"Minimally Invasive Scoliosis Surgery" -- Harnessing the body's ability to realign. Good news for 13 yo Regan with AIS

There has been a lot of buzz in recent years about the Minimally Invasive Spine Surgery (MISS), and in some cases minimally invasive scoliosis surgery, using small puncture incisions, XLIF's, slipping rods under the skin, and/or going anteriorly with tethering through the chest.

But many people have not heard much about the LEAST invasive scoliosis "surgery", which really isn't surgery at all, which is Schroth Physiotherapeutic Scoliosis-Specific Exercises (PSSE), and 3D CADCAM bracing, also known as Rigo-Cheneau Bracing.  Even I was not aware of these two techniques, that both emanated from Europe until about 3-4 years ago, which really has brought a transformation for the way we can manage scoliosis at Hey Clinic, especially in our new, much larger facility we moved into a year and a half ago on the Duke Raleigh Hospital campus at 3320 Wake Forest Road, Raleigh, NC, where we had the room to add physical therapy, and in-house brace measurement and construction, as well as put in an EOS X-Ray machine, and have a large open area for training and classes.

Yes, this has been a total "game changer" for us at Hey Clinic, and for now hundreds of our pediatric, adolescent, young adult, middle-aged adult, and older adult patients.

We had another example of a huge success in clinic this past Thursday with 14 yo Regan.
3 months ago, she got some very bad news... she had a 28.9 degree scoliosis.  We recommended Schroth physiotherapy.  She rolled her eyes. She was not psyched.  This whole thing was a complete downer.

But she was willing to give it a shot, encouraged by one of our Schroth Therapists, Mariah, that we have seen many successes.  She chose to do Schroth only for starters, and hold off on the 3D CADCAM Brace, to see what we could get.  Over the last 3 months, Regan has come to Hey Clinic once a week to learn how to do the PSSE exercises, and started doing them at home for about 20-25 minutes a day, 6 days a week.  She actually began to actually LIKE to do the exercises, and was faithful to do them.

Well, this past Thursday morning was the big reveal.....

Her mom and dad were there.....and the results were....29.5 degrees, down to 11.6 degrees.... 18 degree improvement in 3 months.  And less pain!

At that point, there was lots of "hootin' and hollerin'" and celebration with Regan and her parents and also with Mariah.  

Then there was time for a quick Team Win Photo

Then Regan shares her story to inspire other children and teens to consider Schroth PSSE

With Schroth and the 3D-CADCAM braces (when needed), we are seeing 90+ % success rates thus far with conservative management.  However, some curves still do progress despite our best efforts, but especially when we can inspire the compliance, the success rate is very high.  When the curves do get into the range where surgery could be considered, and when it is paid for by insurance, we also are happy to discuss that option as well so that the patient as well as the family completely understand and have the freedom to make their own personal choice.  About 60% of AIS scoliosis curves will progress during adulthood, so we do also always recommend lifetime follow-up.  

We do see many happy patients who chose the surgical route as well, especially for curves that are in the 40-50 degree range where scoliosis surgery may be considered, and over 50 degree range where it is usually strongly considered.  Curves under 40 are sometimes considered for surgery if there is ongoing pain/quality of life issues that do not respond to conservative therapy.  At Hey Clinic, we take a LOT of time to help our pediatric, adolescent and adult patients to fully understand your diagnoses, as well as your CHOICES, since it is YOUR BODY, and YOUR CHOICE... which will affect you for the rest of your life, since your spine is literally the very CORE of what has to hold you up!!

So for example, on Thursday we also saw Elizabeth, who was treated at age 12 for her scoliosis with Schroth and bracing, but unfortunately her curve progressed to 56 degrees, at which point her and her parents decided to have her scoliosis addressed surgically.  Bracing and Schroth compliance was a bit harder for her, which may have contributed to her curve progression.  She had her surgery a year ago, and recovered quickly, back to cheerleading, and now is taking up diving, and also showed me her new dress from Christmas which she is proud of, confident in her posture going into high school and beyond.  

So maybe it's time to take a trip to Hey Clinic, and get a second opinion for bracing, Schroth, and possibly very very "minimally invasive" scoliosis care that could bring joy to your family too!  

Congratulations Regan and Elizabeth!!! 

Lloyd A. Hey, MD MS

http://www.heyclinic.com

Leah's Thankfulness Tree: for those who give a more positive outlook to overcome scoliosis....

It was a beautiful sunny fall afternoon in our Hey Clinic Great Room today when I bumped into Andrea, one of my scoliosis moms.  She had to show me something her daughter Leah made this week in school for Thanksgiving.  She showed me the "Tbankfulness Tree" Leah made, and a long list of things she is thankful for.  Take a look -- I'm the brown leaf toward the middle of the tree!  How cool!  I asked if it would be OK to share these thankgivings with all of you, and Andrea replied:

"Absolutely you can share it! Leah thinks the world of you and your talks with her have helped her immensely! Thank you for educating us and for your wonderful encouragement! We will see you on December 5th!  Happy Thanksgiving "

Andrea pointed out that "Dr. Hey" actually made it onto the Thankfulness Tree, and in her list of thanksgivings explained why:




"... because he has helped me to have a more positive outlook on my scoliosis and to not give up on my ability to overcome scoliosis."

Leah also shared that she was thankful for scoliosis:
"because though it has hindered me greatly, it has taught me a dedication to physical therapy and helps me appreciate things I wouldn't normally appreciate." 

