Monday, April 30, 2012


It is always awesome when former Hey Clinic guests take the time to share their story of getting "back to life."  Some share of getting back on golf course, others share about getting back on lacrosse field or softball field... and then there are others who go SCUBA diving in Micronesia, "heli-hike" in the Canadian Rockies, or in this case, go on safari in Africa!

Henry had major spinal reconstructive surgery with us at Hey Clinic, and then also needed a hip replacement.  He then set off for his dream come true to go on a real African Safari!

Thanks for sharing, Henry!  Give our best to your family.

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery

------ Forwarded Message
African Safari - Henry

Hi gang! I'm doing good with the back and right hip.
This picture shows "Bwana" Henry in Tanzania in front of the Land Cruiser during the amazing 'great migration'. Think I was the best than anyone tolerating the bumpy trip though the Serengeti.
Best to all. Tell the Doctor that I have told a whole bunch of people about his great work and the great team he has working with him.
Forever grateful,
Henry H___

 Henry H_
------ End of Forwarded Message

Thursday, April 26, 2012

Dad with young daughter gives thanks for Hey Clinic after spine surgery allows him to be a Dad again!

We received the attached encouraging letter of thanksgiving from one of our Hey Clinic guests, that was shared at our weekly Hey Clinic Quality Care Meeting this morning.  Tony is one of our postop surgical patients who has been able to start a new life with his family and work.

 Thanks so much Tony for taking the time to share with all of us!

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery

38 yo executive with huge trunk shift scoliosis caused by huge disc herniation -- fixed this afternoon

This investor/developer had a disc herniation last year, and now has huge disc herniation at level above.  What is interesting, is that he also has a huge trunk shift scoliosis, as a response to the painful sciatica on his right side.  This pain causes him to shift his trunk way over to the left to try to ease the pain off his nerve roots that were being crushed.

I just broke scrub after fixing the problem:  as you can see below, I pulled out a monstrous free fragment disc herniation which was crushing the nerve roots on the right side, and actually obliterating most of the neural canal.

After he wakes up and gets through recovery room, he should be able to stand up straight again, with the severe sciatica relieved now that his lumbar disc herniation has been removed.

What a relief it is to get this pressure off the nerve.  His lumbar nerve roots were tight as a guitar string, stretched over the mountain of the disc herniation.  After the disc was removed with microsurgical techniques, you could see the nerve roots lie down flat again, much happier!  It is amazing to think that such a small "problem" could literally cause his whole body to be thrown out of whack -- fixable not with a big scoliosis fusion, but by minimally invasive, or certainly much less invasive "pebble removal."

In between surgeries, saw a gentleman who could barely walk with clumsy legs, and severe multilevel spinal stenosis and degenerative scoliosis.  We should be able to get him back walking much better in the future -- real hope for this gentleman losing the ability to walk.   This morning, we helped a lady in her early 60's with this exact problem, who had a previous laminectomy / discectomy years ago and now had collapsing scoliosis with severe spinal stenosis.

On Pandora on our awesome operating room sound system:  "Time for Me To Fly"  by REO Speedwagon.  Great tunes that remind me of my fraternity days at MIT, where the seniors I roomed with my freshman year at TDC would blast REO Speedwagon every night around midnight, while hanging out the Flag Room Window and yelling at the passers by.... Meanwhile, I was looking down at my calculus book wondering if I'd survive!

Our folks upstairs here at Duke Raleigh hospital are doing well.  Our 14 yo scoliosis young lady Julia is getting up and around, receiving lots of messages from her relatives in Europe --- some of which have required translation for the rest of us to understand!

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery

Wednesday, April 25, 2012

Adolescent Scoliosis Humor!

In between surgeries today, I got a chance to see a couple more scoliosis patients.  One is young man named Jacob who is 13, soon to be 14 years old.  We are following him and his brother for adolescent idiopathic scoliosis.  His right thoracic curve has progressed a bit since last visit and is now around 26 degrees.

We had a long talk with him and his mom about using a scoliosis Boston Brace at this point.  After discussing the commitment of time *(18 hrs / day x approx 5 years til done growing), Jacob especially had strong negative interest in wearing the brace.  You gotta pick your battles with your teenagers!  (I know -- I've had 2 teens)

Jacob turned out to be much more of a "card" than I initially expected.  When I told him the choice of Boston Brace vs. just "follow you" with repeat X-Rays, Jacob responded ----- "So you are going to stalk me?"  ----- At first I didn't get it, so he had to explain ---->  "You told me that you were going to FOLLOW ME!"

Then Jacob told me he had a couple of jokes to tell me....which I told him I had to hear.  With his permission and his mom, here is Jacob telling his two jokes.

The first joke is:  "Two peanuts were walking down the road, and one was a "salted"  (assaulted).
The popcorn kernel that a-saulted him was charged with "a salt and buttery"!!

