Monday, February 25, 2013

Can you Wrestle after Kyphosis / Scoliosis Surgery? Brandon's Dad Gives A Facebook Answer!

Michael S < Feb 11 Hi Dr. Hey!  This is Michael S______, Brandon S_______'s father.  You did surgery on him a couple of years ago.  I saw you pop up on facebook for some reason so I thought I'd take another opportunity to say thank you!  Brandon is doing wonderfully.  He returned to normal activities soon after surgery.  He wrestled as a senior in high school, he graduated in Egypt in front of the pyramids, he served in AmeriCorp and now he's in college.  God has blessed our family and you will always be a part of us.  Thanks again!  Sincerely, Michael S.

Michael had a 76 degree painful Scheuermann's kyphosis that I straightened up a few years ago, now continuing to do well.
Dr. Lloyd Hey -- Hey Clinic for Scoliosis and Spine Surgery  --

Thursday, February 21, 2013

Sabrina B is an ACC Champion...THANKS Dr. Hey for your help!!

Hi Dr. Hey and Shelbi,
The below is written by my husband, Leo (Sabrina's dad):
Blessings for a great day,
Dianna T. B__________
Dr. Hey and team,

I just wanted to send you all another encouraging update.  In case anyone asks if you can return to competitive swimming after major scoliosis surgery, I think you can answer with an emphatic YES.  Last night at the ACC Championships, Sabrina and her teammates pulled off a surprising upset and won the 200 Medley Relay!  Not only was their time fast enough to set a new school record, but it also qualified them for the NCAA Championships next month.  Sabrina led off the relay and swam her fastest 50 yard Backstroke time ever!  She swam the first leg/stroke of the relay (backstroke is first in the medley relay) and she won (first backstroker to touch the wall), so she had VT in the lead, and the breaststroker, the butterflyer and then the freestyler maintained that lead for the win. All of this, and it has not even been 10 months since she was fused T5-L1 last May.  It’s been a lot of hard work on her part to return to competition, and we can’t thank you enough for you and your team's skill and kindness throughout the process.  Please feel free to share this with your team and anyone else looking for encouragement facing such a major surgery.

In the champion celebration photo attached here: A split second before the reporter snapped this photo, Sabrina's relay teammate and roommate at VT (the freestyler, which is the last stroke in med relay) hit the wall, finishing first amongst all the other freestylers

Blessings to you all!

Leo B________

Dr. Lloyd Hey --- Hey Clinic for Scoliosis and Spine Surgery --

Sunday, February 17, 2013

Does Kyphosis Surgery Really Help Decrease Pain, Improve Posture and Improve Self-Esteem in Teenagers?

Ashley is a 17 yo young lady who had Scheuermann's kyphosis surgery with me back in May 2012, which was covered by a surgery blog post, and a follow-up note from Ashley's mom.  Ashley's mom just emailed me a letter summarizing the difference the surgery has made in Ashley's life these past 9 months, and expresses her thanksgiving to the team at Hey Clinic and Duke Raleigh Hospital next door.  Thank you Crystal for sharing your family's journey with all of us.
Dr. Lloyd Hey -- Hey Clinic for Scoliosis and Spine Surgery

February 17, 2013  Re:  Ashley T________  Date of Surgery:  05/31/12
Diagnosis:  Scheuermann's kyphosis   Surgery:  T3-L3 instrumentation and fusion

Dear Dr. Hey,
Just wanted to drop you a note with an update on Ashley's recovery.  She's now almost 9 months post surgery and nearing the end of her senior year and very busy.  Most amazingly, she's not had to take even a Tylenol or ibuprofen for back pain this year.  No more low back pain or neck pain at the end of a school day as before.

She is so relieved to have this surgery behind her, and she is really enjoying her new posture.  She comments from time to time that she can hardly believe it's corrected.  We are amazed at the difference in the way clothing fits her.

Sitting on bleachers for sporting events used to really aggravate her back as well as make her very self conscious about her hump-backed appearance.  She now does this with no problems, and her posture is near perfect.  Ashley's primary consideration for surgery, was increasing discomfort, but as her parents, Johnny and I now know that it was affecting her emotionally more than she was admitting.  We had all become quite used to Ashley's posture before surgery, and it was only after surgery and witnessing the improvement that we realized just how much of a deformity she had prior.  Since surgery, I have caught her in a full-length mirror just staring at her back and posture and remarking that she can't believe it has been corrected.

