A few weeks back I had a Blog entry regarding Zachary, a wonderful 9 yo boy, who was the victim of “Shaken Baby Syndrome” as an infant, with severe brain injury and subsequent severe motor and other deficits.
He had a couple of thoracic fractures at that time, and has developed a huge kyphoscoliosis to the point where he cannot sit in his wheelchair, and is experiencing significant pain, and cannot be braced.
Today, we did posterior reconstructive surgery using pediatric pedicle screw instrumentation from T1-L3.
Zachary did just great. Estimated total blood loss was 400 cc. He received one pint of blood, and 123 cc of cell saver and had a postoperative hemoglobin of 12.
His curve was very stiff, not correcting significantly when he was prone.
Extra care was needed to position him, given his severe kyphosis.
I performed 4 posterior thoracic osteotomies to try to free up the spinal mobility to aid in the correction of the deformity.
The spinal correction was performed in a step-wise fashion, starting at the top and then working my way down the spine, attaching the rods to the screws on each side, while gently pressing down on the rods like a lever.
Intra-operative radiograph as well as postoperative physical examination shows excellent correction of his kyphoscoliosis.
Zachary was extubated immediately after surgery, and is doing well tonight in the WakeMed Pediatric Intensive Care Unit (PICU)
Many thanks to the wonderful team who helped out today in OR 9 at WakeMed Raleigh, which included: Katherine who assisted me as FNA, Yan Yan and Sheila as scrub techs, Vondella and Angela who helped out as nurse circulators, Martin and Melissa who were our CRNA and SRNA, and Dr. Jeremy who was our anesthesiologist.
Lloyd A. Hey, MD MS
http://www.heyclinic.com
Hey Clinic for Scoliosis and Spine Surgery
Raleigh, NC USA
Carolyn is a delightful 64 yo woman from Georgia who had an L3-S1 posterior instrumentation and fusion performed elsewhere, who suffers with flat back syndrome, with low back pain and trouble walking.
Her X-Rays and CT scan suggest possible pseudarthrosis at the L5S1 level, where she also has an anterior spondylolisthesis. Her lumbar lordosis preop measures 40 degrees.
This past Thursday, we performed an anterior L5S1 disc removal and fusion using an “ALIF” interbody titanium spacer, followed by a posterior removal of old instrumentation with removal of old hardware, and revision L2-S1-Iliac wing instrumentation and fusion with decompressive laminectomies at L2 and L5 where she had stenosis. Her S1 sacral screws were both very loose, and were removed and replaced, along with the remaining hardware. I performed a posterior osteotomy at L2 and L5 to help improve lordosis as well as the placement of the anterior cage at L5S1 which helped to “jack up” that disc level anteriorly.
Her surgery went very smoothly, and was all completed on one day, but in two stages, with the anterior procedure performed first. Total surgical time was approximately 5 hours.
Intra-operative radiographs showed her lumbar lordosis improved to 58 degrees, from 40 degrees preop, and you could actually see a noticable improvement in her lower back contour at the end of surgery.
Postoperatively, she has done very well, and stood up for first time yesterday, and stood up perfectly straight!
Her preoperative posture problem was really the result of the “toggling” of screws at S1, causing pain which caused her to pitch forward, on top of a fairly low fixed lumbar lordosis as well, and the spinal stenosis that also causes people to want to pitch forward away from the nerve pinch.
All three of these issues were addressed with our reconstructive surgery.
She will spend the weekend with us at Duke Raleigh Hospital getting physical and occupational therapy twice a day, while her very supportive husband gets to stay with her in the large “suite” rooms, which have 2 full beds for patient, as well as family member. She will likely get discharged Monday, and possibly stay around in Raleigh for a couple days before heading home to Georgia.
Correcting flat back syndrome is one of the most rewarding things we do with Hey Clinic. Allowing someone to stand up straight again not only affects their appearance and self-image, but has a great effect on quality of life in terms of standing and walking distance, pain, and endurance. Pain can sometimes even be caused up in the neck region with flat back syndrome, since the neck has to hyperextend in order for person to look where they are going, which strains the neck, aggravating existing neck arthritis and neural impingement.
Lloyd A. Hey, MD MS
Hey Clinic for Scoliosis and Spine Surgery
http://www.heyclinic.com
