Wednesday, August 15, 2012

An answered prayer from 12 yo girl with scoliosis.

On morning rounds today, I saw our postop woman in her 40's who had the big thoracic scoliosis that we fixed on Monday.  She is doing very well this morning.  She stopped me as I was about to leave and told me the following story:

When she was 12 years old, she knew that she had a fairly severe scoliosis.   She prayed at that time that God would straighten her some day.  She told me that this prayer has now been answered, some 30+ years later.

Our 27 yo young lady from Philadelphia is doing great this morning as well, who had the kyphosis correction yesterday.  She actually looked great even yesterday evening, with her trunk and chest now back in a normal position.  She said she can tell the difference lying in bed as well, with her thoracic hump now removed.  Her significant other actually got decent night sleep next to her on the pull out bed in their private room.  We will get her up today.  She is going to be way taller.

After that, I whizzed over to clinic to see a very nice 14 yo young lady and her mom from near Charlotte, NC.  They were not happy with the evaluation of their daughter's scoliosis and came in for another opinion.  My PA Leslie and I spent a good half hour with both of them.  The patient has a 34 degree thoracolumbar curve which we remeasured, and had significant trunk shift down and to the left creating a bit of a skin crease below her rib cage on right.  Patient has significant growth remaining, with physes open and menses beginning only few months ago.  She has significant back pain, especially carrying heavy book bags, or prolonged sitting.  She has noticeable hump on her left low back.

We took a lot of time to go over best treatment options for her for both the back pain, and her scoliosis.  We talked over the option of scoliosis brace, vs. the thinner light-weight brace to help treat the back pain portion of her problem.  After reviewing all aspects of the purpose of the  scoliosis brace, with the research (it may help decrease chance of scoliosis surgery by skeletal maturity, but does not improve the curve) vs. the commitment of 18 hours per day for several years, the patient and mom opted for follow-up in a few months and not to do the brace.  We spend a lot of extra time to explain the pros and cons of bracing, and try to enable the teenager to think through what they are willing and not willing to do, and also consider the family dynamic.  At the end of the day, the adolescent really has to be willing to wear the brace for the required time period each day, but also know that the brace is not a guarantee that surgery will not be necessary in future, and that it won't make the curve smaller.  I have dealt with some very unhappy patients in their late teens and twenties who ended up needing surgery, who were braced for several years, and thought that their commitment to wearing the brace meant that they would never have to have surgery.  One 21 yo patient I remember, from New Jersey, had a complete meltdown in my clinic over at Duke when I told her that her curve had progressed to over 50 degrees.  She screamed and pounded her fist and told me that it wasn't "fair", and that she was promised that she could choose the brace vs. choosing surgery.  Now she was really upset that she needed both, and would have never worn the brace if she knew that surgery was possibly still on her future.  I think the brace does help in some cases, but there is some "cost", psycho-social development and family dynamic "cost", that in some cases outweighs the possible benefit.  The key thing is to empower the patient and family with the information so THEY make final choice, not me.

Just about to scrub in to help Katelyn, a 13 yo who lives about 3 hrs away who has a 66 degree severe thoracolumbar scoliosis.  She arrived late this morning, so we are getting a late start.   Time to scrub up!  I would definitely prefer to operate on these curves BEFORE they get to 66 degrees, since we are able to get a better correction with less risk and less surgical time.  Hence the importance for careful scoliosis awareness and screening and follow-up --- an area where Hey Clinic seeks to help work with local pediatricians, chiropractors, and family physicians as well as other surgeons in Southeast to ensure that we catch a "stitch in time" to save "nine."

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery

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