Adolescent Scoliosis Patient back playing competitive softball within first 3 months of surgery. FW: Hey Clinic

From: Nick
Sent: Monday, September 22, 2008 2:42 PM
To: Meredith Railey
Subject: Re: Hey Clinic

Hey Meredith

So you were able to get the photos. Great! Thank you again for all ya'll have done. We were very proud this weekend and every one was amazed. Emily has been involved with travel softball for 6 years, and all of these girls from all over the state are like one giant family. When word got out this April about Emily, everyone from all these teams called or stopped by to give her encouragement and to let us know they were praying about her. After the first two games Saturday morning, everyone was coming around and congratulating her on the recovery and expressed amazement. And she had a very good tournament to start of with.

We had a lot of prayers and they were answered. Thanks again to everyone in the office.

Jill

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Lloyd A. Hey, MD MS

Hey Clinic for Scoliosis and Spine Surgery

Raleigh, NC USA

http://www.heyclinic.com

O: 919 790-1717

M: 919 215 0170

Member, Scoliosis Research Society (SRS) http://www.srs.org

Lifelong Spine Care at Hey Clinic. The age range of success stories seen today in clinic

At Hey Clinic, we do life-long scoliosis care, from small children, through adolescent, young adult, middle-aged adults, and older adults.

In the picture above, we can see an example of the age range of guests we have served, and seen in clinic just today and yesterday.

Each guest and their family has their own goals, and receives different benefits from getting their scoliosis fixed. Some of the guests below have been featured in previous blogs, including Mary, from Princeton NJ who got a phenomenal correction from a thoracolumbar sacral instrumentation and fusion, now with excellent posture and ability to return to active walking program, and ability to go back to work at at a Princeton "Think Tank". We also saw Candice, who is a grad student with thoracic scoliosis with hypokyphosis / lordosis which we were able to fix to pull her chest wall out to a normal shape. Our 12 year-old was also only 3 months out, and played 3 different sports this summer after her surgery, and is also playing sports this fall as well.

On Monday this week I saw a very nice 14 yo girl from Indiana with severe Scheuermann's kyphosis, measuring almost 85 degrees, who found us through Molly, our Michigan teenager who came down this summer to get her kyphosis fixed.

It has been a very busy week at Hey Clinic, and now it's time to recharge the batteries.

Lifelong Spine Care at Hey Clinic

Lloyd A. Hey, MD MS

http://www.heyclinic.com

Hey Clinic for Scoliosis and Spine Surgery

Raleigh, NC USA

Member, Scoliosis Research Society (SRS) http://www.srs.org

Preoperative questions about possible lost flexibility (stiffness) after scoliosis spinal fusion.

I received this email earlier this afternoon from an approximately woman with a collapsing thoracolumbar scoliosis with increasing back and hip pain who has tried all conservative therapies, and is not considering spinal instrumentation and fusion, with lumbar laminectomies and osteotomies.
She had a few more questions, and had been in touch with some of my other patients who were in the same “boat” as she was just a few months ago, and are now recovering well after surgery.

Hopefully her questions and my answers may be helpful for many others out there who have similar questions!

Lloyd A. Hey, MD MS
http://www.heyclinic.com
Hey Clinic for Scoliosis and Spine Surgery
Raleigh, NC  USA
Member, Scoliosis Research Society (SRS) http://www.srs.org
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On Sep 14, 2008, at 3:22 PM, Embarq Customer wrote:

Thanks so much for the phone call and email.  However, I could not pull up the websides and wonder if your office could check on these websides for me, as I would like to see the videos.

I have contacted two of the ladies and they have nothing but praise for their surgeries performed by you.  I was very encouraged and hopefully can schedule surgery in the fall.

I do have a couple of concerns which we did not discuss. (Just forgot to ask.)  How about flexibility after surgery?  Also, I have quite a lot of pain in my right hip (in the joint) as well as down the outside of my thigh. (I had an injection in the right groin  in April that greatly relieved the pain, though I still have some.)  I had an MRI in June which I brought to your office and I'm not sure it was viewed, but nothing shows up that would cause hip pain, so are we to assume this pain is caused by the spinal disorder?  What are your thoughts on this?  I am hoping surgery will relieve pain in the hip as well as back.  I also would like to check on my insurance plans, which I can discuss with the front office.

With many thanks for your interest and the helpful discussion we had in your office.  We were greatly impressed.

N_______

 
---------- DR. HEY’S RESPONSE ---------


N______,

I am glad you were able to get a hold of the other ladies who have had similar surgery.

I just got back from our international Scoliosis Research Society (SRS) Meeting in Salt Lake City, and several new papers were presented documenting marked improvements of quality of life with adult scoliosis surgery.  There was also one paper presented on flexibility postop after spinal fusion, but that paper was in adolescent scoliosis, and did not really address functional range of motion, but a couple of tests typically used by physical therapists to assess spinal flexion and side bending distances only.


