Monday, January 28, 2013

This past week in review! Seeing Kayla for her 6 week postop check

This blog is a chance for me to reflect on powerful experiences, and memorable patients and families which I don't want to forget.  Life can be so busy, rushing by with one thing after another that probably all of us don't take enough time to reflect, and be more aware of all of the special people who cross our path, and become a part of our life.  For some of you, I understand, it is interesting to read these stories and see some of the pictures of the special people I've had a chance to meet recently, or have known like family over many years at Duke and Hey Clinic.

One of my happiest moments this week was seeing Kayla and her mom from South Carolina back for her 6 week postop visit this past Friday.  Kayla is the 20 yo young lady who had two curves, both over 120 degrees, that I corrected with a single 9 hour surgery at Duke Raleigh Hospital.  Her previous blog entry from her surgery and her preop story can be found by clicking HERE.  Whew.  That was a day!  Preop, I got helpful input from several Scoliosis Research Society (SRS.ORG) colleagues, including Dr. Steve Glassman, Dr. Sig Berven, and Dr. Larry Lenke.  SRS not only does great research to help improve scoliosis care, it is an international supportive network of scoliosis experts who actually collaborate and help each other serve patients better as well.  Each of us has different strengths and "tricks of the trade"  -- which we can share and come up with new solutions.  Many thanks to Steve, Sig and Larry for their help --- the end result was worth the time!

Kayla was just so happy with her new posture, already feeling much better than preop and looking great --- 3 inches taller!  Notice how her trunk is now balanced over her pelvis (the hourglass figure is back, and the big creases are gone), her shoulders are nice and level, and her chest also is derotated considerably, improving her posture from the front as well as the back.  The "humps" have been reduced down to reasonable bumps that she's very happy with. We all had many thanksgivings as Kayla now begins to start a whole new chapter of her life.  Her before and after clinical photos and X-Rays made her mom go "Wow"!

Many thanks also to my highly skilled scoliosis surgical team in Room 12 at Duke Raleigh Hospital that work with me day in and day out four days a week to help folks like Kayla and her mom.  Thanks to the awesome nurses, physical and occupational therapists from our Orthopaedic / Scoliosis / Spine Unit at Duke Raleigh Hospital who also do such a great job with our adolescent, young adult and older adult guests and their families.

You're lookin' great Kayla!  Look forward to see you back again in a few months.

Thankfully, most of the guests we see at Hey Clinic have curves that are less than 120 degrees.  There are obviously lots of benefits of catching the curve earlier!  We started off Monday morning last week with a family who drove 5 and a half hours the Sunday before so they could meet with me for a second opinion at 7:30 am before I went in for surgery that day.    She's a very nice 12 yo girl who was just recently diagnosed with scoliosis, put into a brace, and very quickly had her curve continue to progress until now it was about 60 degrees!  As shown in photos below, you can see her big trunk shift the the right, with a large right hump.  With forward bend, she has a very large rib hump with the Scoliometer reading over 20 degrees.  She has not started to have her period yet, and her Risser Score is 0, showing that she has a lot of growth remaining.

We had a very good dialogue about her scoliosis, and concerns about her remaining growth.  The curve is now way too big for bracing, and surgical correction sooner rather than later will give her the best possible correction with the least risk, and also likely preserve more "motion segments" which is important later in life.  As we have discussed in PREVIOUS BLOGS, surgery will not "stunt" her growth -- she will actually have a huge growth spurt on day of surgery, and her spine can continue to grow normally outside the fusion area, and also can grow somewhat within the fusion area, which could even help straighten the curve a bit more.  Most of the longitudinal growth at her age occurs at hips and knees, with less growth occurring in the spine at this stage of development.  Please check out Chris Moore's excellent blog entry on this topic (click here for more on spine growth).

I was sent another young lady shown on the left here with a similar curve this past week, who was already seen by an excellent local spine surgeon, who measured to have a 30 degree curve, and had a brace ordered and fitted and then sent to us for further follow-up.

My nurse practitioner and I remeasured the outside X-Rays and actually found the curve to be around 46 degrees, which is actually too big for bracing.  You can see her similar trunk shift to the right as our young lady above with a similar thoracolumbar curve.  We do see quite a few second opinions for scoliosis, not just before surgery, but before bracing as well.  We measure so many scoliosis and kyphosis X-Rays every day using special software that it helps us possibly end up with different readings from the outside radiologist, pediatric orthopedic surgeon, neurosurgeon or chiropractor.  It is also important to make sure that the X-Rays are taken properly with the right equipment, preferably in a "PA" posterior-anterior beam shot rather than "AP" ---- this gives less radiation to the breast area.  We always try to use outside films and import them into our custom information system database and electronic health record, but sometimes we do need to get additional images, such as a lateral image, if not done by the outside doctor or clinic.  Mom was bummin' out a little bit here, since she did have a high out of pocket expense for the brace, which her teenage daughter wasn't exactly psyched to wear anyway!  Spending some extra time talking about bracing with the adolescent and family is time well spent before making a major investment in a piece of plastic sculpture that may not make it out of his/her closet!

