoliosis surgery, and it is great for me to see how each family rises to the occasion to encourage and help their family member through the process.

This lady had adolescent idiopathic scoliosis that was never treated. As an adult, her scoliosis collapsed terribly, causing severe pain, trouble standing and walking and a very abnormal posture. She is now three years out from surgery with a great standing posture.

It is important to continue to have your scoliosis checked as an adult on a regular basis, even if you are "done growing" and your pediatrician may have told you not to worry about progression. With accelerated disc degeneration which can occur with scoliosis, the curves can definitely start to collapse, and do so in an accelerated fashion. This collapse can then also result in severe leg symptoms with spinal stenosis.

This lady had a degenerative scoliosis with severe spinal stenosis, and had trouble even walking around house preop. She now stands up straight and is graduating, and can walk long distances without significant pain.

This young lady had spina bifida / myelomeningoceole as a newborn, with early detethering and meningocele closure and fusion as a child, with some chronic spinal cord deficits. She then had collapsing scoliosis as a young adult, with worsening neurologic status and had surgery with me a couple years ago. It was great to see them back. She has made dramatic improvements with excellent physical therapy, personal drive, and family support.

Here is another one of our postop adolescent idiopathic scoliosis patients back for follow-up visit, with a beautiful posture and doing well in school and with sports/exercise. I have actually done spinal surgery on her mom as well, who was there with her today, and also quite thankful for her own surgical results, before she entrusted her daughter to us for her surgery!

This man and his wife came all the way back from Maryland for his six-week postop visit, in large part because they were just so thankful for his excellent pain relief. For most of our out of State guests, we try to minimize the need for lots of travel by getting imaging done locally and then sent to us, and then talking on phone/Skype and/or via email. This gentleman had severe adjacent level spinal stenosis and spondylolisthesis from a surgery performed in Maryland years ago. Preoperatively he got to the point where he could not do his carpentry and his quality of life was horrible. He was sent to us by a family in Maryland that I had helped with surgery over six years ago. This other family actually helped this man financially to get the surgery done down here in North Carolina -- an incredible act of generosity to help a neighbor.

This young lady from the Outer Banks 3.5 hours away was back with her husband for her six week postop. She had flat back syndrome with collapse below an old scoliosis fusion, and had history of adolescent idiopathic scoliosis. She now looks and feels awesome, with her normal "sway" returned to her low back, and is getting back to a much improved quality of life and outlook. Both her and her husband were extremely thankful, and wanted to make the long drive to say "Thanks" to the whole Hey Clinic Team. She has an anterior ALIF at L45 and L5S1 as well as posterior thoracolumbar-sacral-iliac wing instrumentation posteriorly. She is back into a very active exercise program.

This young lady had a severe kyphosis as a young teenager, which I fixed for her years ago. Unfortunately she developed a problem called proximal junctional kyphosis (PJK) above her fusion over past couple years, which is known complication from especially kyphosis and some scoliosis surgeries. I did a revision extension instrumentation and fusion for her, going up to the cervical-thoracic junction. Her posture has now been restored to normal, with also relief of the severe pain she had developed in that upper thoracic area. She is working toward becoming an occupational therapist, and I am sure will be a compassionate and excellent caregiver. Her family has been incredibly supportive of her.

This lady was also back for postop follow-up for her lumbar scoliosis. Her posture now looks great and strength restored.

Saturday I did one urgent surgery on a 38 yo from Wilmington, NC. He is now doing well.
Yesterday afternoon I had a relaxing afternoon with a walk through the Duke Forest with the dogs and family -- 65 degrees and sunny!

Today after church I've been reviewing applicants for an opening we have for a physician assistant (PA) for Hey Clinic. If you know of any good physician assistants who may want to join our team to help us serve our patients, please let us know. You can find more information about the opening on the TAPA website:

Hope you are all doing well!

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery

No comments: