At Hey Clinic, we treat the following conditions in all ages (pediatric and adult):

• Scoliosis
• Kyphosis
• Spondylolisthesis, Spondylolysis (Stress fracture)
• Spinal Stenosis
• Cervical and thoracic disc herniations
• Non-emergent spine fractures

Scoliosis can be classified as idiopathic, congenital or neuromuscular. Idiopathic scoliosis is the diagnosis when all other causes are excluded and comprises about 80 percent of all cases. Adolescent idiopathic scoliosis is the most common type of scoliosis and is usually diagnosed during puberty (according to the American Association of Neurological Surgeons).

Scoliosis affects 2-3 percent of the population, or an estimated six to nine million people in the United States. Scoliosis can develop in infancy or early childhood. However, the primary age of onset for scoliosis is 10-15 years old, occurring equally among both genders. Females are eight times more likely to progress to a curve magnitude that requires treatment. (-National Scoliosis Foundation, June 2007.)

According to the U.S. Preventive Services Task Force (USPSTF), annual scoliosis screening is recommended in children and adolescents ages 10-18.

Scoliosis curve progression occurs most often at the onset of puberty, where progression can be rapid if not caught early. This is why early detection is so critical. Knowledge is key!

Anyone can screen someone for scoliosis! Have the person of interest bend forward so that the spine is parallel to the floor, making it easier to visibly perceive any unevenness. A scoliometer may be used to measure the specific angle of trunk rotation during the forward-bend test, or you may even use several available apps on your cell phone! A trunk rotation angle of more than 5 degrees indicates the need to schedule an appointment with a scoliosis specialist for further evaluation, have x-rays taken if necessary, and determine an appropriate course of action, whether it be observation, conservative treatment options, or surgery.

Scoliosis screening is a simple, non-invasive process where the person bends forward at the waist with palms together and the evaluator stands behind (The Adams Bend test). A scoliometer may also be used for a specific angle of trunk rotation. Any abnormalities in curvature can be noted and the person can then schedule an appointment with a scoliosis specialist to further evaluate, have X-rays taken if necessary, and determine an appropriate course of action, whether it be observation, conservative treatment options, or surgery.

In addition to screening with the Adams Bend Test, there are several other signs that may indicate the possibility of scoliosis. If one or more of the following signs is noticed, schedule an appointment with a doctor.

• Shoulders are uneven – one or both shoulder blades may stick out
• Head is not centered directly above the trunk or pelvis
• One or both hips are raised or unusually high
• Rib cages are at different heights
• Waist is uneven
• The appearance or texture of the skin overlying the spine changes (dimples, hairy patches, stretch marks, color abnormalities)
• The entire body leans to one side

The size of your child’s curve when diagnosed will determine our recommended course of action:

• 10-20 degree curves: Observation is suggested. Schroth Physical Therapy may be prescribed depending on the child’s age.
• 20-30 degree curves: Bracing is recommended to prevent curve progression and optimally reduce the curves. Maintaining or reducing curves to below 30 degrees has proven to be most effective at preventing adult progression based on internal studies at Hey Clinic. Bracing at this point is recommended in conjunction with Schroth Physical Therapy.
• 30-40 degree curves: Bracing is strongly recommended, Our goal is to prevent the curve from progressing above 40 degrees at which time surgery may be considered. Schroth Physical Therapy is recommended in conjunction with bracing.
• NOTE: In some cases surgery can also be considered for curves below 40 degrees.
• +40 degrees: Surgery may be considered at this point based on speed of progression, rigidity of curves and any present pain. In children, the two primary goals of surgery are to stop the curve from progressing during adulthood and to diminish spinal deformity. (-American Association of Neurological Surgeons). If the scoliosis angle at completion of growth exceeds a “critical threshold” of between 30° and 50°, there is a higher risk of health problems in adult life, decreased quality of life, cosmetic deformity and visible disability, pain and progressive functional limitations (-2016 SOSORT guidelines).

Each Hey Clinic patient receives guided advice and treatment recommendations that will best fit their specific needs. Just as no two curves are alike, not all diagnoses have the same treatment options. We use a team-based approach to establish the best plan of action to include the following treatment options:

• Observation
• Custom Bracing
• Schroth Physical Therapy
• Surgery

THERE IS NO RUSH! At Hey Clinic, we understand that choosing how to proceed with your diagnosis of scoliosis is an important decision and want you to feel comfortable with your choice. We want you to take the time to consider all options and what will work best for your child and your family. So remember, in the words of Dr. Lloyd Hey, “There is no rush!” Take your time and make an informed decision. We’re here when you need us.