 Last week or so we also helped this lady with severe athetoid cerebral palsy, manifested mostly with scoliosis in her neck region, due to unbalanced muscle forces.  Take a look at her CT scan that shows how this imbalance of forces led to her cervical spine discs and facet joints completely wearing out!  We were able do to a multilevel cervical ACDF procedure to decompress her nerves and spinal cord, while also help greatly diminish her neck pain!  She is also thankful that she can now hold her head up straighter.  

Another really interesting patient we helped this past week is this 66 yo lady who came to us with progressive weakness and clumsiness in her arms and legs.  Her X-Rays showed a slightly increased atlanto-dens interval (ADI), which only moved a couple millimeters with flexion-extension.  Her MRI showed a severe pinch of the spinal cord at C1 with cord changes suggesting myelomalacia, or "flash lesion" in the spinal cord. Not good.  In general, one might consider doing a laminectomy as well as an instrumentation and fusion for this problem, but I was curious to see if we could come up with a less invasive option to help preserve her neck range of motion and flexion-extension, and also have a surgery with less risk.  I actually took about 3 hours one afternoon and early evening last week, and got into "study mode" in our Duke Raleigh Hospital Doctor's Lounge combing through hundreds of articles to find case reports of patients like this that were actually treated with less invasive laminectomy only procedures.  3 papers in particular -- one from Italy, and two from Japan gave me great hope that the less invasive way was the way to go,  when combined with my biomechanical understanding of the underlying stability of the C1-2 joint based on the flexion-extension films.  Dr. Bob Wheeless, one of my former Duke Residents, and original author of the "Wheeless Textbook of Orthopaedics" Online Textbook, popped in to say "hello" when I was in my study mode, with 2 computers open, articles printed out and strewn around, and obviously deep in thought.  Bob, a fellow "Nerd" like me was impressed and psyched to hear what I had learned so far.  Bob's wife used to work for my lab at Duke, the Center for Clinical Effectiveness years ago.

So, I was able to give this lady a call before her surgery, and propose the less invasive approach, explaining the risks vs benefits, and she was psyched to give it a try.  As a result, her surgery actually took about an hour as opposed to several hours, she had much less risk, and her recovery was very quick -- going home the next morning with good neck motion and her arms and legs coming back to life!  I told my family that evening that I ended up spending probably 5 times more time planning her surgery than it took me to do the surgery itself!  For my student readers, just remember that the learning never stops, and you can always continue to enjoy digging up new ways to solve complex problems.

I saw a bunch of postop patients back in clinic this past week, including this 40 yo woman to the left, who is so pleased that we were able to restore her posture and get her curves down to nearly perfectly straight!  She had been told that usually you don't get much correction for adult scoliosis compared to kids / adolescents, and there is some truth to that ---  the curves are definitely more flexible in the younger group, which is a good reason to fix them earlier rather than later.  However, there are quite a few tricks that can be used, including osteotomies, and special instrumentation techniques that can allow us to get really awesome corrections in a lot of adults.

We enjoyed having Dylan with us this past week, a pre-Med from UNC who got a chance to see surgery for the first time, and hang out with us in clinic.  He wrote up his experience just spending 6 hours with our team, and I was blown away by what he learned not just about the spine/medical facts, but about what should drive you as a compassionate physician.  Great job Dylan.  We'll hopefully get to share your learning in future blog.

ICE STORM FRIDAY!  This past Friday we were dealing with an impending ice storm in the Raleigh-Durham area, and I really wanted to close the clinic by noon to let my staff get home, and ensure my patients didn't get trapped on the side of the road.  We had a really bad ice storm here back in January 2005, which left all of our roads like a skating rink, and hundreds of students and others trapped!!  I ended up deciding to sleep in my office that night, since my anterior-posterior reconstruction patient for surgery who had arrived from out of town would have been totally HOSED if I could not make it in.  Anyway, Shelbi at my front desk told me that we couldn't really close early, since one of our adolescent scoliosis patients was coming all the way from Asheville, NC to see us (5.5 hr drive), and the mom had to also go to UNC in the morning to see a doctor herself, and would come over ASAP.

During the day on Friday, we saw a bunch of postop patients, including Adreanna, who is a 17 yo young lady who had a very complex congenital scoliosis at her lumbosacral junction who was back for her one year follow-up looking and feeling great!  Man, a lot of planning went into her osteotomies.  Great to see you Adreanna!

