Sunday, August 24, 2014

Is adolescent scoliosis surgery worth it as a young adult? Angela's surprise visit this past week to Hey Clinic

9 years ago this past week, I met a young lady named Angela from North Raleigh, NC who was about to start high school.  Her pediatrician noticed a hump on her back, and sent her to me for possible scoliosis.  It turned out that she had thoracolumbar curve over 50 degrees with a very large hump and trunk shift. Mom and Angela were like deers in the headlights -- what a shock!!  She was a cheer-leader, and was afraid she would have to give it up.  She was glad to hear that we get our athletes, including gymnasts, cheerleaders, swimmers, lacrosse players, soccer and basketball players, climbers ... and much more back to their sports quickly after surgery.  They decided to go ahead and get Angela's curve fixed right away.  I rearranged my OR schedule for the following week.  She went to her first day of high school on Monday, had her scoliosis surgery on Tuesday at Duke Raleigh Hospital, went home from hospital on postop day 2 on Thursday.  The day after that on Friday, she went to school for a few hours, and the following Monday went to school and her first cheer leading practice!  Her mom was so psyched, that she videotaped Angela at practice and drove it over to show me at Hey Clinic that afternoon!  Angela continued to do well, very happy with her posture, and gradually returned to full cheer-leading as a "flyer."  Her mom gave me the picture shown below which is on our Hey Clinic wall showing Angela AFTER her scoliosis surgery up on top of pyramid with one leg directly over her head!!

9 years have gone by since then, and lo and behold, almost 9 years to the day since I did her surgery, Angela dropped in to see me this past week!!  Here we are at Hey Clinic in front of her picture on the wall as the cheer leader in high school --- now she's all grown up, graduated from college and has a great job in the Triangle working with local universities.   Above you can also see a short YouTube clip with Angela from her visit.   Thanks for dropping in Angela!! So glad you are still looking and doing awesome 9 years after scoliosis surgery!!  
Dr. Lloyd Hey, Hey Clinic for Scoliosis and Spine Surgery

Saturday, August 16, 2014

Back from vacation…."She Looks AWESOME" text from Bree's Mom correction of 110 degree Early Onset Scoliosis (EOS)

This Wednesday I got back from a wonderful two and a half week vacation with family, which included some phenomenal time out in the Pacific Northwest, including Glacier National Park --- breathtakingly beautiful!!!  If you ever get the chance to go there, GO!!  Also got a chance to see San Juan Islands, Seattle, and Helena, Montana.  We were also part of my brother's wedding celebration out in Seattle, which was just wonderful with lots of family gathering together.  It was a good break, although I did have to spend some time on my break working on some research papers and committee work for Scoliosis Research Society, which has a big meeting coming up in September.  I flew back into town Tuesday evening into RDU, glad to be home. I actually met 2 of my surgical scoliosis patients at the airport, and got a couple of hugs as I went through baggage claim!  So good to see some folks I haven't seen for a while doing well, enjoying travel.

The next morning, I was back in the scoliosis crafting "shop", and glad to be back.   I performed 2 scoliosis surgeries at WakeMed Children's Hospital, in Raleigh on a 9 yo Michael and 12 yo Jackson, both of whom had rapidly progressing right thoracic curves.  Both surgeries went very well, taking about 3 hours each, with very nice corrections, and no blood transfusions.  Jackson went home today  -- (he gave me a big green balloon before he left) on postop day 3, and the other will be going home tomorrow.  Both were up walking postop day 1 with one night in the PICU, extubated in the operating room.

Thursday we helped a girl at WakeMed Children's Hospital named Bree who just turned 10 who had a 110 degree early onset scoliosis (EOS).  Depending on the size of the patient, chest wall size, and other factors, we consider 3 options for treating such curves in younger children:  Growing Rods or Shilla Technique for a multistage surgical approach vs. a definitive instrumentation and fusion, possibly anterior/posterior and/or with posterior osteotomies, or possible larger vertebral body resection (VCR).  In the "old days", we used to worry about "crankshaft phenomenon" when performing definitive fusions in kids under 10, but with the dawn of stronger segmental instrumentation with thoracic and lumbar pedicle screws, this no longer appears to be an issue even for younger kids, down to even 6 or 7 in some cases.  We often do second opinions to help families decide which is best approach, and the best timing to optimize growth, minimize surgical risk and number of surgeries needed, and maximize curve correction.  the other issue that has to be addressed is when to use preop skeletal traction.

Over the years, I have been working on figuring out less and less invasive ways of trying to get better and better scoliosis curve corrections with less surgical risk and surgical time.  Bree's surgery this week gave us ample opportunity to hone this "craft" of curve correction in a very severe 110 degree curve.

Bree was totally psyched for her surgery Wednesday morning and let me know how straight she wanted to be!  She did not have preoperative skeletal traction.  Using some less invasive, but multiple osteotomies over several levels, and some creative instrumentation engineering leverage, we were able to get a really nice correction for Bree without any changes in her evoked potential monitoring, and no blood transfusions, and about a 5 hour total surgical time, extubated at the end of surgery.

I also used some new twists on a pedicle screw insertion technique I have been perfecting that worked very well, helping to direct the screws in her incredibly twisted and deformed spine in a very safe and efficient way bilaterally.

Bree was extubated in the OR, spent a short time in PACU, and one night in the PICU off the ventilator.  On postop day one, she was transferred to the floor, got up and walked around, and was 3 inches taller!!  Around lunchtime I received the "before and after" picture below texted to me by Bree's mom which said

 "She looks AWESOME!"

Get well soon, Bree!  You do look Awesome!!!

The learning never stops, learning every day -- day after day -- year after year how to serve and "straighten" children, adolescents and adults better and better.  This job is never ever gets boring.  The families are awesome, the people I get to work with in the clinic and hospitals are awesome, and it is just so great to see how together, as a team we are literally able to change a life for the better -- a change that will benefit children like Bree for the rest of her life -- even her first day back to school.  Her smile, and her mom's smile seeing her X-Ray and new posture after surgery makes us smile too!

Friday I did another scoliosis surgery on a 13 yo and made his "hump" that was painful and on right side of chest go away.  His preop curve was 53 degrees.

While it was great to be on vacation, my passion, and our passion at Hey Clinic and with our team members at Duke Raleigh Hospital and WakeMed Children's Hospital is definitely helping kids like Bree, Michael and Jackson, as well as some older teens and adults as well.

It's good to be back.

Lloyd A. Hey, MD MS
Hey Clinic for Scoliosis and Spine Surgery