Tuesday, September 18, 2012
Surgical time: 2 hours 15 minutes.
Correction: very nice.
Out to talk to family. They should be quite happy!
Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery.
40 yo woman with painful thoracolumbar curve fixed yesterday; 11 yo 50 degree thoracolumbar adolescent idiopathic scoliosis (AIS) to be fixed this morning
This morning I am at WakeMed, here to straighten up an 11 yo young lady who has the same curve as the woman we straightened up yesterday. This young lady has a 50 degree curve already, which is why we are fixing it now. Will get you an update later. Time to scrub in!
Hey Clinic for Scoliosis and Spine Surgery
Monday, September 10, 2012
Had to cancel first scoliosis surgery, so moved up second surgery for our 58 yo woman w very painful collapsing scoliosis.
Time to suit up. Good to be back w to clinic and OR Room 12!
If you get a chance, sign up for eText at Srs.org. awesome free online spine textbook!!!
Lloyd A Hey, MD MS
Friday, September 7, 2012
I am riding bus to Art Institute here in Chicago after another action-packed day at SRS international scoliosis meeting.
After the meeting, i quickly changed into my running gear and ran down to the Navy Yard. It looked kinda windy out on the water w lots of white caps, but i was running in the lee of the buildings. As i got out to the point of dock, all of a sudden i was hit ny a blast of wind that literally stopped me in my tracks!! Moving forward seemed impossible! I stuck my arms out to see if i could just take flight, but was unsuccessful.
Rest of run went great. Pretty city!
Dr. Lloyd Hey
Wednesday, September 5, 2012
The actual presentations got started at 8:00 sharp, and have been literally going all day, including a luncheon symposium. Major focus today was on what changes have occurred in the last 10 years in spinal deformity treatment for children, adolescents and adults, and what challenges still remain for the next 10 years.
A couple of key takeaway points I found was when Dr. Peter Newton from San Diego Children's Hospital talked about genetic testing for scoliosis using the ScoliScore, and how the possible benefit is not worth the $2,900 cost of the test, since it doesn't significantly change the need for careful follow-up. That was my opinion from the very beginning of the commercialization process of this test, first released a few years ago at SRS. At the end of the day, having an experienced scoliosis team, combined with careful follow-up is the only way to really know which way and how far the curve is going to go!
I got a chance to see a couple of my old friends from Boston Children's Hospital, including John Emans and Tim Hresko --- both doing very well. Continue to be very thankful for the great training and mentorship I received there in residency, fellowship and chief residency, and always enjoy to go back. Got a chance to review a possible adolescent revision surgery with Dr. Emans, which was very helpful as usual!
Several good talks about the benefits vs. risks/costs of scoliosis bracing for adolescent idiopathic scoliosis (AIS), with special note of the lack of really tight, very long-term well controlled studies to confirm efficacy. There is certainly some evidence that it could have some benefit of slowing curve progression and decreasing the rate of surgery at least at point of skeletal maturity. However, other data was presented to show that compliance as well as psychological and emotional effects are possible with bracing that can last well beyond the bracing period. This is all consistent with our family-oriented, personalized, thorough dialogue we have with scoliosis families before prescribing the brace so that the adolescent or younger child as well as the parents are fully informed and are not just rushed off to the brace shop.
Late afternoon I went to a smaller symposium on case presentations for adult spinal deformity. I heard good comments and case presentations from Dr. Chris Shaffrey from UVA, and Dr. Khaled Kebaish from Johns Hopkins, and an interesting case presentation from a surgeon from Glen Cove Community Hospital where I was treated many years ago. I got a chance to share about some of our latest biomechanical and clinical innovations we have been working on at Hey Clinic, including new Proximal Junctional Kyphosis (PJK) surgical techniques, including the use of less invasive fixation and more flexible rods to help in this effort. Several scoliosis surgeons from Japan came up to me after the talk and agreed with our approach, and have been working on other sublaminar techniques even at bottom of long constructs, combined with more flexible rods in these more complex deformity cases. How awesome is this, to be able to share with doctors half way around the world, to continue to improve our ability to diagnose and treat children, adolescents and adults with spinal deformity! The SRS is definitely a very supportive international community to accomplish this mission.
Dr. Lloyd Hey
I just walked into this huge hall here at Chicago Sheraton, and I must admit, my heart jumps with excitement! Shortly this hall will be filled with spinal deformity experts from around the world. Even though I've been in this scoliosis world for over 20+ years, there is still more to learn, and more to share.
Yesterday's SRS Adult Deformity Committee Meeting was really good, catching up with Dr. Steve Glassman and others. Sig Berven did a great job as Chair, with new scoliosis outcomes database being discussed and planned to enable all SRS members to collect prospective outcome data integrated in their practice. I am hoping to use my epidemiology, information systems, and quality control engineering background combined with 20+ years of innovation to help in this effort. An Adult Spinal Deformity Treatment option paper is also being developed, with the hope of using it to help guide patients and families and policy makers on the process of helping spinal deformity patients make decisions around their treatment options, including surgery.
Had a nice dinner last night overlooking the water at the Navy Yard, while catching up with my son on the mobile. While Chicago is known as the "windy city", the winds were quite gentle, with sailboats just scooting gently along -- bright sky above!
The clock is ticking down, and the conference is about to begin!
Lloyd A. Hey, MD MS
Tuesday, September 4, 2012
I am on my way to the Scoliosis Research Society (SRS.ORG) Meeting in Chicago. The SRS website is a great source of information, and can also be used to find a scoliosis surgeon in your area ---- ANYWHERE IN THE WORLD! I serve on the SRS Adult Deformity Committee, which meets this afternoon. There should be a very good white paper coming out shortly on the indications for scoliosis surgery in the adult. I am also interested in exploring the continuity between the pediatric and adult deformity population, including how we can seek to intervene earlier to help save motion segments in the lower lumbar spine, with less invasive approaches.
I will try to share some highlights from SRS over next few days on the blog!
Had a long talk this weekend with mom of an adolescent idiopathic scoliosis patient, who had surgery performed elsewhere, and has large residual deformity with pain. Discussed various treatment options. Revision surgery is sometimes indicated for pain and imbalance, and to help improve loads on lower lumbar spine for disc preservation. If you are going to consider revision, it is helpful to do it sooner rather than later, since not only does the postero-lateral fusion get more solid with time, but the anterior discs become stiffer and stiffer, eventually turning virtually to bone. To correct deformity at that point could require a more invasive osteotomy, like a vertebral body resection or VCR.
We have done quite a few revision deformity surgeries, for both kyphosis and scoliosis. In many cases, however, after we evaluate the patient we might suggest not proceeding with revision surgery and just following it conservatively.
Now that Labor Day is passed, I want to say Thank You to all of our Summer Interns who served at Hey Clinic this summer! You guys were just awesome. Francesca just finished up with us, and sent me an email to share what she learned this summer.
Well, I am going to get back to finish my Cobb salad and head North to Chicago! Looking forward to see Dr. Sig Berven and others at the meeting.
Dr. Lloyd Hey