I also got to see Abby back.  Abby is in her 30's, and I did a complex anterior/posterior revision scoliosis for her 5 years ago, and she is still doing well and just wanted a checkup.  I wrote a blog about Abby when I was doing Christmas Eve shopping at her jewelry store about 3 years ago.  You can see that blog by clicking HERE.  Since then, Abby had some news to share:  she had a new baby boy!  So, if you wonder whether you can have a baby and carry a baby to term, and successfully deliver a baby --- even after complex scoliosis surgery -- Abby will tell you "YES", although in her case her obstetrician recommended C-section due to the pelvic fixation.  Abby was even able to have a spinal anesthesia for her C-section, but it required a little extra effort from the anesthesiologist to get it in with the spinal fusion.

Toward the end of the clinic I saw George and his wife -- he's doing great just a few weeks postop from a revision extension decompression fusion with TLIF.  He's a very active guy, and needs to be reined in a bit postop to ensure he doesn't overdo it.  Both he and his wife gave me a big hug, and handed me a dozen eggs from their own chickens.  The eggs were absolutely huge!!

So time kept ticking away past noon, and still no sign of our family travelling from Asheville.  The snow and ice were definitely falling outside, and the traffic report sounded bad.  I hoped and prayed this family was not stranded somewhere along the way.  But then, just around 2 pm, they arrived!  Well, her doctor appointment at UNC took longer than expected, but we all did hang out until 2pm and saw her and her mom.  They were WAY thankful that we waited, and we got her and her scoliosis squared away.

After doing my late afternoon rounds (carrying my eggs out to the car first), I made the drive home which was definitely a challenge.  I had about an inch of ice on my little VW Jetta by the time I got home, but the car stayed on the road well.  I saw lots of SUV's and other cars off in the woods along the way --- we don't do winter too well here in North Carolina!

During the day on Friday in clinic, one of my friends who is a spine surgeon in Raleigh contacted me via email to help his "best man" in his wedding who has a son with scoliosis from Louisiana.  Friday evening once I got home and had some dinner I was able to look at the clinical photos and X-Rays that were sent to me, remeasure them, and then call the dad back in Louisiana and go over the results.  Out of State second opinions like this are common for us at Hey Clinic.  Always remember there may be a scoliosis expert near you that you can find at SRS.ORG, but for some families they like our Hey Clinic approach and team and choose to make the trip, starting first with an email / phone consultation.  This physician family will actually be coming out for a visit in mid-February, and we will arrange for a hospital tour of Duke Raleigh Hospital with our Patient Navigator Holly.  Our clinic is less than 20 minutes from RDU Airport, and some folks come in and out the same day.  There are convenient hotels across the street from Hey Clinic, which sits right next to Duke Raleigh Hospital.

On Sunday morning I got an anxious scoliosis mom email sent to Hey Clinic at 4:15 am, which I saw at 7:30 am when I was sitting down to have a cup of coffee.  "Contact me ASAP!!", she said.  Well, I felt led to drop her a quick text back, and she returned the call about 9:30 am, and we agreed to meet this morning at 7:30 at my office before surgery.  Her 12 yo daughter Celeste has a significant 50 degree double curve with severe back pain, which is rapidly progressing.  She texted me later today and thanked me for getting her in so soon and giving her, and Celeste peace of mind and a good plan to get her straightened up sometime soon.

Probably my most memorable scene from this past week was on Tuesday, just before doing scoliosis on Madelyne, a very sweet young girl with a rapidly progressive scoliosis currently just over 40 degrees.

Madelyne's parents actually did something you may want to consider:  they actually scheduled a separate appointent to come in and meet with me before Madelyne's surgery to ask questions without Madelyne being there.  They had some other questions, and felt more comfortable doing this dialogue with just the 3 of us.  They left feeling very peaceful about the upcoming surgery.

On Tuesday morning, Madelyne was in the nice private room in preop where we put our scoliosis patients with their parents.  I went over everything with the family, and had a brief prayer with them at their request, and shook each of their hands.  As I was just exiting the door, Madelyne's dad asked me to wait just a minute.... I thought he had one more question.  Instead, he grabbed my hand, looked me in the eye and said, "I know you will take great care of my daughter... I have all the faith in the world in you and your team... but do remember how precious Madelyne is to all of us."

"I definitely understand, and will take excellent care of your daughter", was my reply with a gentle smile.

As I walked away, I took a deep breath and thought about this extra "Dad Encounter" I just had.  Life is so precious.  Family is so precious.  We're not just straightening up spines here, we are caring for precious people and families, which create precious moments like this.    I have no idea whether my mom or dad grabbed my orthopaedic surgeon's hand before any one of my 11 surgeries that I had on my badly damaged leg when I was a teen, but I know they were at least thinking about it.