We also discussed his future career building robots.  When I was at MIT, I loved their Course 2.70 robot competitions, and there is apparently some sort of NC robot competition here for high schools.   Jacob's mom will check that out.

Never a dull moment.  We love our younger guests here at Hey Clinic!

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery

Final scoliosis X-Ray for this morning's adolescent idiopathic scoliosis corrective surgery

Just broke scrub. Start 8:57 am. Finish 12:45.  Surgical time 3 hr 50 min.
ebl 1 liter
Cell saver 625 cc
Blood transfused: none.

Now out to meet w Julia's parents.

They will be happy to see this xray!

Dr. Lloyd Hey --

Julia's Intra-Operative X-Ray right after I corrected her adolescent idiopathic scoliosis

I just broke scrub on Julia's scoliosis surgery -- the 14 yo I talked about on this morning's blog with the large adolescent idiopathic scoliosis double curve.  Her surgery this morning went great.  Surgical time was 3 hours 50 minutes.  EBL was 1000 cc, with 650 cc given back in cell saver, and no blood transfusions.  Evoked potential monitoring was normal, and we got a really nice correction, even though her curves were very stiff!! Sometimes when patients are braced for a long time, I find their curves are stiffer.  Fortunately we were able to overcome the stiffness by doing multiple osteotomies, and some additional manipulation using double rod technique and compression/distraction.

Just showed the films to Julia's mom and dad.  They are so happy and wanted me to post this up to the blog so their family back in France can see the results.  They are welcome to leave Julia "get well wishes through comments on the Blog.

It was a very nice morning.

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery

Today's Scoliosis News! 5th opinion this morning and Today's Scoli Surgery

On hospital rounds this morning:  Our young man that we removed the huge disc at L5S1 was feeling great this morning, after suffering for 2 years with severe sciatica.  I've had a cervical disc herniation removed, which felt like an ice pick in my left scapula and left arm for a year.  What a blessing it was to wake up in recovery room with that "dagger" removed.  It reminded me of the story of when the lion has the thorn removed from his paw....

Our other inpatients also look good --- the lady who had severe myelopathy due to spinal cord compression in mid-cervical spine is doing much better after her posterior cervical decompression and fusion.  Another lady who had chin on chest kyphosis after a upper thoracic fusion years after a scoliosis fusion now looks great, and is so pleased with her new posture.  We did a C2-T6 extension instrumentation and fusion using our new "U-Rod" technique.  She'll be discharged tomorrow.

This morning I met with Julia and her parents before her scoliosis surgery today.  Julia is 14, and is from France, but lives in South Carolina for part of each year.  She's been braced for a couple years in France, including a night cast, but her double curves have continued to progress up into the 50's.  I asked her this morning how straight she wanted to be, and she gave me the "straight salute" with her hand ---- "I want to be as straight as possible".   "You got it!"  That's the plan!  It was good to see Julia and her parents smile before surgery.  There are a lot of things we do to help make this whole scoliosis surgery journey a positive experience for the adolescent as well as for the whole family.  Having had many surgeries as a teenager, I've seen the good and bad through the patient's eyes. We'll keep her parents in the loop during the surgery each hour and a half. 

While Julia was getting set up for surgery, I got a chance to see a very nice 26 yo woman who had scoliosis surgery done elsewhere years ago, and has been having major pain issues and problems with increasing kyphosis above her fusion, affecting her neck posture.  She has seen MANY doctors about this, including many pain specialists, and is on narcotics on a regular basis.  Her X-Rays show that her hardware goes up to mid-thoracic area, and she has bottom screws at L3 on one side and L4 on the other. 

We explained to her the differential diagnosis for her pain and posture problems, which includes pseudarthrosis, adjacent level degeneration, pain related to prominent hardware, and posture/balance issues.   We're getting her plugged in to our very best "Level 1" program, including meeting with a "black belt" scoliosis physical therapist from Duke, who also works as a trainer.  In addition, we'll get a CT scan of her thoracic and lumbar spine and take a closer look at the fusion and adjacent levels.

I am typing to you now from OR 12, just waiting for prep to drive on Julia, and then we will get to work!

Time now to scrub up.  We've got some beach music on our sound system here in the operating room.  Nurse Kelly is running the show as usual as circulator!

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery

Friday, April 20, 2012

Away at Scoliosis Conference, and Hey Clinic Quality Retreat.

I am here at a spinal deformity course here at Washington University, in St. Louis, MO, which is sponsored by Dr. Larry Lenke and Keith Bridwell and others from Scoliosis Research Society.  This has been a very unique course, where there are two simultaneous surgeries going on, with the surgeries being broadcast to our conference room in real time.  We have the ability to hear the operative surgeon, and ask questions.  Scoliosis surgeons from all over the world are here, and there has been lots of great dialogue, sharing cases with each other and helping each other.

