Dr. Hey does another hyper-correction

[Pooka1]

Damn.

http://drlloydhey.blogspot.com/2016/...ely-after.html

[rohrer01]

I see that. I don't understand the reasoning for that as it caused a slight cervical as well as lumbar curve...???

The girl isn't going to "grow" into the fusion so that it straightens. once fused, it's done. She'll always have to live with the consequences of that cervical and lumbar curve. They may appear slight now, but as she ages all I see is trouble. Maybe he just got a little carried away or has another theory. I could see doing a hypercorrection with tethering or VBS, but no fusion. As a parent, I would be upset unless he could give me a good reason for doing that.

[Pooka1]

The post-fusion cervical and lumbar look straighter to me than the pre-fusion curves.

As Boachie claims, the straighter you can drive the unfused areas, the more "one-stop" the surgery will be. The full quote concerned a T fusion that stops at T12 or L1 and leaves the lumbar aligned is likely to never need extending into the lumbar at least. He didn't address the neck.

Because the lumbar and neck are straighter, she will presumably have less problems down the line. That is my understanding to the point of hyper-correction. Our surgeon told me daughter she was one-stop for surgery presumably because she was hyper-corrected.

[rohrer01]

My point is that slight neck curves do hurt. You have more neck-aches after activities, etc. The lumbar curves take the brunt, I agree. However, If he hadn't hyper-corrected she could have ended up with NO lateral lumbar curve at all. Then, as DDD sets in as it does in all of us, she wouldn't be battling the unevenness of those vertebrae along with DDD. With DDD those discs get pushed around more easily causing the inevitable nerve pinching. I just think with NO curve, nerve pinching with DDD would be less.

My DDD is causing a lumbar curve and I started with none as you can see in my x-rays. I still need to post my most recent ones so people can see. It's not scoliosis, yet, as it's only 6^o and I only have DDD in one disc as far as I know. But when it hits the "magical" 10^o, I'll have a triple curve. Not that this is necessarily relevant to this girl, but it is somehow. It's just my lay opinion that it will speed up the DDD or make her more susceptible to bulging discs if she ever has a lumbar injury like I had when I was only 29. My injury caused a bulging disc that never healed properly and was weakened. If that ever happened to someone with any lumbar curve, I would think the disc would always tend to want to bulge since the vertebral bodies aren't sitting properly aligned above and below the disc.

[Pooka1]

My point is that slight neck curves do hurt. You have more neck-aches after activities, etc.

But the neck curve appears to have been reduced compared to before. So she will have less chance of neck pain with the fusion, yes?

The lumbar curves take the brunt, I agree. However, If he hadn't hyper-corrected she could have ended up with NO lateral lumbar curve at all.

I think she would have had a bigger lumbar curve absent correction. The lumbar curve, if not structural, will come to match the now-fused thorax. The straighter you get the thorax, the straighter will be the lumbar. Her lumbar is much straighter because of this and per Boachie, she may never need any more surgery because her discs are close to normal even loading. If he didn't hyper-correct her, her lumbar would not be as aligned as it is now and she might have disc problems later in life.

Then, as DDD sets in as it does in all of us, she wouldn't be battling the unevenness of those vertebrae along with DDD. With DDD those discs get pushed around more easily causing the inevitable nerve pinching. I just think with NO curve, nerve pinching with DDD would be less.

The smallest lumbar is achieved by hyper-correcting the thorax as far as I know. The lumbar will come to match the thorax to balance. The hyper-correction is driving the most straightness possible in her lumbar without fusing it.

My DDD is causing a lumbar curve and I started with none as you can see in my x-rays. I still need to post my most recent ones so people can see. It's not scoliosis, yet, as it's only 6^o and I only have DDD in one disc as far as I know. But when it hits the "magical" 10^o, I'll have a triple curve. Not that this is necessarily relevant to this girl, but it is somehow. It's just my lay opinion that it will speed up the DDD.

Per Boachie, the straighter the lumbar the less chance of disc damage. Hyper-correction has driven the most straightness possible in her lumbar as far as I can tell. This is her best chance of avoiding disc damage.

My hyper-corrected daughter has a straighter lumbar than her sister who was not hyper-corrected. I predict her sister will develop more disc problems in her lumbar than the hyper-corrected kid because there is a bigger curve remaining there. The hyper-corrected kid has a pretty straight lumbar as does Hey's patient.

[rohrer01]

I took another look at this girl's x-rays just to make sure that I was correct in what I saw.

Yes, I totally agree that she's better off with regard to neck and lumbar pain after fusion than before. But what I'm seeing is that he's driven the neck curvature and the lumbar curvature in the opposite direction of where they were. So in essence, she still has cervical and lumbar curves (though the lumbar is pretty darn small). It just looks to me as though if he would have stopped before hyper-correcting her she would have been left with NO cervical or lumbar curves at all. That's my point.

I don't know what will happen with the lumbar as she continues to grow or build core muscles. I do know that even small curves in the upper thoracic (T1/2) to cervical vertebrae cause premature neck fatigue and trapezius build-up which can lead to pain and headaches. My DIL was left with an upper curve about that size and she suffers from similar symptoms. My DIL has a straight lumbar and nine years post-op she suffers from lower back pain with no diagnosis of degeneration. My only guess is that the weight of her instrumentation (they used stainless steel and the one little piece they gave her is HEAVY) along with the lack of flexibility in the thoracic spine. So if she had a lumbar curvature I could only imagine that it would be way worse.

But yes, Dr. Hey's patient is better off with the surgery than without and so is my DIL even though she had a subpar surgeon. I still contend she would be better off without the unnecessary residual curves.

[Pooka1]

The before and after are shot from different aspects, one is from the front and one is from the back.

Given that, I think both her neck and her lumbar are much straighter but rather than have a curve they are leaning slightly in a direction opposite the original curves.

Hard to say.

[rohrer01]

Time will tell. She is obviously active. I know he likes to show kids like her so other's aren't afraid that the surgery will severely limit them. I think that is one of the biggest fears that back patients have. TiEd helps people by showing his videos, too. It's good to alleviate anxiety from those fears. I'm just not sold on overcorrection. The long-term effects of overcorrection have yet to be seen.

My DIL was told after surgery not to twist and bend, which is normal protocol. They failed to tell her that this was NOT a lifetime restriction. She was a little over six years post-op and seeing another doctor for a follow-up (she only had ONE six month follow-up from her surgeon!) when she found out that her "limitations" were only during the post-op period and not forever. It really angered me how she was treated. So kudos to Dr. Hey for being honest about restrictions so these kids, or adults for that matter, don't remain scared that they are going to ruin their fusions if they move wrong.

[Pooka1]

There is at least one paper critical of hyper-correction. If I recall correctly, I think it was the issue of expense of the extra hardware needed to achieve it. I think I read there is also slightly more risk but I am not sure.

I guess I would like to see the surgeons who were critical of hyper-correction address Boachie's claim that the straighter you can drive the lumbar, the less chance of ever needing n extension. Our surgeon is clearly in this camp with the one kid who he would hyper-correct. He said straight up (no pun intended!) she will not need more surgery. That may have been cavalier but he said it.

He did not say that about the other kid who has a~25 degree lumbar curve because if he hyper-corrected her, she would have a high left shoulder. So he went for balance but maybe at the expense of needing an extension into her lumbar later in life. So maybe the choice was obviously unbalanced shoulders or losing her lumber. Life is very unfair.

[rohrer01]

Yes,
Life is unfair! I just saw too much in the lumbar. I totally agree, and that was my initial point, that you want a straight lumbar. Maybe that was the best Dr. Hey could do to get as close to straight as he could. Not arguing leaving a crooked lumbar at all. We're definitely on the same page there. I just saw some curvature in her lumbar in the opposite direction. That's what spurred my initial reaction. It is a very small curve. I just thought he would have stopped before he curved it in the opposite direction even a little bit. Maybe the x-ray on the table looked different than the standing x-ray. She could have a slight LLD that wouldn't have shown up on the operating table. He seems to be an excellent surgeon.

It seems that NC has a lot of world class surgeons. I've travelled to NC for surgery before. My Dr. was world renowned, literally. Of course it was out-of-pocket, something I can't afford with back surgery.