Little Madelyne's surgery went really well, taking less than 3 hours and got her scoliosis straightened up beautifully.  I saw both her mom and dad who stayed with her in her private room twice a day, every day.  After the surgery, her dad shook my hand more than once --- this time it wasn't to ask -- it was just to say "thanks" for taking care of his precious daughter.

So it has been good to catch up a bit.   It has been a blessed week or two.  Slowing down and processing what I've experienced and learned helps energize me for the day and week ahead.  Some day when I may not be able to be in the fray each day as I am now I will likely look back at these blogs and remember the incredible journey with incredible people I have had the chance to experience.  Otherwise I fear I'd forget these precious times.

If this is encouraging or helpful for someone out there, that is wonderful.  I especially like to inspire that next generation of compassionate physicians and other healthcare providers who are taking a study break from Organic Chemistry or some other premed class.  Hang in there, and remember that it is more than just the science:  medicine and surgery gives you this unbelievable privilege to connect with patients and families in an incredibly special way.  Take time to find good mentors, and develop your HEART as well as your mind during your training years.

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery

Friday, January 18, 2013

Greetings to Olivia's Grandma in Buffalo.... and this week in review

 I wanted to start of today's blog with a special "hello" to Olivia's grandma in Buffalo, NY.  Olivia had her adolescent idiopathic scoliosis fixed with us for her double curve back about 6 weeks ago, and is doing extremely well!  Her grandma also has scoliosis and kyphosis, and has followed Olivia's surgery and recovery closely.  Olivia was back to school a few weeks ago, and is going to England in March for a big school field trip.  She really likes her new improved posture.

More later.... need to go see another patient in clinic.  Dr. Lloyd Hey, Hey Clinic for Scoliosis and Spine Surgery

-------------------- email back from Olivia's Mom this afternoon ----------------

On Jan 18, 2013, at 3:23 PM, Gretchen Ca wrote:
Thank you!

From olivia's mom:

We feel truly blessed to have found Dr. Hey and his incredible staff who deliver such compassionate care and the wonderful nursing and therapy staff at Duke Raleigh hospital.   Liv is beautiful proof that miracles happen every day at the Hey Clinic! 

Chapel Hill, NC

Tuesday, January 15, 2013

Mom of college athlete who had scoliosis surgery shares her story.

At age nine, Sabrina was diagnosed with idiopathic scoliosis with a twenty degree double curvature; meaning, her spine was S-shaped due to a thoracic curve and a lumbar curve jutted in opposite directions. For a year she only had x-rays every few months to monitor the curvature as she grew. At age ten, it increased to twenty-eight degrees, so she was placed in a full body (torso) bending brace twelve hours a day. The bending brace overcorrected her spine to allow only twelve hours per day wear versus twenty-four hours. She wore the brace for five years and had x-rays regularly to monitor the curvature. At age fifteen, an x-ray of her hip showed the growth plate closed, indicating she was nearly done growing. Scoliosis protocol at that point indicates bracing is no longer necessary.  

Every patient is different, and for Sabrina the curvature worsened out of the brace, the first year to thirty-three degrees. An increase isn’t uncommon as the body adjusts to life without a brace, but unfortunately her increase continued. When she was seventeen, her curve worsened to thirty-seven degrees. Less than a year later, to forty-four degrees. That x-ray led to Sabrina’s five-hour surgery May 2012 at Duke Raleigh Hospital, performed by Dr. Lloyd Hey, the top scoliosis surgeon in America who operates on professional and college athletes.
Sabrina’s freshman year in college (fall 2011), she started to suffer acute lower back pain. A full scholarship swimmer at Virginia Tech, she pushed through the pain during the swim season, especially at ACC Championships in February 2012 and NCAA Championships in March 2012. From fall 2011 to spring 2012, she endured three in-hospital spinal injections and took pain meds and an anti-inflammatory regularly. Due to the year of intense pain she suffered, her Virginia Tech coach was stunned by her performance at ACC’s—she broke records and her performance qualified her for NCAA Championships. At NCAA’s, her right leg numbed due to nerve involvement and her back muscles froze to protect her spine. Soon after, an x-ray showed her curvature at forty-four degrees. Surgery from T5-L1 (thoracic #5 to lumbar #1) was now inevitable.
Since x-rays give an extreme limited view, Dr. Hey’s three-dimensional direct view was only available via surgery, and during Sabrina’s five-hour surgery on May 2, 2012, he found her rib cage concaved in four inches due to the rotation of her spinal curve (Think: thoracic spine curved to the side and twisted inward). He straightened her severely crooked spine, fused her vertebras, and inserted two parallel titanium rods and twelve screws to hold her spine straight in-line. Sabrina is proud of her scar from her thirteen-inch incision. It’s a reminder of how much she’s overcome.  

