Today, I spent 8 hours straightening up 62 yo Roberta, who had developed a severe kyphosis with severe lumbar flat back syndrome, and thoracic kyphosis which all added up to her being totally hunched over, barely able to walk, and looking down at the floor with severe pain.
Before surgery, she got a thorough preoperative assessment performed, including a cardiac stress test to help ensure that she was able to get through such a big operation.
We also spent quite a bit of time going over the surgery in detail, along with conservative treatment options which she had failed, and reviewed the benefits and risks of the surgery w/ her.
To fix this problem, I first did anterior discectomies at L45 and L5S1, working with Dr. Chris Watters, an excellent general surgeon who works with me a lot.
Chris and I got down to these lower, completely flattened discs, and then I was able to remove them, and gradually jack them open, back to the height they were many years before.
I then replaced the discs with special titanium hollow ALIF interbody spacers packed with bone graft. These spacers, or “cages” hold that space open, and begin to help restore the lumbar lordosis.
I then fasten some hardware anteriorly to ensure that the cages do not migrate out anteriorly.
The anterior incision is then closed.
The patient is then turned to a prone position on the OR table, and prepped and draped again.
I then did a T3-Iliac Wing instrumentation and fusion with titanium pedicle screws and titanium alloy rods.
I did a 5 level laminectomy to relieve the severe lumbar spinal stenosis she had at several levels.
I then did 5 lumbar osteotomies, removing wedges of bone posteriorly (Smith-Peterson Osteotomies), to help allow me to fold the lumbar spine back into proper lordosis so she could stand up straight.
I then put in the bone graft, and a couple cross-links, and then checked X-rays from AP and lateral directions which showed that her posture was restored.
Since I can’t get the whole lateral spine on an X-Ray on OR table, I took lateral photo from head down to buttock which shows how her big “C” shaped spine is now a gentle, normal “S” shape.
We did her surgery in our high-tech laminar flow room, with my excellent experienced OR team, who has helped me do hundreds of these complex cases before. Jaclyn was my awesome physician assistant PA.
Teamwork and experience really pays off to get these complex surgeries done effectively and efficiently so we can minimize the perioperative risk, which goes up with surgical time.
Her surgery took right around 8 hours, and she was extubated after surgery, and will spend the night in the ICU.
Her family was very thankful for this “total body reconstruction” which will allow Roberta to get back to a much better, and straighter quality of life.
After 8 hours of surgery for her today (2 hours for anterior, and 5 hours posterior, 1 hr turning and re-prepping and draping), I was very glad to sit down with the family and go over her X-Rays and new overall shape photo.
If Roberta had come to me a few years earlier, I might have been able to fix this without having to go front and back, which would have made the surgery less invasive.
Many of the patients I see for second opinion, including Connie, who consulted me from Los Angeles, have been told that they HAVE to have an anterior/posterior approach for their scoliosis or kyphosis reconstruction. In Connie’s case, since she was well-balanced especially in the sagital plane (no severe flat back), I was able to offer her a less invasive approach, going posterior only, and putting in the bottom cage through a transforaminal (TLIF) approach.
When anterior/posterior surgery is strongly indicated, it can often be performed all on the same day as we did today for Roberta, as opposed to doing it on 2 separate days, separated by a week or 2 in the hospital on bed rest.
Roberta should do very well, even though she definitely needed the anterior/posterior (A/P) approach.
She will probably stand up about 4-6 inches taller tomorrow, with her face looking straight ahead at the world, as opposed to down at the floor.
One of the happiest moments for me and my staff and the physical therapists , occupational therapists and nurses is to see the smile of these patients when they get to stand up for the first time and they can actually stand up straight!
Their smile tells the whole story.
It’s worth the sweat to get there!
Despite the long day in the operating room, I was able to catch the second half of my daughter’s volleyball team. What a joy it was to watch her play, and captain her team to victory, with a tight match right down to the last couple points.
My staff at Hey Clinic work hard to allow me to get to family events during the week, when possible to watch the kids play sports, etc.
Now it’s time to rest up. It’s been a great day. But tomorrow is another big day.
We will be helping an 18 yo young man with a really big thoracolumbar scoliosis who is already 6 ft 4 in tall, followed by another 3-level decompression and fusion at the end of the day.
Lloyd A. Hey, MD MS
https://www.heyclinic.com
Hey Clinic for Scoliosis and Spine Surgery
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