Well, enough about us.  Let's turn the spotlight.  Our thankfulness to you, in addition to Leslie, the entire OR staff, your office staff, and Duke Raleigh Hospital cannot be adequately put into words.  Thank you, Dr. Hey, for allowing God to use you in such a special way.  He has truly granted you great knowledge along with extraordinary skill as a surgeon.  From our first visit in your office in 2008, we knew we had found the right physician for Ashley, and we are forever grateful to you for your care and compassion. You always took the time to answer our questions in great detail and we never felt rushed.  Further, we were relieved to find that you were not just surgery happy.  From our first call to your office back in 2008 to the calls after surgery, each were handled professionally and timely.

I cannot close without commenting on Duke Raleigh Hospital.  Ashley's entire care team was amazing.  Their knowledge, medical care, and compassion was unsurpassable. It was truly a humbling experience.  We can honestly say that we did not have even the slightest issue with any part of her care.  We never encountered a moody personality, a lazy spirit, a rushed demeanor, or a pass the buck to the next shift attitude.  The staff was both professional and personable.

Please accept our apologies for this long overdue note.  The link to my blog for Ashley's surgery is  I really did intend to document more, but days pass so fast.  Still, I think it will provide future patients some good insight.

One last note…I noticed the post you wrote about holding clinic out in the garden at Duke Raleigh.  That garden holds a very special place in our hearts, too.  On May 31st during Ashley's surgery, Nurse Kelly had just telephoned with an update that the osteotomies were beginning.  The updates were so appreciated. An hour can literally seem like a day when you are waiting for news of your child's progress while undergoing surgery.  There is a very odd (for lack of a better word) feeling that comes upon a parent when they are told, "About half the screws are in place," or "the osteotomies are beginning."  Perhaps we had done too much research and knew too much detail about what all this meant and what actually was taking place in our daughter's body.  When Johnny received the call about the osteotomies, I could sense his heart was weeping on the inside.  He asked to be excused from family and took my hand and we walked out to the Duke Raleigh garden and there under the arbor, Johnny and I emptied our hearts out to God.  We were emotionally deplete.  There was absolutely nothing we could do for our baby girl but pray, and pray we did.  God met us there in that garden in the darkest hours of our lives.  So, when you talk about the garden being a special place, we too can attest to that.  I couldn't help but think about Jesus' prayer in the garden before His betrayal. After Ashley's six week followup appointment, we revisited the garden, only this time Ashley walked with us as vibrant as ever before, and there in the same spot, we as a family prayed and thanked God for his extravagant mercy and grace upon our lives.

Dr. Hey, our prayer is that God will continue to strengthen you and use your talents to impact the lives of others.  May you and your family be blessed for the sacrifices we know both you and they must make for this to be possible.  We thank you from the bottom of our hearts!


The T______ Family
Johnny, Crystal, and Ashley Brooke

Thursday, February 14, 2013

Adolescent Idiopathic Scoliosis Surgery -- Is it OK to Run after surgery and play sports?

Dr Hey,
Thanks so much for sending these photos.   I am so glad we got to see you yesterday.  It’s hard to believe that a year has passed since Noah’s surgery.  He turns 16 tomorrow. 
We will always be thankful for you.  Once we met you last year we knew that you would be the one to do Noah’s surgery.  There was no question in our minds.  God has blessed you with such talent, skill and compassion.  Thank you for blessing us.  You will always be special to us.
Attached you will find the pictures that we gave you yesterday plus one more of Noah running a few weeks ago in a track meet.  I meant to print it for you as well.  He had just passed the other runner.
Many thanks and may God continue to bless you richly,

Hey Clinic for Scoliosis and Spine Surgery
Dr. Lloyd Hey

Adolescent Idiopathic Scoliosis Surgery -- Is it OK to Run after surgery and play sports?

Tuesday, February 12, 2013

Lori, Almost 14 years after T12 Burst Fracture I fixed Easter 1999 shows up doing well

A few weeks ago, I saw a former patient named Lori, who brought her mom in with spinal stenosis and spondylolisthesis.  I knew she looked familiar when she came in, but I couldn't quite place her.  She then went on to tell me her story, which she went ahead and emailed me today while her mom is in recovery room here at Duke Raleigh Hospital after I finished her spinal surgery.