Unbelievably, less than eight weeks post that surgery, she competed at the 2012 US Olympic Swim Team Trials for a spot on the US Olympic Swim Team that competed in the 2012 Summer Olympics in London. She qualified to swim at US Olympic Trials back in August 2010, and she refused to not go and try to swim her best, so she started to get back in shape only a couple weeks post scoliosis surgery, and she battled pain as her body adjusted to the new positioning of her spine, scapulas, shoulders and rib cage as well as all the surrounding muscles, tendons and ligaments. She only began to find her new stroke with her new back when she swam in US Olympic Swim Team Trials.

Sabrina is currently training hard at Virginia Tech to compete at ACC Championships in February 2013.

I’m so thankful for Dr. Hey's expertise and talent. Not only is he a skilled surgeon, he’s a man of God. Minutes before Sabrina was wheeled into surgery, Dr. Hey and his surgical RN offered to pray with us. My husband and I and our two younger children gathered hands with Sabrina, Dr. Hey and the RN, and the seven of us prayed. Just a few hours after Sabrina’s surgery, Dr. Hey and our family of five again gathered hands and prayed, this time in thanks.

Through my husband’s cancer, God led us to the Hey Clinic. Sabrina’s dad endured two surgeries and radiation treatments at Duke Raleigh Cancer Center; inside that same building is Dr. Hey’s office. As my husband and I approached the door to his   Duke oncologist for the first time, I spotted Hey Clinic Spinal Surgery right across the hall. Soon after, I transferred Sabrina’s records from her first scoliosis orthopedist to the Hey Clinic, sensing somehow behind that door was the right scoliosis expert for her.   

Thanks Dr. Hey!

(Sabrina’s mom)

Sunday, January 13, 2013

Jim, retired University Professor, sends iPhone Photo and Thank You atop Diamond Head, Honolulu

I received this email yesterday from Jim, who sent me this picture and message from his iphone, atop Diamond Head.  I've included his preop and postop MRI and X-Rays.  He had a L2-Iliac wing instrumentation and fusion with multilevel laminectomies.

Jim: so glad you are back to good quality of life!  Thanks for sharing. Dr. Lloyd Hey

On Sat, Jan 12, 2013 at 3:05 PM, Jim G <> wrote:

"t think a year ago I could barely walk let alone climb to the top of Diamond Head in Honolulu in flip flops.  Thank you Dr. Hey.  Jim

Sent from my iPhone"

Friday, January 11, 2013

Hey Clinic Week In Review. We Eat, Sleep, Breath Scoliosis Every Week, Meeting Patients of All Different Ages and Sizes and Complaints!

 It's Friday night, and I just got a chance to put my feet up after a really good, but very busy first week of 2013.  Our scoliosis surgery this week included 15 yo Thomas, who had a 64 degree collapsing adolescent idiopathic scoliosis and Down's Syndrome.  I did his surgery over at WakeMed on Tuesday. His surgery took about 4 hours, and as shown on our preop and intra-op X-Ray on the left, we got a nice correction.  He's done really well preop, up roaming around with no assistance yesterday and today spending just the first night in PICU.  His EBL was 400 cc, and he had no blood transfusions.  He had a left thoracic curve pattern, which is often associated with neurologic issues like tethered cord and other congenital spinal abnormalities like diastematomyelia.  Fortunately we checked his cervical and thoracic and lumbar MRI's which showed no abnormalities.

Even though his MRI's were OK, we were not able to get any Motor Evoked Potentials on him at beginning of surgery, and the stimulation for sensory evoke potentials caused his legs to jump dramatically --- something was definitely abnormal with his "wiring."  Fortunately, I was able to work closely with the anesthesiologist, neurologist from evoked potentials and anesthesiologist to work out a solution to get some monitoring done while also getting this boy's surgery done without a problem.  Never a dull moment.  The more you work around the neurologic system, the more miraculous and wonderful and mysterious it can be!

Other interesting surgeries this week included a L1 pedicle subtraction osteotomy (PSO) with T3-Iliac wing extension instrumentation and fusion for a lady with a severe proximal junctional kyphosis.  I did her surgery yesterday, and the "kink" is now out of her back, and she's getting up with her fracture straightened up and stabilized with pressure off the spinal cord.  After her surgery yesterday, I did a 2 level ACDF on an executive from West Virginia with severe burning pain down both arms to hands, with numbness, neck pain and trouble sleeping.  His surgery took about 90 minutes, and he was SO happy in recovery room last night.  The anesthesiologist saw me in the hallway this morning as I was headed up to his room and told me that the patient told him he felt great, and wanted to head on back to West Virginia ASAP this morning!

