Triangle Edition August 2006 VOL. 8, NO. 8. Dispelling Misconceptions About Scoliosis The Hey Clinic Provides Treatment That Changes Patients Lives

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1 Triangle Edition August 2006 VOL. 8, NO. 8 Dispelling Misconceptions About Scoliosis The Hey Clinic Provides Treatment That Changes Patients Lives

2 cover story Dispelling Misconceptions About Scoliosis The Hey Clinic Provides Treatment That Changes Patients Lives Scoliosis, a side-to-side curvature of the spine, affects people of all ages, across the entire spectrum of life, from small children, through adolescence, young adulthood, middle-age adulthood and older adulthood. According to the National Scoliosis Foundation, scoliosis affects 2 to 3 percent of the population, an estimated 6 million people in the United States. The primary age of onset for scoliosis is years old, occurring equally among both genders. However, females are eight times more likely to progress to a curve magnitude that requires treatment. Scoliosis can impact quality of life with limited activity, pain, reduced respiratory function or diminished self-esteem. While this condition is potentially debilitating, there is good news. In the past 20 years, tremendous progress has been made in treating the disease. Getting the word out to the medical community and those affected has become a life passion of Lloyd Hey, M.D., M.S., whose training includes MIT, Harvard, a pediatric orthopedic fellowship at Children s Hospital Boston and a combined orthopaedic/neurological adult spine fellowship at Duke. Having trained and worked in this area for all of my professional career, I have witnessed a revolution in how this condition can be treated. Patients who, in years past, may have been told that nothing could be done are now receiving treatment and experiencing life-changing results. Dr. Hey has performed more than 3,000 spine surgeries over the past 10 years. While this article focuses on scoliosis, Dr. Hey specializes in six areas of spinal surgery: Scoliosis, a side-to-side curvature of the spine; Kyphosis, an exaggerated curve that causes a rounded or hunched back; Spinal stenosis, or narrowing of the spine due to age that puts painful pressure on the spinal column; Spondylolisthesis, a slippage of one vertebra over another; Spondylolysis, a stress fracture in one of the bones (vertebrae) that make up the spinal column; and Herniated disc, protrusion or sticking out of a disc or disc fragment that pushes on a nerve. Recently, Dr. Hey moved from Duke University Hospital after almost 10 years as a spine surgeon, Associate Professor of Orthopaedic Surgery, where he served patients with complex spinal conditions, and trained orthopaedic and neurosurgical residents. He established the Hey Clinic for Scoliosis and Spine Surgery, located at 3404 Wake Forest Road, Suite 203, in Raleigh, NC. This new location offers convenient access to his practice, Duke Health Raleigh Hospital, and lodging for patients coming to the Hey Clinic from other parts of the Southeast and beyond, including international patients from Europe, Middle East, Africa and the Far East. WITH SCOLIOSIS, A STITCH IN TIME SAVES NINE Early detection of scoliosis is critical. For most patients with small curves less than 10 degrees progression is unlikely. Curves that are 10 to 30 degrees are also fairly unlikely to progress; however, curves more than 30 degrees begin to have an increasingly higher probability of progressing over the years. Dr. Hey explains, When you stop and think about it, even just a degree per year of progression, which doesn t seem like much at first, becomes significant. For example, a 30-year-old woman may have a curve that measures 30 degrees. If it progresses a degree or so a year, then by age 60, the curve could be in the 60- to 70- degree range. By age 80, the curve could be very large and cause severe pain and make walking difficult. If left completely untreated, it could cause severe pain, and even breathing difficulty due to chest compression and potentially even cardiovascular compression due to decreased thoracic volume. Curves tend to progress most rapidly during growth spurts, typically in ages 11 through 14 in girls, and 13 to 17 in boys. Sometimes, during later phases of scoliosis, the curve can progress rapidly during the patient s 40s and 50s: severe degeneration may occur on top of an earlier curve, causing the spine to loosen and Dr. Hey reviews a case with a 16-year-old swimmer and her mom utilizing the clinic s MedStrat digital X-ray system and SpringCharts electronic medical record. PHOTO BY JIM SHAW PHOTOGRAPHY 6 TRIANGLE M.D. NEWS AUGUST 2006

3 While treatment can be delivered to patients of all ages, young people tend to recover faster and have better results. Again, the old adage holds true: a stitch in time saves nine. PHOTO BY JIM SHAW PHOTOGRAPHY Dr. Hey reviews X-rays with a physician patient and her husband prior to surgery. fall upon itself, resulting in severe curve progression, as well as severe pain. We want to correct the problem well before the patient reaches this state of pain and reduced quality of life, concludes Dr. Hey. This is definitely a case where sooner is better. Scoliosis treatment has evolved dramatically over the past 50 years. Early treatment methods resembled medieval torture devices, as patients were stretched using racks, then wrapped in body casts and monitored for months in hospitals. Recovery times stretched over a several year period, and it was believed that only younger patients could be cured. Progress in the 70s came in the form of the Harrington rod, a single instrumentation that ran the length of the spine: recovery again involved a cast and months of inactivity, but results were much improved. In the past 20 years, segmental hook instrumentation and then segmental pedicle screw instrumentation have achieved remarkable results: younger patients are able to return to school and sports within a few weeks. Older patients who were once told that no treatment was available are now able to receive effective results, as evidenced by Dr. Hey s work. Impressive scoliosis corrections can be obtained. In some cases, curves from degrees are reduced to less than 10 degrees during a single three-hour surgery without blood transfusion. Patients stay in the hospital for only three days, and are usually walking around on the first day after surgery. The results are immediate: patients families frequently say, Wow! when they see the comparison of pre-op and post-op X-rays. Treatment for scoliosis is best provided when patients are young, making regular screening a critical part of medical checkups for children and young adults. However, progression can occur at any stage in life; therefore, it is important that all physicians know how to screen for spinal deformity using physical examination, history and simple tools like height measurement and a Scoliometer. Because screening is relatively fast and easy to do, pediatricians, OB/GYNs, family medicine physicians, internists, orthopedic surgeons, chiropractors and school R.N.s should be trained to perform evaluations on patients. IMPORTANT TRUTHS ABOUT SCOLIOSIS Two misnomers about scoliosis are pervasive in today s health care environment and, unfortunately, these affect how physicians screen, diagnose and treat the condition. Misconception 1: Scoliosis Is Only a Problem for Children. Many still believe that scoliosis is only a problem for adolescents, and that once a child has reached adulthood curves cannot progress. The truth is scoliosis can progress at any age, and because it progresses slowly, it can go undetected for many years, Dr. Hey explains. Parents of children with slight curves may be told to keep an eye on it and not do much more. Unfortunately, curves can progress rapidly in adulthood. For example, during pregnancy, a woman s body undergoes many physical changes: the shifting of the pelvic bone may trigger movement in the spinal column. Later in life, severe degeneration may weaken the spine, and curves may rapidly become more pronounced. If left untreated, the condition will persist and potentially worsen, no matter what a person s age. The bottom line is that individuals who have received a diagnosis of scoliosis should be monitored throughout life. Fortunately, new technologies, such as digital radiography and electronic medical records, can make the long-term follow-up of scoliosis patients much easier and more secure. In the past, patients had a difficult time keeping up with their records, especially over a lifetime. With today s technology, patients are able to be followed for 70-plus years because all of their X-rays and measurements can be stored electronically in a single system. It makes tracking changes over time easier to do. One patient s story illustrates this important truth. Now an Jaclyn Wagner, PA-C, measures the spinal curvature of a scoliosis patient using a Scoliometer. TRIANGLE M.D. NEWS AUGUST

4 PHOTO BY JIM SHAW PHOTOGRAPHY Dr. Hey explains a diagnosis to an adolescent patient and his parents. attractive 25-year-old New York publicist, Kimberly Kress was screened for potential problems in elementary school. Once they heard the news from school, my parents immediately took me to my pediatrician.at that point, he said the curve was minor and that we should just monitor it.years passed, and then when I was about 13, we visited a specialist. The X-ray at that time showed that my curve was already 40 degrees, which is really high. Because she was an active adolescent, and because surgery was an intimidating option, she underwent nonsurgical treatments, but these ended when she transitioned from the pediatrician to an internist. I knew I still had a problem, but even while I was an undergraduate at Duke University, I was not ready to face up to a surgical solution. I heard of Dr. Hey really wonderful things while