Wednesday, August 29, 2012

Yesterday's Adolescent Idiopathic Scoliosis Visit, and afternoon 50 yo with same curve!

At Hey Clinic, we treat patients of the entire age spectrum with scoliosis, from young children with congenital and early onset scoliosis, through the adolescent idiopathic period, young and older adult.  Over the years it has been helpful to treat this wide age range, since we get a chance to see the effect of different scoliosis patterns during each phase of life.

Early yesterday morning, I met a very mature young man named Logan and his mom, who were seeing me for a second opinion regarding his 47 degree thoracolumbar scoliosis.  The curve had progressed about 15 degrees in past couple years, but the last 2 X-Rays done more recently showed no significant change.

He was asking me about the potential effect of choosing to just watch the curve in years to come.  He has developed some back pain, but it is not too severe.

I shared with him that the curve could remain stable, but due to the asymmetric loading of his lower lumbar discs, that there was a possibility that the lower curve could collapse, and lead to a painful degenerative scoliosis that could even result in spinal stenosis.  I've seen countless cases of patients in their late 20's, 30's, 40's, 50's, 60's and beyond who were told their curve was "stable" and they were "done growing" as a teenager finishing off treatment for adolescent scoliosis, only to find out a few or many years later that the curve had begun to progress again.  Logan is extremely bright, and seemed to get the long-term choice he faced, given the possibility of realigning his spine now when he is younger, and possibly be able to save the bottom 2 or 3 discs for a lifetime, while also enjoying a better posture.

Yesterday afternoon, after fixing a big double curve scoliosis in a 64 yo woman, I met with a woman named Sherrie in her 50's who was suffering with significant low back pain, and a long history of adolescent idiopathic scoliosis.  Her curve pattern was the same as Logan's, who I had seen that morning, and was also a little less severe than Logan's when she was in her 20's.  At that point, Sherrie only had occasional back pain, and her discs still looked great even with her large trunk shift and 40 degree thoracolumbar curve.

However, now her curve has progressed to 67 degrees, and she has a fairly significant lateral listhesis at L34, which is compounding back and leg pain, contributing to her spinal stenosis.

Logan's adolescent curve could be fixed with a fusion from T5-L3 or L4, sparing the pelvis and the bottom 2 or 3 discs.  Sherrie will require a bigger operation, since all of her lumbar discs are severely degenerative, requiring fusion from T4 or 5 to the pelvis/iliac wing.  Both are fixable, but "a stitch in time can save nine" or more, and the adolescent or younger adult can enjoy many years of improved posture as well as less years of suffering from less optimal quality of life.

Late yesterday evening, I got a nice email from young Logan, who told me he had been prayerfully considering his long-term decision for his spine, and had decided that he wanted to go ahead and get it fixed now, rather than wait.  I think Sherrie, if she had the chance, would tell him from her experience "down the road" that he is making a good choice.

This morning I saw yet another adolescent young lady with a 55 degree newly diagnosed thoracolumbar curve, and this afternoon saw two 18 yo twins with scoliosis --- one of whom had a double curve treated elsewhere with residual 45 degree double curve and very large residual rib hump, for which they were considering thoracoplasty.   The same discussion of long-term consequences of untreated deformity, especially with these lower curves was discussed as these teens seek to make the best long-term choice to preserve their lower lumbar discs, while restoring proper balance and improving posture. 

 My nurse practitioner Brittaney, PA Leslie and I spend quite a bit of time teaching using the X-Rays, and spine models and other references to help families know their options for treatment, with the pro's and cons of each choice.  Families seem to appreciate this extra time and explanation so they can feel peaceful about their long-term choices.

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery
A Southeastern US Center of Excellence for Spinal Deformity for Patients of All Ages

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