I also fixed up a lady who had a high grade L5S1 spondylolisthesis with severe spinal stenosis and trouble walking.  She is recovering very well after Gill Procedure, L5 foraminotomies laminectomies, and posterior-only approach -- a less invasive way compared with going front and back.  She is recovering well.

This week I also saw Justin, and his mom.  Justin is a teenage lacrosse player, who had a very severe upper thoracic congenital scoliosis with growing severe shoulder asymmetry.  His preop X-Ray reminded me of a patient I got to help treat as Dr. John Hall's Chief Resident at Boston Children's years ago.  I actually brought Justin's X-Rays to a Boston Children's Hospital Grice Lecture Conference, where I presented his case to Boston Children's Orthopaedics alumni --- many of which are leaders in the field now and/or Chairmen around the country and around the world.  I got lots of different opinions on how to best help Justin, but everyone thought it would be hard....

Well, it was pretty hard, doing a upper thoracic osteotomy with congenital vertebral body hemivertebra excision, and complex instrumentation due to his quite mis-shapen vertebrae.  He had one of the worst thoracic hypokyphosis deformities I had ever seen, requiring special instrumentation techniques to pull his chest wall "out" where it was sunken in toward the heart and lungs.  He has done great postop, and is very pleased with his new posture and chest shape.  

Justin is also an avid lacrosse player, and by doing a very strong construct, we were able to allow him to go back and play lacrosse starting back within a couple of months of his surgery, similar to Lexi who we treated from Baltimore.  Justin's mom and dad were very concerned that Justin's Lacrosse would be OVER if he had his scoliosis fixed, and even considered waiting until he was in college to have his scoliosis fixed.  They are not glad they had it done when he was  still growing, and get it fixed when curve was smaller.

I also saw a bunch of second opinions for scoliosis, spondylolisthesis and cervical spine surgeries this week.  I saw two young ladies in their 40's, who had surgical opinions elsewhere 5-10 years earlier, and were told by the surgeon that they would need a 12 hour anterior/posterior spinal reconstruction with several days in ICU intubated and a week or 2 or more in hospital.  This totally scared them away from considering surgery, even though they were already having significant back pain and were definitely affected by the posture being quite mis-aligned.  When I told them that their scoliosis could be fixed in about 5 hours, with no anterior approach needed, and little or not ICU stay.  One of these young ladies actually started to cry a little when she heard that her curves and pain were actually treatable with a reasonable surgical approach.  All of a sudden there was hope, where she had felt hopeless over several years.  The spine doctor this patient saw is a very good spine doctor in Durham, NC, but he does not specialize in scoliosis, and does very few if any scoliosis cases, which makes his surgical times much longer, and makes him more pessimistic about the outcome.  It is quite important to see a surgeon who specializes in scoliosis when getting a first or second or third opinion regarding your scoliosis or kyphosis treatment.  A good place to find someone to help you is at, where you can find physicians who treat children, adults, or both with spinal deformity.  Both of these ladies also had chiropractic treatment which actually has helped them with their back pain over the years, but has become less effective over past year.  We get quite a few referrals from chiropractors, and I've been supportive of chiropractic care for the low back pain aspect of scoliosis.

Years ago when I was Chief Resident at Boston Children's and was in charge of the resident educational conferences, I invited a chiropractor to come in and teach us more about what they do to our orthopaedic residents.  In general most orthopedic and neurosurgeon residents I have helped train are always very dubious about chiropractors --- I actually learned a lot by working with chiropractors over the years, and do think they can help with low back pain, even low back pain associated w scoliosis.  I do agree, though, with 99% of chiropractors and that chiropractic treatment is NOT effective for treating / improving the curves of scoliosis and kyphosis.

I saw several cervical spine patients for second opinion this week, including a guy today with a "flash lesion" in his spinal cord with cord edema, and severe numbness going down his left arm to his index and thumb.  He has tight stenosis at C34 where the cord is edematous, but also had severe foraminal stenosis especially at C56 on the left side.  I spent quite a bit of time going over all his images, and his physical exam findings, which included 3+ myelopathic reflexes in both lower extremities and continuous clonus in both ankles -- a sign that his spinal cord was not working properly with that cord pinch and edema.  He had a ski trip planned to Steamboat --- not a good time to fall down on your head right now for him until he gets this fixed.  His procedure will be a C34, C45 C56 ACDF with plating.   This coming week we have 3 ACDF surgeries planned, ranging from 2 level to 4 level ACDF's .