I was at Duke, but I still wasn t ready to deal with the problem. After college, Ms. Kress began leading the life about which she had dreamed in Manhattan.Always on her mind, however, was her curve. Finally, she decided to see a specialist. The X-rays confirmed her worry: the curve had progressed to greater than 60 degrees. The news was devastating. I knew then that surgery was inevitable. The words coming from NYC specialists did not comfort her. I didn t even want to think about it, she admits. It was the scariest time of my life. Her family s concerns were great. My father was very upset. He believed that the pediatrician should have referred my care when I became an adult to a scoliosis specialist for continued follow-up. No one told us that my curve could progress that much in later life.we just didn t know. Then, a series of happy coincidences changed Ms. Kress s life forever. One day at his men s choir practice, Mr. Kress mentioned his daughter s situation. Immediately, a fellow vocalist began describing his son s clinic in Raleigh, NC. My dad called me as soon as he got home to tell me about the Hey Clinic. Suddenly, I remembered Dr. Hey from my days at Duke. My father said that Dr. Hey and his family would be visiting soon to see the chorale group s next concert.we arranged to meet. Dr. Hey was not what Ms. Kress expected. He was different from the doctors I had seen before. He calmly explained that because I was young and healthy, the surgery would be smoother and I would have a faster recovery than if I waited. He put it simply: it doesn t get any easier than now. I listened, but I was still concerned. Dr. Hey patiently discussed the procedure with her, describing what she could expect. He answered her questions about how soon she would be able to return to work (within a few weeks, if she felt like it), if it would leave an ugly scar (no, with dermabrasion it would leave only a line down the center of her back), if it would limit her physical activity (only as much as she wanted). He even answered silly questions I had, like would I trigger all the alarms at airport security? she laughs now (the answer to which was no, as the hardware is titanium). His knowledge and sense of calm gave me confidence. Now, eight months later, Ms. Kress glows when she talks about the experience. My surgery was on October 18, 2005, and all I can say is that I wish I had done it sooner. It was the hardest choice I ve ever faced, and it was the best decision I ve ever made. Dr. Hey was fantastic: he and this surgery changed my life. I even grew an inch in the process, which is pretty cool! If a picture is worth a thousand words, the photographs of Ms. Kress post-surgery tell volumes. As she puts it, she s never felt or looked better. Misconception 2: Adult Scoliosis Is Not Treatable. The second misconception is that adult scoliosis is not treatable a falsehood that is particularly troubling for Dr. Hey. In my career, I have treated patients who have long suffered from spinal deformity.they may have sought help from a physician perhaps many physicians and been told that there is nothing to be done. This is simply not true. Although it is true that treatment early in life is easier for patients to undergo, with results achieved at a faster pace, adults Patient education is a key focus at the Hey Clinic. Dr. Hey uses a spine model to aid in teaching patients. PHOTO BY JIM SHAW PHOTOGRAPHY 8 TRIANGLE M.D. NEWS AUGUST 2006

5 may be successfully treated. So many adult patients have lived for years with intense pain, the condition greatly affecting quality of life, their ability to stand, walk or sleep, and how they look. Having received the verdict, it s too late, they have lost hope. The truth is that there is hope, hope in the form of a treatment that has a very high success rate in individuals of all ages.adult scoliosis is treatable. PHOTOS BY JIM SHAW PHOTOGRAPHY THE HEY CLINIC: PROVIDING HOPE AND TREATMENT The Hey Clinic s mission is three-fold. First, the team is committed to providing excellent service to patients, their families and other providers. Second, Dr. Hey strives to create an environment in which learning is constant: from this learning comes innovation and the opportunity to improve the quality of care. Finally, the Hey Clinic focuses on sharing what it has learned with others, so that they are inspired and can serve well. The Williams family s experience at the Hey Clinic provides a reallife example of how this mission is implemented. Mr.Williams introduces their story: It was Liza s mother who noticed the curve one day when Liza was bending over to pick something up. It was alarming for us Liza was 13 years old, had always been athletic, very involved with cheerleading and dancing. She never complained about pain, but still the curve was evident. Their pediatrician ordered the first set of X-rays: the extreme degree of the curve necessitated a referral to a specialist in Charlotte. The specialists were blunt about it: Liza would need surgery. The curve was already too big for bracing, and as Liza grew, it would only get worse.we tried to make an appointment.the earliest date we could get was more than a month out. Something did not feel right to Mr.Williams. I had a hard time communicating with the doctors, he explains. It seemed like they weren t giving me the details I needed. And when Liza was present, they didn t talk to her directly. It bothered me. I was already alarmed, because this was happening to my little girl! But to not get assurance from the physicians? It was disturbing. TRIANGLE M.D. NEWS AUGUST