I hope you enjoy it as I did.  Dr. Lloyd Hey, Hey Clinic for Scoliosis and Spine Surgery


Dr. Hey,
On April 2, 1999 the day started with cleaning the barn and preparing for certification at a therapeutic riding center.  After the work had been done we decided to reward ourselves with some riding time.  After about an hour into the ride my horse spooked and the next thing I knew I was on the ground unable to stand up.  I was able to bring my legs under me, however as I pushed up with my arms I could not bring myself to stand.  I laid down in the dirt and waited for the ambulance to arrive. 

The medics arrived and were unable to get me on the backboard.  After several attempts and excruciating pain I put myself on the backboard.  I was taken to a local hospital and told that I had broken my back, but there was nothing they could do for me and they asked me where I wanted to go.  The first hospital that came into my head was DUKE.  They arranged for transport and I was on my way.  After 110 miles I arrived at DUKE ER around midnight, Easter Sunday.  Dr. Hey heard my case arrive and decided to stay.

They explained that I burst fractured T-12 and I would need surgery.  Easter Sunday morning Dr. Hey and his team went to work.  My spine required extensive surgery.  My vertebrae was compressed by 60% and the spinal canal was compromised by 50%.  They had to decompress the spinal canal and remove all the bone fragments around my spinal cord.  After about 8 hours of surgery I was fused from T10 – L2 with complete spinal stabilization.  The recovery began.

I spent 5 days in DUKE getting my legs back under me.  I felt like I was “learning” to walk again.  I felt so fragile.  Dr. Hey and his team were amazing and along with my husband and family I gained not only strength but confidence.  I was glad to go home but I was also scared.  What could I do, would life ever be “normal”, would I always be in pain?  The questions were many but the answers were few.  I spent 6-12 months walking and trying to build my strength.  My husband and I had a larger goal, we wanted to start a family.  We had struggled for many years with infertility and we were ready to try invitro-fertilization.  I felt strong and ready to carry a baby.  The invitro was a success and we were having a baby!

The pregnancy was challenging and at times difficult.  I was sick for 9 months and as the baby grew the pressure on my back was excruciating. If I would lay on my back the baby would compress the blood vessels between the rods and I would pass out.  I was moving slower and slower. I was ready to have this baby but it wasn’t time.  In the last few weeks I spent most of my time resting and keeping my back comfortable.  3 weeks before my due date my water broke.  Our daughter was born 2 years to the day of my surgery. 

April 3 will be a special date for us for many reasons.  Dr. Hey gave me my legs back and our beautiful daughter was born.  Life is full of many blessings.

Thank you Dr. Hey.


Monday, February 11, 2013

Marie, with progressive kyphosis after T12 fracture 10 months ago, shares her story now after surgery October 2012 w/ us.

My Back Story
By: Marie
My story begins on August 17, 2011 at about 2:00a.m. when I fell down our
basement steps. We believe I was sleep walking and fell down the steps in the
dark and my husband heard me and found me at the bottom of the steps with
a broken bone sticking out of my wrist. After securing my back, neck and arm,
the paramedics transported me to Wake Med Hospital. I do not remember much
about the ER visit, but I was admitted and had to have surgery on my wrist. I
was seen and treated by a doctor from Wake Orthopedics and the surgery on my
wrist was a success. It healed quickly and I have no problems with it.

When I went for my first follow-up visit with the doctor treating my wrist, I told him
about pain I was having in my back. This was in September 2011. He said they
did x-rays in the ER and they found no structural damage and to give it time. At
my second follow-up visit, I complained more about my back, but maybe I had
a sprained or strained back and they suggested P/T at Wake Orthopedics. I
started P/T mid-September and continued through the end of November. At my
last P/T visit, the therapist was putting more intense pressure on my back and
did something that caused immediate intense pain. She immediately quit and
suggested that I see Wake Orthopedics’ back specialist. She felt something
might be going on other than just a strain or sprain.