 Today in clinic we saw a bunch of postop patients and a few interesting surgical consults.  We saw Neal for his One Year Graduation visit for his L4-Iliac wing instrumentation and fusion for spondylolisthesis and severe pain.  Neal has been "gunning" to be the "Poster Child" for Hey Clinic with his rapid and full recovery.  He's been able to return to the sports he loves, including kayaking, and has only occasional pain.  He had suffered for over 20+ years with pain and limited quality of life.  Neal runs a local chamber of commerce, and is absolutely a fountain of positive energy.  What a blessing it has been to care for him this past year --- but now he's officially graduated from Hey Clinic, and also officially noted as the "Poster Child."

I also saw Barry back for his 6 month follow-up today, who is very successful pharma executive who works in the Philadelphia area.  Barry also had an incredibly long history of increasing pain and trouble walking, and also has made a very rapid recovery, returning back to work traveling to/from Philadelphia within 6 weeks from surgery, and doing an a aggressive several mile walking program.  After avoiding exercise and walking for years, Barry now takes a 3-5 mile walk every day at lunchtime along the Schuykill River!  A new joy for him.  I had shared Neal's story with Barry before Barry's surgery, so I went ahead and introduced these guys to each other.  Since they are both very competitive businessmen, they BOTH wanted the "Poster Child" award.  I ended up deciding to give it to Neal, since he is one year out and Barry is only 6 months.  I've actually known Barry for several years, and it was a blessing to have him come up to me at a Christmas party recently with a big smile standing up straight, and tell me how the surgery has really changed his life for the better.  Words of encouragement like that are helpful after a long week.

I also saw Hope, a retired nurse, back for her one year anniversary after her scoliosis surgery. She is also doing very well, keeping up with her exercise program and working on maintaining her good posture.

She is in her 70's, and has a very big improvement in quality of life.

This young lady in her 40's is just 6 weeks postop from her T4-Iliac wing reconstruction.  You can see from before and after X-Rays that we got a very nice correction of deformity, which has made a huge difference in her posture.  She also is doing very well advancing on her exercise program.  You can tell from her smile, and her husband's smile that she is doing well.  She is heading back to work as a dental hygienist his coming week.  We used some of our latest research out of NC State's Department of Mechanical Engineering Finite Element Analysis Modeling lab to come up with the best construct for her to maximize correction while minimizing risk, including risk of hardware failure / rod breakage.  Her husband has been awesome through the process, and really understands the bio-mechanics behind the "bending/lifting/twisting" restrictions that are beneficial during the fusion process to help minimize the loads while the bone knits together around where the hardware is holding things together.  The bone actually heals up and over a lot of the hardware, forming very much like a "rebar" construct you see in concrete.  

These two will be moving out to Charlotte, NC soon, but will be back to see us in a few months for her 6 month follow-up.  We reviewed with her what exercises she can do in the gym, and which weight machines to use and not use, etc.

It would have been nice to fix her scoliosis with a shorter fusion, but her lower discs had already worn out too badly ---- good motivation to fix your scoliosis when you are younger and before you have done too much damage to the lower levels.

I saw Amanda and her mom from Charleston, SC today as well in clinic.  She's a young lady who had scoliosis surgery 6 weeks ago referred to us by Dr. Steve Poletti in Charleston.  Steve, like some of our other referring neurosurgical and orthopaedic referring physicians are very kind to send us initial X-Rays and MRI's for me to take a look at before the patients come up for an appointment.  I got a chance to fly Amanda and her mom home after Amanda's surgery back to Charleston, which the mom said really made the whole experience much more tolerable --- a 45 minute smooth ride, as opposed to a 5 hour car ride!  During my "spare time" I sometimes get a chance to do charity flights also for Angel Flights, where we transport mostly children to and from their doctor's appointments who are unable to afford the transportation, and often live in remote areas more easily reachable with smaller aircraft -- this is a great charity to support!

And so ends another exciting week at Hey Clinic.  All hands were definitely all on deck from the full Hey Clinic Team, who work so hard each week serving new guests and existing guests with excellence and compassion.  So thankful for all of them. This is definitely a team sport.

Hope you all have a good weekend.  I'm going to spend part of this weekend preparing a talk I need to give next weekend in Charlotte, while also catching up with family and a few odd jobs around the house.

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery

PS:  Don't worry: We always ask permission before publishing photos of me with patients  and their families. All of these families pictured above gave their enthusiastic permission to have their photos included in this week's blog!

Monday, January 7, 2013

Photo of Sabrina's Backbend After Scoliosis Surgery -- Back to College Sports. Bracing EOS. Back to Work 2013!

