I received this email earlier this afternoon from an approximately woman with a collapsing thoracolumbar scoliosis with increasing back and hip pain who has tried all conservative therapies, and is not considering spinal instrumentation and fusion, with lumbar laminectomies and osteotomies.
She had a few more questions, and had been in touch with some of my other patients who were in the same “boat” as she was just a few months ago, and are now recovering well after surgery.
Hopefully her questions and my answers may be helpful for many others out there who have similar questions!
Lloyd A. Hey, MD MS
http://www.heyclinic.com
Hey Clinic for Scoliosis and Spine Surgery
Raleigh, NC USA
Member, Scoliosis Research Society (SRS) http://www.srs.org
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On Sep 14, 2008, at 3:22 PM, Embarq Customer wrote:
Thanks so much for the phone call and email. However, I could not pull up the websides and wonder if your office could check on these websides for me, as I would like to see the videos.
I have contacted two of the ladies and they have nothing but praise for their surgeries performed by you. I was very encouraged and hopefully can schedule surgery in the fall.
I do have a couple of concerns which we did not discuss. (Just forgot to ask.) How about flexibility after surgery? Also, I have quite a lot of pain in my right hip (in the joint) as well as down the outside of my thigh. (I had an injection in the right groin in April that greatly relieved the pain, though I still have some.) I had an MRI in June which I brought to your office and I’m not sure it was viewed, but nothing shows up that would cause hip pain, so are we to assume this pain is caused by the spinal disorder? What are your thoughts on this? I am hoping surgery will relieve pain in the hip as well as back. I also would like to check on my insurance plans, which I can discuss with the front office.
With many thanks for your interest and the helpful discussion we had in your office. We were greatly impressed.
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———- DR. HEY’S RESPONSE ———
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I am glad you were able to get a hold of the other ladies who have had similar surgery.
I just got back from our international Scoliosis Research Society (SRS) Meeting in Salt Lake City, and several new papers were presented documenting marked improvements of quality of life with adult scoliosis surgery. There was also one paper presented on flexibility postop after spinal fusion, but that paper was in adolescent scoliosis, and did not really address functional range of motion, but a couple of tests typically used by physical therapists to assess spinal flexion and side bending distances only.
ANSWER TO QUESTION #1: LOSING FLEXIBILITY WITH FUSION?
a. LIMITING FLEXIBILITY DURING HEALING PERIOD. We do limit your extreme bending, lifting and twisting during the first 6 months to a year until your fusion is well healed to prevent hardware loosening or breakage. However, once your fusion is healed, we allow you to return to all preoperative activities. Surprisingly, however, most patients have no difficulty with their overall body range of motion, and activities of daily living regarding bending and flexibility. There are several reasons why this is true.
b. SPINE BENDS A LITTLE, HIPS BEND A LOT. Your spine itself only bends a few degrees at each level. Most of your flexibility for bending occurs at the hip joints which are not affected by the surgery.
c. YOUR SPINE IS PRETTY STIFF NOW. Your spine already is even less flexible, or barely flexible due to the collapse and degeneration in the area that we are fixing, since your scoliosis has caused it to twist, and lose virtually all of it’s bending ability.
d. PAIN IS LIMITING YOUR FLEXIBILITY AND ACTIVITY. The pain that is associated with the collapse and severe degeneration greatly limits functional range of motion, causing your muscles and brain working together to stop you from bending or twisting due to the pain. Although your spine has a little motion left in the collapsed zone, your brain says "Don’t bend that spine, ’cause it’ll hurt", and causes muscles to stiffen to prevent worse pain from occurring. When we can eliminate the bone from rubbing on the bone and hitting the nerves in between, the pain is greatly decreased or eliminated, allowing less pain and more FUNCTIONAL motion and activities of daily living.
So, in my experience over past 14 yrs of practice and thousands of scoliosis surgical cases, I have had only 2 patients who had some moderate complaints of difficulty reaching their bottom area after surgery. These patients had very long torsos/trunks and wide buttock and who had horrible totally collapsed kyphotic thoracic and lumbar spines which I was able to correct, restoring excellent standing posture. However, when I lengthened their torso back to it’s proper length, they had some difficulty reaching down around their buttock area, because their arms were relatively too short to reach. We were able to make some adaptations with occupational therapy so they could manage their own self-care. Fortunately your curve type, severity and body habitus, I have not had any people have this problem.
QUESTION #2: HIP PAIN.
A: You are absolutely correct. Your hip pain is very likely referred pain coming from your pinched nerves (stenosis) going to that area of your body. This stenosis is being caused by the spinal collapse (scoliosis) and bone slipping over the bone (spondylolisthesis) and the buildup of thickened ligament and facet joints and disc which encroach on the nerves causing the lumbar spinal stenosis. By opening up the central canal, and freeing up the nerve roots both centrally, and out the lateral recess and foramen on both sides, the pain going to the hip and leg is usually eliminated or significantly reduced. It is important, however, to check a hip X-Ray, which we could see on your spine X-Ray, and show that your hip joint is ok. I just saw a case last week where the pain was indeed caused by a worn out hip joint (osteoarthritis) of the hip. This patient needed a hip replacement!
I hope this helps.
I’ll look into the website access issue for you
Take care,
Dr. Hey
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Lloyd A. Hey, MD MS
http://www.heyclinic.com
Hey Clinic for Scoliosis and Spine Surgery
Raleigh, NC USA
Member, Scoliosis Research Society (SRS) http://www.srs.org