I saw the back specialist in December and he again said no structural damage
on my x-rays but suggested an MRI. I told him the pain was getting worse
and I felt my lower back was curved. I was told they would call when they had
results. I had MRI on December 23, 2011. After the holidays came and went
and had hearing anything, I called Wake Orthopedics on or about January 4,
2012. I was told that the doctor did not release information over the phone and
because he was out of the country and would be backed up when he returned
I would have to wait a month to see him to get the results. I was in terrible pain
every day and laying in the bed on a heating pad more than I was able to be up.
When I was up, the pain was almost unbearable. I could not get any relief. My
husband called the office back and said we needed results of MRI or suggestions
as to what to do about my pain. He was told that it was against policy to give
information over the phone but they would get in touch with Dr. and call us back.
The nurse called back and said he was upset that we demanded results over the
phone but that he saw no problems on the MRI. I was devastated. I was in so
much pain and no one could tell me why. I was beginning to think it was in my
head. Needless to say I became depressed and decided I had to live with the
pain. After about another month my husband talked to our medical doctor and he
suggested The Hey Clinic. He spoke very highly of Dr. Hey.

I went to The Hey Clinic on April 16th, 2012 and my first appointment was with
Brittany. I explained the back pain that had gotten increasingly worse since the
fall. I had also started having left hip and leg pain that radiated down my leg to
my foot. They did x-rays and immediately told me I had an anterior compression
fracture at T-12. Brittany said there were a few things she wanted to try. I was
willing to do anything at this point. I was given Celebrex, Prednisone Dose Pack
and Flexeril. I was fitted with a back brace. I was to return July 5.

The meds helped the pain a little but not enough to really make a difference
in my day to day routine. Brittaney ordered an MRI and scheduled a surgery
consult with Dr Hey on August 15th.

Dr. Hey suggested surgery for several reasons. Everything else we had tried
had not worked, my quality of life was unacceptable and the surgery would
greatly help my pain. Dr. Hey said I had the fracture at T-12, with a bone
fragment. I also had a significant curve in my spine. After meeting and talking
with Dr. Hey, I was convinced surgery was the way to go. After talking with my
medical doctor and at his suggesting getting a second opinion and trying some
pain clinic injections, I scheduled the surgery for October 16th. Dr. Hey was
wonderful. The morning of surgery he was very reassuring, very compassionate
and offered a prayer before I went into the OR. I was very relaxed and sure I
was in great hands. My husband and mother were equally assured that I was
going to be fine.

The first couple of weeks were a little rough. I have about a 10 to 12 inch
incision in my back. Dr. Hey said my back was a mess. (I will let Dr Hey insert
particulars because he did a lot of things to my back.) I can say that my back is
completely straight and the pain I was having before the surgery is gone. I am
3 ½ months out of surgery and I feel that I am doing great. I am still recovering
and there is still some pain from surgery but it is tolerable. I am functioning much
better than before the surgery. Dr. Hey said to allow a full year to reach my full
potential and I am expecting to be pain free soon.

The only regret I have is that I didn’t meet Dr Hey in August 2011. Dr. Hey and
his entire staff have been wonderful. I have called many times with questions
and concerns and they have been so helpful and caring. Every time I visit the
office it is a wonderful experience.

Thank you Dr. Hey. Because of you I have a life again and I know when I am
completely healed I will be pain free.

Dr. Lloyd Hey -- Hey Clinic for Scoliosis and Spine Surgery -

"Life is Short, the Art is Long, The Opportunity Fleeting"....Soraya's Hippocratic Oath Gift --- Explained!

As I shared on my Saturday blog post, I received a generous gift from Soraya, a young lady from Charleston, SC that  I helped correct a fairly severe double curve scoliosis a year ago.  Soraya is a Greek scholar, and had a special granite carving made, which she explains in her email that I received today.

Thanks again Soraya!  Hope to see you in Charleston sometime soon!
Dr. Lloyd Hey -- Hey Clinic for Scoliosis and Spine Surgery -

Dear Dr. Hey,

Thank you for your email.  You are very welcome.  I think I mentioned it while I was at your office, but I got the idea from an exhibit I saw on ancient medicine in Greco-Roman times.  Part of the exhibit was a display of surgical tools and other methods used to treat various ailments during the time.  Kevin and I were amazed how far medicine has come from then.  I thought the disease was probably better than the cure!  I was grateful to live in our modern time where people like me could be helped and was thankful you were there to do it! I've attached some pictures that I took of the exhibit.  I think you might find them interesting (the bone saw just completely floored me).  Just so you have it in writing, below is the translation of the engraving:

(What's around the snake):  "Life is short, the art is long, the opportunity fleeting" (the last part can be translated in a number of different ways, I prefer this one).