Wow.  I can look back to my own teenage experiences as a patient and say "Amen", although it took me longer to figure that out than Leah!

Having a thankful spirit has been shown to be the key to resilience, which is why Remembering "Three Good Things" every day is one of the best suggested cures for burnout.  There are definitely things that my physician assistants, physical therapists, orthotists, MA's and other staff do to really help patients and families through this difficult journey, and actually grow and thrive.  There is much more going on here than a cobb angle or trunk shift changing -- there is a little precious person becoming a big person, with a growing foundation of compassion, strength and hope and confidence!

Strong work Leah for facing your scoliosis with courage, and thriving through it!  I am thankful for you and your family, and the many other patients and families who bring life and light to our lives at Hey Clinic every day.

Happy Thanksgiving from all of us at Hey Clinic for Scoliosis and Spine Care.
--- Lloyd A. Hey, MD MS

Precious Layla's twelve year scoliosis and life journey from AIS surgery... to Physician Assistant Student ... and beautiful bride!

Last Friday, I had an incredible reunion with one of my former scoliosis patients - Layla - who is now a physician assistant student at Campbell!  I went there last Friday to do a lecture on the importance of compassion as the driving force for resilience through medical training and years of care for others, and also how compassion is the driving force for quality and safety and lean improvement.  Several of my medical student mentorees from this past summer's Better Samaritan Institute summer program were there as well as I shared personal stories from my own journey from being a patient, to becoming a surgeon and an influencer for driving change to improve safety, and effectiveness of care.  I also got a chance to help them launch our first CareGuard.org "Outpost" at Campbell, which med student Gabriel is leading.

Below is a quick summary of Layla's history that she emailed me after we met up again.... what a great joy to hear about her recent wedding, and how our paths got to cross again.  So proud of you Layla!!  Hope to see you again for a lecture gathering again soon.... Dr. Lloyd Hey - Hey Clinic for Scoliosis and Spine Care

LAYLA'S JOURNEY:  

You performed by scoliosis fusion on Monday, December 17, 2007.  I remember being so brave for my parents and siblings, but I began to cry when they wheeled me back to the OR. You and Jacklyn, one of your PAs at the time, bent down next to me and prayed with me before the procedure.  It is something I will never forget.

It was my sophomore year (2013) at NCSU when I started shadowing in your clinic and in the OR, and serving as a surgery mentor for adolescent patients needing instrumentation.

My junior year (2014) was when I completed my undergraduate research project with you. It was studying 1000 cases of idiopathic scoliosis in 4 distinct age groups, comparing the patients that needed instrumentation, and comparing their pre-op X-rays and their 6-week post-op X-rays.  We determined what age group exhibited the best curvature corrections and concluded that it is best to receive surgery at a younger age for better/optimal surgical results.

In 2017, I reached out and you submitted a letter of recommendation for my first year applying to PA programs.

In 2018 I was accepted to Campbell and committed to start with the 2019 school year.

Our paths crossed again this past Friday, and I have to say it was a breath of fresh air. 

Your outlook on medicine and patient care inspired all of my classmates.  We will be spreading the news about CareGuard and the shadowing/internship opportunities you offer.  

Thank you for helping in shaping me into the woman, person, and provider I am today.  Thank you for the reminder to continue to love all of God's children unconditionally and show them compassion.

With love and admiration,

-Layla

15 yo Rachel from Tennessee had 40 degree progression of her AIS over a couple years, then surgery this week with 90 degree curve

Rachel is a wonderful 15 yo young lady from Tennessee diagnosed with scoliosis just a couple of years ago with a curve in the upper 40's, possibly low 50's.  She then had follow-up X-Rays just recently when experiencing increased pain, and her curves had jumped up to around 90 degrees x2.

Her family made the long drive from Tennessee to Raleigh this Saturday just ahead of the huge snowstorm that crashed in on us here in the Triangle, dumping 10 inches on Sunday, and another 3 inches on Monday!   They stayed at the hotel across the street from Duke Raleigh Hospital, and luckily I was able to make it in early Monday morning to do her surgery.

She did very well during her nearly 5 hour surgery using our special electronic checklist quality and safety control system that has over 400 safety checks that enables our team to work seamlessly together.  We were able to get a very nice correction safely, and she woke up smoothly, nice and warm, using some new warming techniques that worked like a charm.

Rachel bounced back quickly from surgery, and stood up next to her "big" (older) sister postop day 1, and realized that her bigger sister was now shorter!!! Rachel had gained about 3 inches in one day!

Rachel advanced quickly on her diet and walking program, and felt ready to make the drive back to Tennessee this morning after being cleared by physical and occupational therapy today climbing stairs and getting into and out of a test car in they physical therapy room at Duke Raleigh Hospital.  Rachel and her family stopped by our Hey Clinic office right next to hospital after discharge, got her ultra-low radiation ultra-HD EOS X-Ray in our office, and wanted a quick photo together before driving the 8 hours home through the mountains.

 

She also took a minute to give thanks to all of the kind nurses, scrub techs, implant reps, neuromonitoring techs, CRNA's, SRNA's, anesthesiologists, nursing aids, Hey Clinic PA's and support staff who helped make her dream come true.

Meanwhile, Rachel won over the hearts of ALL of the Duke Raleigh nursing and other staff who worked with her, as Rachel shared thankgivings to everyone with kind words, but also hand-written thank you notes and drawings!!

Get well soon Rachel, and thanks for brightening up all of our lives here.... you brought a smile to many caregivers!!! 

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

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