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View Full Version : Dr. Hey standing on his head again



Pooka1
06-05-2012, 06:15 AM
This time to stop a fusion at L4 instead of immediately to pelvis on a 16 year old girl. Hopefully he bought her many, many years.

http://drlloydhey.blogspot.com/2012/06/16-yo-holly-straightened-up-this.html


16 yo Holly straightened up this morning with her severe trunk shift and lumbar scoliosis

Holly had a collapsing adolescent idiopathic scoliosis, lumbar Lenke 5C. We had to do extensive preoperative planning due to the degree of her trunk shift and some concerns about an oblique takeoff at the pelvis. Preoperative CT scan as well as bending X-Rays and in-surgery prone view with manual pressure to fully evaluate the lumbo-sacral junction was very helpful to confirm that we could safely preserve her bottom two discs, rather than having to fuse to the iliac wings.

Extra care was also taken to help with her trunk shift with fine adjustments to our correction while doing rod insertion. Some Smith-Peterson osteotomies also helped to improve her correction and ensure proper lordosis.

I think she will be very happy with her new posture!
Estimated Blood Loss was only 75 cc. No blood transfused.
Surgical time 2.5 hours, with fusion levels T11-L4.

I would like to know if these heroic measures to save lumbar levels in kids are working and if so why other surgeons might not be doing them.

lisazena
06-05-2012, 09:59 AM
Sharon,
You've cited it before (and this isn't the essence of what Dr. Hey's post is about), but since I have a significant trunk shift I'm wondering about the implications of trunk shift in scoliosis. Thanks.
Lisa

Pooka1
06-05-2012, 07:52 PM
Lisa,

Obviously I am not the person to ask about the implications of anything in scoliosis. :-)

All I can do is repeat what I have seen written. Specifically, Dr. Hey seems to think trunk shift can account for pain even in small curves.

Also, per this blog entry and per other things I have read, certain curves require certain corrective maneuvers to avoid a post op trunk shift. I don't know the specifics.

rohrer01
06-05-2012, 10:03 PM
My opinion is that it is a trade off. The person either gets years of flexibility, thus more active young adulthood, with probable future revision vs. surgery hopefully only once in the person's life. Of course, there are no guarantees either way. I think it's a hard call.

Pooka1
06-06-2012, 05:44 AM
My opinion is that it is a trade off. The person either gets years of flexibility, thus more active young adulthood, with probable future revision vs. surgery hopefully only once in the person's life. Of course, there are no guarantees either way. I think it's a hard call.

It doesn't seem like a hard call for many surgeons who are loathe to fuse too low in kids. Per testimonials, there are any number of kids with frank lumbers (to my eye!) that have their fusion stopped at L3 almost per se. It's more than a coincidence that all these fusions just happen to be able to end at L3.

So they seem to value the flexibility plus future surgery higher than the one-stop surgery in kids. The opposite appears obviously true for most adults, again per the testimonials.

rohrer01
06-08-2012, 11:42 PM
I just think of the one mom who left the forum because she misunderstood people's advice to get a second opinion to see if some of the lumbar could be spared. She thought people were telling her to try bracing. I don't know where she could have even thought that. But that was one obvious case of not trying to spare the lumbar. I think it would be a hard call for me if it were my kid. Stopping at L3 wouldn't be hard, but if they wanted to go to L4 or L5 instead of to pelvis I might have a harder time with that decision. Granted, growth left would play a HUGE role in my decision. For girls, at least, the pelvis continues to widen even after such said growth spurt is over. I would wonder what role that would play in childbearing later on if the pelvis were fused very young. Would it guarantee them c-sections? I just think there's more to this than any of us realize. I think Dr. Hey appears to be an outstanding surgeon that is on top of the game as far as keeping up with the latest trends. I think some other docs are afraid of changing their comfort zones where most of their experience lies.

mariaf
06-09-2012, 02:19 AM
I think some other docs are afraid of changing their comfort zones where most of their experience lies.

In addition to probably being true with regard to the issue here (i.e., which levels to fuse), it also seems to be true in general about some doctors. They don't seem willing to leave that comfort zone where the majority of their experience lies.

Lorraine 1966
06-09-2012, 02:49 AM
It has not made any difference to me as the years after my fusion continued that the last couple were left as I cannot bend at the waist anyway and only bend from the hips. In fact I honestly wish I had been fused to the pelvis as the discs they left are now diseased anyway..

Lorraine

Pooka1
06-09-2012, 08:10 AM
It has not made any difference to me as the years after my fusion continued that the last couple were left as I cannot bend at the waist anyway and only bend from the hips. In fact I honestly wish I had been fused to the pelvis as the discs they left are now diseased anyway..

Lorraine

That's a valuable observation, Lorraine.

But I think you had more flexibility during some of those years than people who are fused to pelvis. Ti Ed posted some range of motions and I think the L4-L5 was 25*. That would be noticeably different from a ROM of 0* I would think but of course I don't know that.

Lorraine 1966
06-10-2012, 08:05 PM
I think you are right dear, I so enjoy your posts, lovely to see you answer.


All the best

Lorraine