Tuesday, November 13, 2018

Is there such thing as "Minimally Invasive Scoliosis Surgery"? Can a herniated disc give you scoliosis? Define "Cattywampus" and can it be treated?

I just saw 20 yo Hannah back for her 4 week postop visit, and she is one happy young lady!  I saw her a few weeks ago and she was completely "cattywampus" preop, several inches to one side with a thoracolumbar scoliosis and trunk shift and having quite a bit of pain.   For those who are not familiar with the medical term "cattywampus", you can google it, and Google the Answer Man says:

"adjective. The definition of cattywampus, often spelled catawampus, is not lined up or not arranged correctly, or diagonally. An example of something cattywampus are the positions of the items on the top of a coffee table after a two year old has been playing with them and moving them around."  -- yourdictionary.com

Cattywampus when it comes to scoliosis is a super obvious trunk shift, so that one hip sticks out like crazy and in some cases it looks like the patient literally is going to fall over to one side, like the leaning tower of Pisa... maybe worse.  

So what made Hannah so cattywampus?   As you can see above, the root cause was a disc herniation at L45 on the left, which was causing her to unconsciously lean forward and to the right, AWAY from the pain.  After failing conservative therapy, I performed a minimally invasive microdiscectomy, and her posture and pain began to improve immediately.  Her scoliosis has improved 11.3 degrees from 38 to 26, and trunk shift has improved 5cm from 8 to 3 cm.   Her sagittal posture has also improved dramatically.  The way to think about this is that the disc herniation is like a "hot poker", in this case on the left at L45.  The patient instinctively leans AWAY from the hot poker, and also may lean forward.  When the disc herniation and foraminal stenosis is removed, then the spine can gradually come back to a more normal position. 

Since "Sad Crooked Hannah" is now "Happy Much Straighter Hannah", I gave her option of doing some Schroth therapy to keep working on getting that 26 degree curve hopefully even lower down into the teens to help prevent back problems and progression later in life.  I also gave her the option to just observe and see if it progresses or improves.  We love to give people CHOICES, especially conservative choices that could train them with techniques that could benefit them for many decades to come.  She's opted for the Schroth therapy which we will get done closer to her home in Chatham County with our wonderful Schroth therapist colleagues at Advance Physical Therapy in Chapel Hill!!  After we finish our training class for 12 more Schroth therapists here at Hey Clinic in December, we should have many more sites around NC and SC to help folks locally to "get it straight" conservatively, sometimes with 3D CADCAM comfortable ultra-low profile braces like the Rigo-Cheneau that we fit and build here at Hey Clinic -- for children, adolescents and adults.  

So, is there microsurgery or minimally invasive surgery for scoliosis?  Yes.... but unfortunately not for everyone!  We can do microsurgery also for some patients who have severe sciatica with spondylolisthesis and/or scoliosis even if they are not catttywampus.  Anyway, especially for a rapid onset scoliosis this is good thing to think about.  Not all disc herniations need surgery -- some can get better with conservative therapy, but in cases that do not, microsurgery / microdiscectomy is a really cool solution that can be life changing for folks like Hannah.

Lloyd A. Hey, MD MS . --- Hey Clinic for Scoliosis and Spine Care.  http://www.heyclinic.com