Custom 3D CADCAM Scoliosis braces are a conservative treatment option available at Hey Clinic. Bracing is considered with curves 20 degrees or greater, but sometimes with smaller curves if deemed necessary. Family history, speed of curve progression, and skeletal maturity are taken into consideration when starting to brace. Custom 3D CADCAM braces are made in-house at Hey Clinic by our ABC Certified Prosthetist-Orthotist, specifically to the individual patient. These braces address the Cobb angle and rotation of the curve. Our 3D CADCAM custom scoliosis braces that are founded in the basic Cheneau Principals, have been shown to minimize curve progression, help with pain, and often provide correction in flexible curves.

The size of your child’s curve when diagnosed will determine our recommended course of action:

30-40 degree curves: Bracing is strongly recommended, Our goal is to prevent the curve from progressing above 40 degrees at which time surgery may be considered. Schroth Physical Therapy is recommended in conjunction with bracing.

• 10-20 degree curves: Observation is suggested. Schroth Physical Therapy may be prescribed depending on the child’s age.
• 20-30 degree curves: bracing is recommended to prevent curve progression and optimally reduce the curves. Maintaining or reducing curves to below 30 degrees has proven to be most effective at preventing adult progression based on internal studies at Hey Clinic. Bracing at this point is recommended in conjunction with Schroth Physical Therapy.
• 30-40 degree curves: Bracing is strongly recommended, Our goal is to prevent the curve from progressing above 40 degrees at which time surgery may be considered. Schroth Physical Therapy is recommended in conjunction with bracing.
• +40 degrees: Surgery may be considered at this point based on speed of progression, rigidity of curves and any present pain. In children, the two primary goals of surgery are to stop the curve from progressing during adulthood and to diminish spinal deformity.

Yes! The primary goal of scoliosis bracing is to maintain curves and prevent progression. And with the newly developed technologies in bracing that address the spinal rotation along with curvature, we can even reduce flexible curves!

We can brace adult scoliosis patients too! The goals with adult patient’s are different than that of adolescents, as we cannot correct curves in the skeletally mature spine. However, custom bracing can be a great option to prevent curve progression (with full time wear) and to control pain. Bracing in adults is often used in conjunction with Schroth Physical Therapy.

This depends on your child’s age and development at diagnosis. If she has already started menses, one brace should be sufficient through full skeletal maturity. However, if your child is still growing, an increase of 2 inches and/or 10-15 lbs may require a new brace to provide appropriate curve correction. Changes in shoe size are a good indication of needing a new brace.

Bracing is continued until your child reaches full skeletal maturity, meaning they are no longer growing and their curves are stable. This is approximately 2 years post menses in young ladies but is specifically monitored at every provider visit via Risser and Sanders scales, at which point they will be weened out of the brace.

Absolutely! While our Orthotist will design your custom brace based on your specific curve type and presentation, you get to choose the design pattern on your brace out of over 70 different options! Let your brace reflect YOU!

Schroth Physical Therapy is another conservative treatment option available at Hey Clinic. It may be done simultaneously with bracing or on its own. Each plan is uniquely developed based on the individual’s curve presentation. It aims to slow or stabilize curve progression, reduce pain and reduce the risk of future complications associated with scoliosis.

Due to the need for frequent x-rays in following scoliosis patients, Dr. Hey recognized the need for low dose imaging. He installed the EOS system in our state-of-the-art facility on the Duke Raleigh Hospital campus to allow for the safest evaluation tool possible, exposing patients to 1/5th that of regular x-ray radiation to reduce patient radiation dose while providing exceptional image quality. https://www.eos-imaging.com/us/our-expertise/imaging-solutions/eos-system

Our adolescent patients have updated imaging taken every 3-12 months while they are actively growing. This way we can monitor changes and react quickly as needed. This is also why we use an EOS imaging machine at Hey Clinic.

Absolutely! In one 20-year study, about 40 percent of adult scoliosis patients experienced a progression. Of those, 10 percent showed a very significant progression, while the other 30 percent experienced a very mild progression, usually of less than one degree per year. (-American Association of Neurological Surgeons)

Surgery for scoliosis, kyphosis or other spinal conditions such as spondylolisthesis and stenosis and disc herniations can be considered as one of your choices for treatment.  Dr. Hey can walk you and your loved ones through a “Shared Decision-Making” dialogue to thoroughly explain the short and long-term benefits versus the risks of various treatment options including conservative, injections, and surgical options. Surgical options include minimally invasive and smaller surgical options, growth modulation (tethering), and spinal deformity correction with instrumentation and fusion.  At the end of that discussion you and your family can make your own decision for what is best for you, and we will be happy to then help you through that treatment choice every step of the way.  Dr. Hey has been gradually perfecting his surgical techniques for scoliosis and other spine surgeries for over 25 years now with his clinical and surgical teams, and has even developed special quality and safety improvement software which is used by his teams to error-proof every step of the surgical process just like they do in aviation.