Well, ladies and gentleman, we have our first winner of the Hey Clinic Challenge Question.
Yesterday we received this answer from “TwistedSister” via the Hey Clinic Blog:
“I suspect that her neck pain may be attributed to her trying to hold her neck in a normal vertically straight upright position. Thus, her neck musculature is competing against the "natural" gravitational force caused by the scoliotic curvature...just my guess (unfortunately deduced from personal experience). “
Posted by twistedsister to The Hey Clinic for Scoliosis and Spine Surgery <http://drlloydhey.blogspot.com/> at October 15, 2010 1:23 PM
Twisted Sister is absolutely correct!!!
If you look carefully at the X-Ray, you’ll notice that I actually drew an angular measurement in the upper thoracic spine, showing 14 degree “lean” to one side. This gives the neck a tilted “foundation”, so that in order for her to keep her head level, she has to bend her neck back about 14 degrees or so to get her eyes level. This puts extra strain on the neck. As we all get older, and our neck gets more arthritis / degeneration in the facet joints and discs, it is harder and more painful to compensate for this.
This particular patient will be having surgery with us, and we’ll straighten that up for her along with the rest of the deformity, which should help her posture as well as pain and functioning for a better quality of life for the long run. That unbalanced gravitational force is what also can cause scoliosis to progress more rapidly in later years, as the discs and facets break down, and the “moment arm” or lateral force becomes stronger. That’s why they had to fix the Leaning Tower of Pisa before that unbalanced loading would have caused the 500+ year old tower to come crashing down to the ground if it had gone beyond the critical few degree threshold.
Patients who have kyphosis also have trouble with neck pain.
Years ago I saw a 50 woman from Chicago who had a normal neck MRI with severe neck pain.
It turned out that she also had a 90 degree thoracic kyphosis, which meant that she had to hyperextend her neck all the time in order to just look straight ahead.
I fixed her kyphosis, and her neck pain went away!
She also told me that she no longer looked like a “Turtle” --- a posture she never liked since she was a teenager.
Here’s web link to her interview with me after surgery: http://web.mac.com/drhey/iWeb/Dr%20Hey%27s%20Blog/Podcast/E6422EF7-7EC5-45C3-9C46-C51722F4425F.html
TwistedSister — strong work on the quiz. Sorry to hear you had to learn it through your own painful experience. If you send in a web request with your correct email through heyclinic.com, Tiffany in my office will send you out an official Hey Clinic T-Shirt this coming week, in white, or pink (our breast cancer walk color).
Hope you are all having a great weekend.
If you like the clinical puzzles, let me know and I’ll come up with some more.
Gotta get you thinkin’ and learning even more.
Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery
http://www.heyclinic.com.
Saturday, October 16, 2010
Tuesday, October 12, 2010
The first Hey Clinic Clinical Puzzle.. 2 matching curves.
second opinion for her severe scoliosis with large trunk shift.
Surprisingly, her pain is primarily in her neck.
Question: Why is she having neck pain, when her obvious problem is in her
thoroaculumbar spine?
I welcome suggested answers via comments.
First correct answer wins a Hey Clinic T-Shirt!
Other notes this week that are interesting:
Yesterday, I saw a 12 yo girl with a 33.5 degree thoracolumbar scoliosis.
She has occasional low back pain, but it is not limiting. Her folks
initially came up to see me from Florida for another opinion. They now live
in far western North Carolina. Since her curve has been stable since last
visit a few months ago, we all decided to wait on surgery. She still has
some growth remaining, as documented with her iliac wing growth plate
carilaginous edge.
Later in the day, I saw a 19 yo young lady, who had the exact same curve
pattern, and exact same 33.5 degree curve. However, she had a larger trunk
shift to the side, and is having significant back pain throughout the day at
college. It is also starting to greatly affect her posture and standing
appearance. She was braced for quite a while during her younger teenage
years, which she did NOT like! Even though her curve is under the 40 degree
measure where surgery is considered, her quality of life at this point is
unacceptable and getting worse.
The main point of this comparison is to show the importance of taking more
than just the curve measurement into consideration ---- age, symptoms,
progression, and other factors should be taken into consideration. We need
to be careful to take care of the "whole person", not just the Cobb angle of
the scoliosis curve.
Have a great rest of your week!
Dr. Lloyd Hey
Hey Clinic
Monday, October 11, 2010
Erik comes back to see us from Kentucky after Flat Back Syndrome Surgery at Hey Clinic
During Friday’s clinic, we saw Ekic and his family who drove seven hours (341 miles) from his home in Richmond Kentucky to come back to see us for his one year postop visit.
Erik had a previous scoliosis fusion done years ago, and has had difficulties with flat back syndrome for many years with severe deformity and pain.
You can see his previous blog entries here:
Surgery Sept 15 2009: http://drlloydhey.blogspot.com/2009/09/36-yo-gentleman-from-kentucky-sp.html
Postop Day 1 Sep 15 2009: http://drlloydhey.blogspot.com/2009/09/back-to-my-old-self-standing-3-inches.html
7.5 months postop: http://drlloydhey.blogspot.com/2010/05/fw-eric-37-yo-gentleman-w-flatback-flat.html
In this Blog, 38 yo Eri and his family share their thanks to Hey Clinic and Duke Raleigh Hospital Staff, for his new posture and new life off narcotics and enjoying family again.
Great to see you Erik, and thanks for making the trip to come back and see us!
Take care,
Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery
Friday, October 8, 2010
"Do you think that laminectomy might have affected my scoliosis?
The woman pictured here was diagnosed with scoliosis as a teenager, but it was considered mild.
She did fine for many years, but about 8 years ago had a minimally invasive microdiscectomy and laminotomy done for a pinched nerve in her lumbar spine.
Soon after that, her posture began to lean to the right and forward, and she developed severe progressive pain and deformity.
Now she walks with quite a limp, and has quite a lean to the right and is quite kyphotic.
Her X-Rays show a severe collapsing double curve kyphoscoliosis and MRI shows severe spinal stenosis in lumbar region.
We can help her with a thoracolumbar sacral iliac wing instrumentation and fusion, with laminectomies and osteotomies, since her quality of life is bad, and getting worse each week.
Early detection and life long follow-up for scoliosis and kyphosis, as well as caution especially when considering laminectomy only in face of deformity are all helpful suggestions to help prevent severe curve progression and more complex reconstructions, and also prevent lost quality of life days!
Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery.
Hey Clinic on Breast cancer walk !!!
organizing fund-raising and awareness for breast cancer research. We even
created a pink version of our Hey Clinic T-Shirt that we have been giving
out to our guests who made a donation for the American Cancer Society -
"Making Strides Against Breast Cancer" Walk October 1st.
Our Hey Clinic team helped raise over $1,100 for the charity with the help
of many of our Hey Clinic guests who have visited us. THANK YOU SO MUCH TO
EVERYONE WHO HELPED OUT WITH THIS EFFORT. Your donations have been given to
American Cancer Society, and Shelbi, Jimmy and Sue are pictured here for the
actual "Making Strides" Walk held at North Hills, in Raleigh NC. Many
thanks also to the Hey Clinic associates who made this happen.
Most of our families, including my own, have been touched by cancer,
especially breast cancer. Learn more about the event at :
Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery
Raleigh, NC
http://www.heyclinic.com
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