This morning I had the pleasure of teaching at Grand Rounds for the WakeMed Obstetrics and Gynecology (OB-GYN) service, including faculty, residents and medical students from UNC.
I started off the lecture sharing a recent email I received from a 50 yo woman who I did scoliosis corrective surgery for in past couple of years. She shared how tough her scoliosis was on her self-esteem, and how embarrassing it was to try to talk about it with her OB/GYN, or primary care doctor. It was easier to just not bring it up, since the doctors never brought it up.
I gave an overview of spine biomechanics, including explaining how loads over 290 pounds can be created across the L5S1 disc just lifting small objects slightly in front of you. We also reviewed Five healthy habits for spine health, including the importance of checking and following up on potential spinal deformities. We talked a bit about how the mis-alignment of scoliosis can result in premature wear on the lower discs, due to asymmetric loading A couple of the slides are attached.
It is important to note that several articles have documented the continued progression of scoliosis and kyphosis curves during adulthood. It is estimated that 25 percent of patients with scoliosis by end of skeletal maturity will progress during adulthood. In Betz’ 1987 JBJS article, he recommends that adults less than 25 yrs w/ scoliosis should have a scoliosis evaluation every 2 years, and every 5 years after age 25. We will often follow the adolescents every 3-6 months, depending on curve size and growth remaining, and follow the 16-25 yo once a year if curve is bigger. Betz also recommended getting evaluate immediately after each pregnancy, minimizing the chance of exposing fetus to X Ray. It is helpful if these X-Rays can be stored digitally, measured by same observer to minimize error, and kept for decades, since curves are often very slowly progressing.
We talked about the effect of scoliosis and kyphosis in several key areas:
- Self-image and appearance. Often the first big effect of spinal deformities.
- Back Pain
- Curve Progression during adulthood
- Late pulmonary and cardiac effects, especially in those with severe hypokyphosis, or severely narrowed chest wall.
We had an enthusiastic group of residents who eagerly wanted to try out the scoliometer on each other, which is a great tool for pediatricians, OB/GYN’s and others to use to screen for scoliosis. The residents and medical students were all measuring each other at the end of the lecture, and going over their quiz answers. Strong work!!!
Ever since I was at MIT, I have always enjoyed teaching, and inspiring the next generation. The most important place we teach is inside the Hey Clinic and over at the Hospital with our patients and families. We always find our patients and families eager to learn more about their spinal conditions, and to then better understand their treatment options.
Lloyd A. Hey, MD MS
https://www.heyclinic.com
Hey Clinic for Scoliosis and Spine Surgery
Raleigh, NC USA
