Wednesday, September 5, 2012

Day 2 Scoliosis Research Society 2012

My day today at the SRS Meeting here in Chicago started at 6:45 am with breakfast, and looking over many of the poster presentations, and having a wonderful meeting with Steve Schwab from SurgiMap regarding their spinal deformity measurement software.  We are working on ways to integrate tools like SurgiMap into our Hey Clinic comprehensive quality control information system and electronic health record as we continue to weave outcome assessment and quality improvement into patient and family care.

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

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