This Wednesday I got back from a wonderful two and a half week vacation with family, which included some phenomenal time out in the Pacific Northwest, including Glacier National Park — breathtakingly beautiful!!! If you ever get the chance to go there, GO!! Also got a chance to see San Juan Islands, Seattle, and Helena, Montana. We were also part of my brother’s wedding celebration out in Seattle, which was just wonderful with lots of family gathering together. It was a good break, although I did have to spend some time on my break working on some research papers and committee work for Scoliosis Research Society, which has a big meeting coming up in September. I flew back into town Tuesday evening into RDU, glad to be home. I actually met 2 of my surgical scoliosis patients at the airport, and got a couple of hugs as I went through baggage claim! So good to see some folks I haven’t seen for a while doing well, enjoying travel.
The next morning, I was back in the scoliosis crafting “shop”, and glad to be back. I performed 2 scoliosis surgeries at WakeMed Children’s Hospital, in Raleigh on a 9 yo Michael and 12 yo Jackson, both of whom had rapidly progressing right thoracic curves. Both surgeries went very well, taking about 3 hours each, with very nice corrections, and no blood transfusions. Jackson went home today — (he gave me a big green balloon before he left) on postop day 3, and the other will be going home tomorrow. Both were up walking postop day 1 with one night in the PICU, extubated in the operating room.
Thursday we helped a girl at WakeMed Children’s Hospital named Bree who just turned 10 who had a 110 degree early onset scoliosis (EOS). Depending on the size of the patient, chest wall size, and other factors, we consider 3 options for treating such curves in younger children: Growing Rods or Shilla Technique for a multistage surgical approach vs. a definitive instrumentation and fusion, possibly anterior/posterior and/or with posterior osteotomies, or possible larger vertebral body resection (VCR). In the “old days”, we used to worry about “crankshaft phenomenon” when performing definitive fusions in kids under 10, but with the dawn of stronger segmental instrumentation with thoracic and lumbar pedicle screws, this no longer appears to be an issue even for younger kids, down to even 6 or 7 in some cases. We often do second opinions to help families decide which is best approach, and the best timing to optimize growth, minimize surgical risk and number of surgeries needed, and maximize curve correction. the other issue that has to be addressed is when to use preop skeletal traction.
Over the years, I have been working on figuring out less and less invasive ways of trying to get better and better scoliosis curve corrections with less surgical risk and surgical time. Bree’s surgery this week gave us ample opportunity to hone this “craft” of curve correction in a very severe 110 degree curve.
Bree was totally psyched for her surgery Wednesday morning and let me know how straight she wanted to be! She did not have preoperative skeletal traction. Using some less invasive, but multiple osteotomies over several levels, and some creative instrumentation engineering leverage, we were able to get a really nice correction for Bree without any changes in her evoked potential monitoring, and no blood transfusions, and about a 5 hour total surgical time, extubated at the end of surgery.
I also used some new twists on a pedicle screw insertion technique I have been perfecting that worked very well, helping to direct the screws in her incredibly twisted and deformed spine in a very safe and efficient way bilaterally.
Bree was extubated in the OR, spent a short time in PACU, and one night in the PICU off the ventilator. On postop day one, she was transferred to the floor, got up and walked around, and was 3 inches taller!! Around lunchtime I received the “before and after” picture below texted to me by Bree’s mom which said
“She looks AWESOME!”