Hippocratic Oath: "So long as I continue to keep this oath faithfully, and do not violate it, may it be granted to me to enjoy life and the practice of the art, respected by all men for all time."
I find the word the ancient greeks referred to the practice of medicine very interesting - tekne which is usually translated as 'art' but also means skill or craft, akin to the derivative word technical in English.  I like how they thought of medicine as an art as much as a skill.  

Now in addition to being a spine surgeon and a pilot, you can say you know some ancient greek :) 

Thank you again for all you have done for me.  I'll always be grateful.

Take care,

PS You should definitely visit Charleston other than dropping off patients!  It's a beautiful city, though I am partial.  I think you and your wife would enjoy it if you haven't been already.

Saturday, February 9, 2013

Memorable Moments Interacting With Precious People This Week

I took a few minutes late this Saturday afternoon to download the photos I have taken over the last 8 days or so on my phone camera.  Below is a sample of some of the patients I have seen back at Hey Clinic for their postop follow-up visits at 6 weeks, 6 months and a year after surgery.  We call these photos our "Hey Clinic Graduation" photos --- marking a special completion of a journey for all of us together through the scoliosis / kyphosis monitoring, conservative treatments, and in some cases surgical treatment and recovery.  You can get a sense of the "life-long" focus of Hey Clinic, where we evaluate and treat small children with scoliosis, many adolescents and young adults, middle-aged adults, and older adults.  I treasure each of these photos as I remember each family.

 Courtney is doing awesome after her adolescent idiopathic scoliosis surgery
 This was a very nasty kyphoscoliosis that we straightened up nicely, using new proximal fixation technology that helps prevent proximal junctional kyphosis (PJK)

 Complex anterior-posterior revision surgery using U-Rod, and complex pelvic fixation construct now obtaining her wish of walking standing up straight, and free of sciatica.  Margo and Jim have become like family --- Jim is retired MIT Professor.

 Extension instrumentation and fusion for flat back below Harrington Rod done less invasively with smaller interbody spacers.
 PreMed in College, who wants to be a surgeon!  Maybe she can take my place some day!

 Another adolescent scoliosis doing great postop
 Many thanks to my brother Ken, an amazing mechanical / structural engineer, who flew in this week and helped me design a new Truss construct to help solve a complex scoliosis / spondylolisthesis revision surgery for patient Diana.  Diana did great, and is now standing up straight with little pain, and very thankful!  Thanks Ken.

Here is Diana's mechanical reconstruction, using XLIF, and special new Truss Technique with load sharing.

  Complex Adult Scoliosis reconstruction, now doing great using a different truss technique to help prevent hardware breakage at lumbo-sacral junction.  It worked great.  Notice her excellent posture.

Soraya came back to see me from Charleston, SC 1 year postop from her scoliosis correction doing just great!  She gave me an incredible gift of an engraved Hippocratic Oath.  She is actually a Greek scholar, and read it to me.  I shot a quick video of her explanation that I'll likely share on a later blog.
Soraya's gift

This gentleman came to us about 7 weeks ago, losing the use of his arms and legs with a severe multilevel cervical stenosis.  He literally could not even feed himself or hold a cup.
Here he is yesterday proudly holding his coffee cup!  He is so excited that his neurologic function is still returning, including his lower extremities.

 This young teenage lady had kyphosis surgery with me about 6 weeks ago, and now is really psyched about her new posture and pain relief.  Her posture looks normal.  Mom is happy too!

 Noah and his parents came in to celebrate his one year anniversary from his adolescent idiopathic scoliosis surgery.  He went back to long-distance running within a few weeks of his surgery, and actually has run a half marathon!  He brought me a gift of a framed photo with one of the medals he has one this year, and gave me another photo of him running at one of his events.  

 This young lady is another adolescent scoliosis patient postop back with her family.  Unfortunately her dad's head got cut off by my wonderful PA who shot the photo.  Sorry dad.  Otherwise everyone is happy, and her posture looks great.