ANSWER TO QUESTION #1: LOSING FLEXIBILITY WITH FUSION?
a. LIMITING FLEXIBILITY DURING HEALING PERIOD.   We do limit your extreme bending, lifting and twisting during the first 6 months to a year until your fusion is well healed to prevent hardware loosening or breakage.  However, once your fusion is healed, we allow you to return to all preoperative activities.  Surprisingly, however, most patients have no difficulty with their overall body range of motion, and activities of daily living regarding bending and flexibility.  There are several reasons why this is true.  
b. SPINE BENDS A LITTLE, HIPS BEND A LOT.  Your spine itself only bends a few degrees at each level. Most of your flexibility for bending occurs at the hip joints which are not affected by the surgery.  
c. YOUR SPINE IS PRETTY STIFF NOW.  Your spine already is even less flexible, or barely flexible due to the collapse and degeneration in the area that we are fixing, since your scoliosis has caused it to twist, and lose virtually all of it's bending ability.  
d. PAIN IS LIMITING YOUR FLEXIBILITY AND ACTIVITY.  The pain that is associated with the collapse and severe degeneration greatly limits functional range of motion, causing your muscles and brain working together to stop you from bending or twisting due to the pain.  Although your spine has a little motion left in the collapsed zone, your brain says "Don't bend that spine, 'cause it'll hurt", and causes muscles to stiffen to prevent worse pain from occurring.  When we can eliminate the bone from rubbing on the bone and hitting the nerves in between, the pain is greatly decreased or eliminated, allowing less pain and more FUNCTIONAL motion and activities of daily living.

So, in my experience over past 14 yrs of practice and thousands of scoliosis surgical cases, I have had only 2 patients who had some moderate complaints of difficulty reaching their bottom area after surgery.  These patients had very long torsos/trunks and wide buttock and who had horrible totally collapsed kyphotic thoracic and lumbar spines which I was able to correct, restoring excellent standing posture.  However, when I lengthened their torso back to it's proper length, they had some difficulty reaching down around their buttock area, because their arms were relatively too short to reach.  We were able to make some adaptations with occupational therapy so they could manage their own self-care.  Fortunately your curve type, severity and body habitus, I have not had any people have this problem.

QUESTION #2:  HIP PAIN.
A: You are absolutely correct.  Your hip pain is very likely referred pain coming from your pinched nerves (stenosis) going to that area of your body. This stenosis is being caused by the spinal collapse (scoliosis) and bone slipping over the bone (spondylolisthesis) and the buildup of thickened ligament and facet joints and disc which encroach on the nerves causing the lumbar spinal stenosis.  By opening up the central canal, and freeing up the nerve roots both centrally, and out the lateral recess and foramen on both sides, the pain going to the hip and leg is usually eliminated or significantly reduced.  It is important, however, to check a hip X-Ray, which we could see on your spine X-Ray, and show that your hip joint is ok.  I just saw a case last week where the pain was indeed caused by a worn out hip joint (osteoarthritis) of the hip.  This patient needed a hip replacement!

I hope this helps.
I'll look into the website access issue for you

Take care,
Dr. Hey



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Lloyd A. Hey, MD MS
http://www.heyclinic.com
Hey Clinic for Scoliosis and Spine Surgery
Raleigh, NC  USA
Member, Scoliosis Research Society (SRS) http://www.srs.org

Dr. John Hall awarded Lifetime Achievement Award, Scoliosis Research Society 2008. Many thanks Dr. Hall for your inspiration and training and example.

I have spent the past several days here in Salt Lake City, attending the annual Scoliosis Research Society (SRS) Meeting.
As always, the papers and posters were excellent, and the ability to interact with scoliosis surgeons from all over the world has been wonderful.

While the conference and interactions have been great, the best part of the trip has been seeing Dr. John Hall again.  Less than an hour ago, I got a chance to catch up for a few minutes with Dr. Hall after he was awarded the Lifetime Achievement Award here at SRS.  In Dr. Hall’s talk, he humbly shared how he has had a lifetime of learning from others and from clinical experience.  My heart was filled with thanksgiving for Dr. Hall, who has been one of my primary mentors and inspirations since I was a Junior Resident at Children’s Hospital, Boston at Harvard Medical School.  Dr. Hall inspired me and trained me in scoliosis surgery years ago, and also supported my academic career, supporting me to obtain a degree in Clinical Epidemiology, and encouraged me to use my engineering and computer skills to enhance clinical care of patients, and to also help conduct research and quality improvement.

I have, and still continue to try to inspire the next generation, passing on in some small way what I have received from great leaders like Dr. Hall, who received training and inspiration from the generation before, including Paul Harrington and many others.

Thanks, Dr. Hall for your inspiration and example of excellence.

Lloyd A. Hey, MD MS
http://www.heyclinic.com
Hey Clinic for Scoliosis and Spine Surgery
Raleigh, NC  USA

Encouraging note from West Virginia a few days after revision decompression surgery with excellent relief.

------ Forwarded Message
From: Pauline
Date: Wed, 10 Sep 2008 09:36:47 -0700 (PDT)
To: Lloyd Hey <>

Hi Dr. Hey,
  
Just a note to let you know we made a very uneventful trip home.  I was pretty tired but other than that I WAS WONDERFUL.  We wanted to tell you and Jacqi bye before we left but thought you were probably in surgery.  So, I chose to do it this way.
  
I can't thank you enough for being so kind to me when I kept telling you the pain was much worse.  Your kindness, patience, and encouragement was far beyond belief.  (I have never experienced this with any other M.D. who was in charge of caring for my back.)  Each time I contacted you by e-mail, phone, etc., you kept telling me you would stand by me in this.  I am sorry ... I know I was a royal pain and each time I contacted you, I thought "Dr. Hey is gonna get tired of hearing this time after time" but you WERE there for me.  You are a special person in addition to being a wonderful, competent, and persistent physician.  I know Monday was a long day for you.  I know you get tired, too.  I guess my husband and I are gonna have to bring you, your wife and children to WV for a week or two of rest!  Here in WV we could hide you and allow you to get some rest.  
  
I had to take a break from the computer because sitting is not on my list of things I can do comfortably.  Will see you on 10/23 for followup.  
  
PLEASE, TAKE CARE,
  
Pauline A.
  

------ End of Forwarded Message