6 PHOTOS BY JIM SHAW PHOTOGRAPHY Technique procedure and surgical team. In the meantime, preparations for surgery began. Liza began the arduous task of giving blood: three visits before the operation were required.the operation itself was to take six or more hours, and she was expected to be in intensive care the first full day and in the hospital for the next four. She would then face six months of recovery with strict requirements. As the date approached, Mr. Williams anxiety increased. I remember asking the surgeon about his experience with this type of surgery. He said because the condition was rarely this advanced in girls as young as Liza, he did not perform the procedure often, maybe eight to 10 times a year.that figure did nothing to comfort me.the sense of dread inside me was almost too much. It was during one of Mr. Williams many Internet searches on scoliosis that he came across the Hey Clinic website. I was looking for stories about patients like my daughter when I began to read about girls who were cheerleaders and gymnasts, who had the surgery, and within a few months were back to their sports, stronger than ever. Here it was: a clinic that specialized in scoliosis surgery. I knew it was a long shot, but I sent an to the contact address. The next day he received a reply. Meredith responded she not only worked at the clinic, she was also a former patient! She was very understanding of my fears, and answered some of my initial questions. She also said that she would tell Dr. Hey about my situation immediately. A single phone call with Dr. Hey led to the Williamses making the drive to Raleigh. The next day we met with him. I couldn t believe how accessible he was! Then, he went out of this way to alleviate our concerns. He answered all my questions, and talked to Liza about what she could expect. He conversed with Liza as easily as he talked with us. It seemed important to him that she know what was happening, and, as her father, that meant the world to me. Even more importantly, he let us know that surgery would take only two hours, require no intensive care and not need blood transfusions. Scarring was minimal, and recovery would be swift. Even the cost went down. It was obvious that we had met the right physician. A few weeks after surgery, Liza has already returned to cheerleading practice. We keep telling her to take it easy and she is but it s great to see her being able to participate. Dr. Hey and his team spent a lot of time with her before she left the hospital, teaching her how to do things to speed up the recovery. She knows what to do, and it s wonderful that she has the kind of freedom that comes with having knowledge of her condition. Mr.Williams admits that the Hey Clinic turned one of the worst events of his life into something immeasurably positive. From the beginning with Meredith s concerned , I began to believe there was a different answer to our problems.then, Dr. Hey s accessibility, the ability of the clinic and hospital to schedule surgery within days of our meeting, his confidence and proven experience, the post-op X-rays that brought tears to my wife s and my eyes and the amazing amount of education he provided to my daughter, wife and myself the solution seemed to come naturally! The Hey Clinic gave me and my family hope at a time we needed it most. Throughout it all, Dr. Hey has been there for us, he says, with obvious emotion. When asked about Liza, he is ecstatic. She s recovering, walking, stretching and, most importantly, laughing! Her outlook has never been better. She s still my little girl, but, having gone through this experience, and with Dr. Hey s assistance, she ll stand straighter, jump higher and run faster who knows what Liza will do as she grows. Liza can do anything she wants! Liza s story represents one of many such experiences patients have had at the Hey Clinic. With accessibility, education, experience and the latest in technology, Dr. Hey and his team are providing life-changing results to their patients and changing the face of scoliosis in the process. FOR MORE INFORMATION Hey Clinic for Scoliosis & Spine Surgery 3404 Wake Forest Road, Suite 203, Raleigh, NC Tel: (919) Fax: (919) For appointment requests and more information, visit our website at or send an to frontdesk@heyclinic.com. 1 0 TRIANGLE M.D. NEWS AUGUST 2006