In photos above, you can see the view I have watching Dr. Bridwell do a growing rod technique on the left side, while Dr. Lenke is doing a thoracolumbar scoliosis correction in a 48 yo woman.  Yesterday we participated in 2 other surgeries including a cervical-thoracic kyphosis correction with Dr. Riew, and a Scheuermann's Kyphosis correction with Dr. Lenke.  Lots of great discussion on a wide variety of approaches and techniques with over 100 surgeons and others sharing together.  Dr. Shaffrey from UVA gave good talk this morning on revision techniques in adults, and Dr. Steve Glassman gave a great talk yesterday about the possible impact of healthcare reform on spinal deformity treatment.  Fortunately, since scoliosis and kyphosis surgery has such a large effect on improving quality of life that usually provides many years of durability/use, these treatments can provide great long-term value. 

I got to share some of our recent experience using new techniques for preventing proximal junctional kyphosis using less invasive techniques for the proximal fixation of the deformity correction.

I've brought a couple people from our scoliosis team here to learn as well  -- my surgical physician assistant Leslie, and our Duke Raleigh Hospital Circulating Nurse Kelly who are really enjoying the learning and sharing as well.

Conferences like this is also a chance to connect with old resident and fellow friends from Duke and from my own training years at Harvard and Boston Children's Hospital.  Bumped into Dr. John Fox, who I knew when he was at Duke as a resident, and now serves as a pediatric orthoapedic surgeon in Norfolk, VA.  It was good to hear his update on his family and his practice!

The scoliosis community is a very supportive group, where we are all constantly trying to improve care for children, adolescents, and adults with spinal deformity.   

On the social side, I had a great taxi driver named Bill, who picked me up from airport and had some great dinner restaurant recommendations!! He also has been quite entertaining with his stories of great entertainers he has had the chance to transport including Bill Cosby and others!!

I fly home tonight, and will be back in the operating room on Monday.  Have had busy last few weeks, including doing huge kyphoscoliosis in 14 yo boy with fairly severe obesity. Got great correction, and he has done well.  Saw a bunch of postop patients back for followup, including several using our newer U-Rod and sublaminar fiber-wire technique with the more flexible rods with very high patient satisfaction.

Also this week we had a Hey Clinic staff retreat, focusing on the "Be Our Guest" book from the Disney Institute which we all read in preparation for our retreat.  Each Hey Clinic associate prepared a "SWOT" analysis -- Strengths, Weaknesses, Opportunities and Threats -- and shared, based on their contribution to overall clinic flow what recommendations they had to improve our ability to serve.  Everyone did a great job, and several new changes are already underway.  Learning to LISTEN to my team, and allowing each associate to contribute to improve the team is something I have definitely gotten better at, the last almost 8 years at Hey Clinic, and 10 years before that at Duke Medical Center.

Will try to be better about sharing more consistently on the BLOG, at least twice a week.  Will shoot for Wednesday and Sundays, but we'll see!

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery

Tuesday, April 3, 2012

Research meeting w Professor Mazzoleni from NC State Dept Mechanical Engineering

Finite element analysis computer model is coming along nicely to help improve instrumentation and fusion. Sunni Wang is the PhD student on the project.

Special plans for experiments this summer!

Dr. Lloyd Hey --

Monday, April 2, 2012

48 yo woman straightened up with thoracolumbar kyphoscoliosis today

This young lady has suffered with progressive back pain and deformity, with 61 degree preop kyphosis combined with 36 degree progressive scoliosis. Her posture has gotten gradually worse, combined with the pain giving her a very poor and worsening quality of life.
Her surgery went well today. The "hump" she had on her back is now gone, and her kyphosis is down in the normal range. Surgery was approximately 4 hours, with 4oo cc blood loss. Just rounded on her and her husband here at Duke Raleigh Hospital. They are both very thankful. He will stay in her room, until they go home likely after 3 nights, on Thursday.

This morning, had a good talk with dad of one of my adolescent kyphosis patients, who had questions from a second opinion about bracing for improving her 77 degree painful kyphosis and scoliosis. Bracing for kyphosis can be very difficult and uncomfortable. Bracing for scoliosis is really meant for children and adolescents who have growth remaining.

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery

Maggie comes back for her 6 week follow-up looking great after "U-Rod" surgery for Early Onset Scoliosis

Well, it is about time to get back to the blog... so sorry for my long delay.

One of the many highlights from the last couple we

made it hard for her Shilla hardware to hold onto her spine. She was gradually falling into significant kyphosis, which also caused heks was seeing Maggie back in the clinic with her mom. She was back for her six week follow-up for her revision early onset scoliosis (EOS) surgery after
Shilla Procedure. Maggie has a tough problem with osteoporosis, which
ardware prominence to
the skin. I revised her
using a special new "U-Rod" technique, using sublaminar fixation at multiple levels using FiberWire. We were able to get a really nice correction of her deformity, and she is now doing very well. She's quite a bit taller, and very happy with her new posture.

She was kind enough to make me a personalized
Thank You Card, which is shown below. She's quite a good artist! Thanks Maggie for the thoughtful card!!

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery