Here is a "Hey Clinic Puzzler" for you.
Is it possible to fix a scoliosis and/or kyphosis with only a 1 inch minimally invasive incision?

Your answer is tucked into the story below.

I just got a nice follow-up note from the mom of one of my recent surgery patients, named Taylor, who is from Kodak, Tennessee, about 343 miles drive from Hey Clinic. (5 hrs 35 minutes according to Google Map!)

Taylor was referred to me from a physical therapist in Tennessee.
He was lifting around 350 pounds doing squats about 15 weeks ago, when he had sudden pain going down both legs, and in his back, and found that he could not stand up straight.

He had seen doctors locally, and had some conservative treatment, but was told nothing more could be done.

I saw him a couple weeks ago, and found that he had a herniated disc with possibly a small endplate fracture at L45.  He stood with a severe scoliotic and kyphotic posture as shown in the photos above.  He could barely stand or walk.

My staff changed around my OR schedule for that week so I could fix his herniated disc and stenosis within 48 hours of our visit.  Interestingly enough, I fixed two other adolescents with scoliosis that same day — the others had idiopathic scoliosis, which required the usual segmental spinal instrumentation with the several inch incision.  Taylor’s was fixed with less than a one inch incision.

When I explored Taylor’s L45 disc space, I found that he had actually not only herniated the disc, but had fractured off a piece of his growth plate, which is just below the disc.  This also contributed to his nerve pinch, and I trimmed this back as well.  His surgery took about an hour. Blood loss was minimal.

Taylor is shown in the pictures above standing up straight just the day after surgery, when he was able to drive back to Tennessee.

Her mom emailed me today the message below.  He is doing well.

So, the answer to the Hey Clinic Puzzler is "Yes – you can fix a spinal deformity sometimes with less than a one inch incision, if it is being caused by a pinched nerve, or disc herniation.  The person will then lean away from the pain, causing the spinal deformity.  Once the pinch and pain is relieved, they can stand up straight again.

The other thing we can learn from this is that weight lifters should be very cautious about lifting extremely heavy weights, with squats or dead lifts.  These lifting maneuvers, due to the biomechanics of the spine can put over a 1,000 pounds of force on the lower lumbar discs, potentially causing disc rupture, herniation, facet injury, pars fractures, and/or end-plate growth plate fractures.  

Fortunately, Taylor should do very well, but for his other similar lifting "buddies" out there, please remember that an ounce of prevention is worth a pound of cure.  Bench press is fine, but avoid extreme lifting with squats and dead lifts to help preserve your low back.

Here is Taylor’s mom’s email she just sent, giving her update.  

—— Forwarded Message
From: <cw…..net>
Date: Fri, 18 Jul 2008 16:18:59 +0000
To: <Dr. Hey>
Subject: Taylor ________ Surgery On 7-10-08

Dr. Hey,

You did surgery on my son Taylor __________ on 7-10-08.  Just to refresh you memory, he is 15 and had a injury from weight lifting for football. we are from Tennessee.

I just wanted to drop you a line to let you know how well he is doing and express how grateful we are to you for helping him.   He is walking completely straight and does not have any leg pain at all.  After 13 weeks of pain, he seems like a different person.  I actually have my son back and he is happy!!  

 
I can not put into words how to thank you.  All I can say is that God put you on this earth for a special reason.   Your compassion and your ability for helping others is a gift that your share.  To see a doctor ask God to guide his hands before surgery and to thank God for doing so after surgery is an amazing witness.   

You had mention that you were going to post something on your blog about this.  When you get time to do this could you please let me know where to find the blog.  His physical therapist wants to also read about it and keep it for future reference for his patients.   

God Bless You and Thank you so much!!    

Carl, Debbie and Taylor

—— End of Forwarded Message

——————————
LLOYD A HEY, MD MS
HEY CLINIC FOR SCOLIOSIS AND SPINE SURGERY
RALEIGH, NC  USA
HTTP://WWW.HEYCLINIC.COM

Taylor and his parents gave their permission to share this story and photos on the Blog.

—— End of Forwarded Message

—— End of Forwarded Message