Her before and after X-Rays

Our biggest scoliosis surgery this week was a 27 yo gentleman with DeVic Syndrome, which is an auto-immune disease that attacks the nervous system.  It unfortunately caused him to become completely blind by age 15, and likely contributed to his severely progressive scoliosis.  As shown below, his curve continued to progress rapidly as an adult, and was about 84 degrees when I straightened him up on Wednesday this week.  His surgery took 5.5 hours, and he had an EBL of 600 cc.  He spent one night in ICU, but was extubated in the recovery room.  He advanced quickly on his physical therapy and went home this morning very happy.  

You can imagine how difficult it was to explain the surgery to someone who is completely blind.
I will tell you though, that Angelo is one of the finest people I have ever met.  Gentle, kind, and a lover of life.  He also has a wonderful family.  Getting a chance to know folks like Angelo and his family, and to be able to play some role to help him is a great joy.

One of the last patients I saw in clinic yesterday was this 15 yo young lady who had a 46 degree scoliosis this past August. At that point, I recommended surgery, but the mom really did not feel peaceful about that.  They decided to wait and see.  The X-Rays yesterday showed that the curve had progressed to 58 degrees -- 12 degrees in less than 10 months ---, and now her daughter is having increasing back pain, and the "hump" and trunk shift has gotten to be very large.

The mom was quite upset, regretting not fixing it last summer.  The teen actually held it together quite well, and is cool getting it fixed sometime soon.    Yes, it would have been better to fix the curve last summer, but all is not lost.

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery

Friday, February 1, 2013

Should I get my teenager's scoliosis fixed? Should I get my Adult Scoliosis Fixed? Two Adult Scoliosis Patients I saw This Week Have an Opinion

 When and why should you seriously consider encouraging your teenager or young adult to have their scoliosis fixed surgically?  Two patients I saw this week have interesting stories that might help.  

On Wednesday this week, in between surgeries, I saw a Karen, very nice 42 yo athletic young lady who had a history of adolescent idiopathic scoliosis treated conservatively in a Boston Brace at CHOP, Children's Hospital of Pennsylvania.  As shown on the chart on the left, her curves measured 37 for her right thoracic curve, and 23 degrees for her lower curve at the time she hit skeletal maturity.  That would deem her a "success" for scoliosis bracing and conservative therapy.  But, to be on the safe side, she actually went back to CHOP to get remeasured as an adult (a rare thing), and as shown on the chart, her upper curve progressed up to 43 degrees and the lumbar curve crept up to 25 degrees in 1994 and kept climbing to 28 degrees in 1996, just 2 years later.  She was still asymptomatic at that point.

Despite this curve progression, aside from a small change in her posture, she was asymptomatic.... until about three years ago, when she began to have a dull ache in her left lower back, right near the "45.6/32.8" measurement is at her thoracolumbar junction.  Her upper curve indeed has now progressed up to 46 degrees, and her lumbar curve has progressed even more rapidly to 33 degrees --- up another 5 degrees since 1996.

She is very fit, and is in the midst of conservative therapy for the pain aspect of her scoliosis.  While her curve is still not dramatically big, it is now becoming symptomatic, affecting her quality of life, and now is also affecting her standing posture.  Even if your curve was less than 40 degrees at skeletal maturity, the curves can continue to progress in adulthood, due to the asymmetric loading of the discs leading do accelerated disc degeneration and collapse, which leads to further curve progression and further disc load asymmetry --> further disc cartilage damage -->  further collapse.  A vicious cycle that can lead to accelerated collapse especially in cases where there is a large trunk asymmetry as a result of the scoliosis.

This stresses the importance to keep an eye on your scoliosis even if you were told not to worry about your scoliosis because you were "done growing."  Adults should be checked every year through age 25 and after each pregnancy, and every 5 years after age 25.  Kyphosis patients should also be checked as well.  It also emphasizes the possible large benefit of fixing scoliosis at a younger age with smaller curves to help center the loads over the lumbar discs and prevent later disc collapse and disability.  We have shared on previous blogs what severe disc collapse can look like, including the 53 yo gentleman I saw from Mississippi years ago who had a huge thoracic scoliosis, but had all of his pain in his low back, where all of his lumbar discs had worn out prematurely, forcing him to give up his career on the riverboat and seek disability.  "A stitch in time can save 9" -- in terms of being able to fix the scoliosis with a smaller less invasive surgery if fixed sooner before additional spine levels wear out requiring additional fusion levels, possibly even to the pelvis.