Sabrina is one of our college-age athlete swimmer who had scoliosis surgery with us, and is in training now down in Florida.  Her mom sent us this cool update with her doing a back bend after her adolescent idiopathic scoliosis (AIS) surgery!  She is also swimming competitively. Check it out at bottom of this blog.

Today was my first day back to work after a nice almost 2 week break.  I went back to work this past Friday and saw a bunch of consults, including a 9 yo young lady who we are treating in a brace for her early onset scoliosis (EOS).  Her curve is not changing at all!  She actually doesn't mind her brace at all and has decorated it with dolphin and other stickers, as well as lots of great well wishes from family and friends!  The patient and her parents said it was ok to share this picture with her and her brace.  One of the things appreciate about Hey Clinic is how we take the time to get to know the child or adolescent as well as the family to help counsel the family with what choices make sense -- taking the whole patient into consideration.  One thing is for sure:  convincing a 7 or 8 or 9 yo to wear a brace is much easier than most 12 or 13 year olds!  We often use special probability growth charts, and discuss the child's daily schedule and how the brace may or may not impact on them during the day.  There is no doubt though:  wearing a scoliosis brace is a big decision, and it is worth the time to discuss it first before spending a lot of money and possible family tension.  No matter what age, you need to get buy-in from the person who is going to have to wear it and explain WHY and for HOW LONG and also that the brace is NOT A GUARANTEE that curve will not progress and possibly need surgery in future.

Today I did 2 complex spine reconstructions, and saw two consults in between, which included a woman with severe flatback syndrome and severe collapsing scoliosis in her younger 60's, which really went down hill after a hip replacement may have changed her leg length, and after 3 laminectomies over the years which may have destabilized her spine.  She's now in agony, and is bent way over with her lumbar lordosis now bent into 8 degrees of kyphosis!  This will require an anterior-posterior reconstruction with mutlilevel laminectomies for her severe stenosis and posterior osteotomies as well, possibly a pedicle subtraction osteotomy (PSO).

It was great to be back at work today and see everyone at Hey Clinic and Duke Raleigh Hospital.  Nurse Kelly noted that I had some minor abrasions on my knuckles --- leftover from "Mr. Fix It" jobs I was doing over my Christmas break.  There is never a dull moment.  I actually got a chance to help out with some repairs on my plane this past week, and had to use my surgical skills to help the guys remove a special electronic device under the pilot's seat!  There was a Phillips head screw way down in a crevice that had to be removed, and then carefully lifted out of that crevice to get the piece out.  This was definitely like the game "Operation", or like my real world "Operation." --- we used great lighting, teamwork, and some cool tools as well as a gentle touch to get it done.  I also fixed a toilet, and several other things.

I just got home, ate some reheated spaghetti and now catching up on 50 emails with my feet up and shooting off quick blog.  Tomorrow I do a laminectomy decompression first thing in the morning, and then go over to WakeMed to do a big scoliosis in a young man with neurogenic adolescent scoliosis (non-idiopathic).  More on that later.  

I got a nice text from one of my old patients from NYC who had a Harrington rod fusion done many years ago.  I sent him some stretching exercises for his back pain, and he's doing a lot better --- thanks for the text Ken!  

We received two second opinion consults for adolescent scoliosis surgery from out of State today -- both will be coming to see us soon.   One is from Louisiana, and the other is from Indiana I believe.  

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery

------ Forwarded Message
From: Dianna
Date: Sat, 5 Jan 2013 13:55:11 -0500
To: Shelbi
Subject: Fw: Sabrina's video text

Shelbi, I forgot to mention in my last email that I'll have Sabrina help me with this article since she's the patient. So, she'll input her viewpoint, emotions, etc.

Also...I thought Dr. Hey would love to see the below photo and short video if he can view it (my computer won't play it) of Sabrina in a backbend. This was taken yesterday -- she's in Florida right now on a VT swim team training trip. She'll swim in ACC Championships next month.

Have a great day,

------ End of Forwarded Message
Lloyd A. Hey, MD MS
Hey Clinic for Scoliosis and Spine Surgery

Wednesday, January 2, 2013

Happy New Year message from one of our athletic women who had scoliosis surgery as adult

Dr. Hey! :-)  Merry Christmas!!

May you continue to be blessed with amazing hands to heal those suffering from scoliosis. It has been 3.5 years almost since my surgery and I continue to get stronger than ever!  In addition, my running time has surpassed many past runs which placed me 2nd in the Masters in 24:30 min  on Thanksgiving out of 750 runners!

Thank you for recently fixing my friend in early December after other surgeons said they couldn't help her. You're in my thoughts daily and I am hoping to get my book published to encourage others to take the leap of faith.

God bless you,
Marcia  :-)