So for Karen, even though her curve might not seem like it is progressing very rapidly, it is progressing at a degree or 2 per year, especially in the lumbar area.  The lumbar area typically does tend to progress more rapidly, since it does not have the rib cage support.  It also is the area that causes more pain, and can even cause spinal stenosis as the body reacts to the disc collapse, causing nerve root impingement with disc herniations in some patients.

So what should Karen do now?  She's still very functional, but definitely having pain every day.  How far will this curve progress?  Well, even if the curve stayed at current rate of progression, her lower curve will be getting into the 50's and then 60's by the time she gets to retirement age.  She'll be at least a couple inches shorter by then with 2 big humps on her back, and likely a lot of pain.  At that point, she'll have more issues with osteoporosis, and will have more surgical risk, and less years to enjoy her improved posture.  The curves also get stiffer as you get older, making it more difficult, if not impossible to get as good a correction that you can get in the younger adult or adolescent.

The problem that Karen and a lot of our adult scoliosis patients face however, is that life gets more complex as you get older --- you've got kids to raise, jobs to go to, and possibly aging parents to care for as well.  That's why many patients like Karen will tell you that she wishes she had her curve fixed as an adolescent or young adult --- life is less complex, and you prevent the risk of this degenerative collapse which can really affect quality of life down the line.  Scoliosis in some cases can shorten someone's life when the decreased vital capacity of the scoliosis combines with aging decreases in lung capacity and lung disease.  However, the much more common issue for adult patients with scoliosis is not LIFE, but QUALITY OF LIFE, and concerns about FUTURE QUALITY OF LIFE.

Unlike CHOP, Boston Children's where I trained, and other pediatric orthopedic centers around the country, Hey Clinic routinely sees the full age spectrum of scoliosis, from young kids with EOS and congenital scoliosis, through many teens with AIS, and then young adult, middle age, and older adults with spinal deformities.  I have learned a ton over the past 16 years of practice caring for this wide age spectrum, where the older patients teach me things I can share with the younger ones, almost like a time traveller who can help you see what life might be like in the future having gotten to know many people who have already been there ahead of you!

As for Karen, she's going to continue to work on her physical therapy, and exercise program, take her NSAID's and track her pain and quality of life.  We explained to her what the surgical option would involve, and when she's had a chance to talk it over with her husband a bit will come back to see us with him to discuss a surgical correction to her deformity as a way of improving her current quality of life and posture, but more importantly maintain this quality of life and posture for the next 50+ years -- worthwhile investment to consider.

Today I saw a 29 yo young lady named Amanda, who just had her third child 4 months ago.  She was diagnosed with scoliosis as a teenager, and was treated successfully conservatively... sort of.  She had a curve in the 30's and was prescribed a Boston Brace, which she wore for about a week... maybe less, then did what many teenagers do:  refuse to wear it.  This is why it makes sense to sometimes get a second opinion about your adolescent's scoliosis bracing, and engage in a very important dialogue with your teen before making a 4 year, 18 hour per day commitment for your teen who then ends up being "non-compliant."

In any case, Amanda's curve was around 40 when she finished growing, and she did pretty well through her teenage years.  She had some back pain, but it wasn't bad.  She got married, and had 2 children with some back pain during pregnancy, but not too bad.  However, 2 months after the delivery of her third child, she had a severe stabbing pain in her low back which literally caused her to be unable to move for several hours, and then kept her on almost complete bedrest for about a week.  Scoliosis X-Rays now show that her curves have progressed into the 50's, and with significantly increased rotation and trunk shift which greatly affects her standing posture. We've discussed in previous blogs that pregnancy can lead to curve progression in some patients due to the increased weight and hormonal "relaxins."   Amanda is trying conservative therapy for the pain, but now is really worried about the future, and when this next bout of severe pain might strike.  Let's face it: It isn't exactly a convenient time to have scoliosis surgery when you have three small children!

Amanda's mom was there, who said it was ok to share this picture with her sweatshirt that said:  "Grandkids: the Greatest Gift of All."  Amanda's mom is willing to help out for the 4-6 weeks Amanda will need to recover from her scoliosis surgery.

Amanda also from her perpective would encourage her younger scoliosis friends to consider earlier surgery before life gets more complex, including having kids.

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery