Surviving Scoliosis Surgery Rich Lehrer ~ CRT, ARRT, BS Ed.

Normal Spine

3 Types of Scoliosis Congenital –born with it Idiopathic –grow into it typically in your teenage years Paralytic –neuromuscular weakness can cause progressive deformity –asymmetric paralysis

Congenital Scoliosis

3 Types of Scoliosis Congenital –born with it Idiopathic –grow into it typically in your teenage years Paralytic –neuromuscular weakness can cause progressive deformity –asymmetric paralysis

The problem is… Pain - back, buttock, other... SOB Leg numbness, weakness, difficulty walking Spinal Stenosis Bladder control

Types of Curves

Available Treatments Do Nothing NSAIDS Exercise –walking, yoga, stretching, swimmimg Epidural Injections Bracing Surgery

Reasons to Go Ahead Increasing pain –back, rib, pelvis, abdominal Poor Pulmonary & Respiratory Function –Cor Pulmonale Progression of the curve –>90 degree always has some pulmonary compromise Conservative treatments have not worked

Making The Decision This is NOT an emergency Is it really time? Why now? Disability benefits - LOA - vacation time Medical Insurance? Where will I recuperate? Will my family be OK? Best case and worse case scenario

98 Degrees

Goals of the Surgery Relieve Pain Improve neurologic & physiologic condition Minimize residual deformity Level Pelvic obliquity Center the head over the spine Restore normal contour to the spine

Restore normal contour

The Pre-Op Process

Preparing for Surgery X-rays Cardiac workup - treadmill, EKG, Echo Autologous Blood Banking - iorn Vitamins, flu shot, good nutrition, wt. loss Exercise - walking, stretching, yoga… Pulmonary Function Study Quit Smoking

Types of Pre-op Xrays Upright Scoliosis Series PA & Lateral Pre-op CXR Sidebending films CT Scan MRI - neurologic involvement Myelogram

Upright is best Sitting Non-supported

Upright Lateral in the wheelchair

Sidebending Film

Out of Balance!

Sidebending Be sure my pelvis is flat before you shoot!

Pulmonary Function Test The Body Box

Pre-op CXR

Pulmonary Compromise

The Surgical Experience

Spinal Monitor

Through the Endoscope

Post - Op & Recovery

In the ICU Coming out of anesthesia Ventilator Cardiac monitor Morning portable CXR Neurologic signs monitored Standard Post-op care

Post-op Day 1

Back in a room Coughing, deep breathing, and sitting up PCA PT fit you with your brace OT teach you how to walk Advance diet Areas of numbness and tingling Loose the tubes - Foley, IV,...

Before & After

Post Op correction 29 degrees

Home Again (Whew!) Change in lifestyle - temporarily slower Exercise - walking, swimming, other physical therapy Brace for several months Shower Chair & Hand Shower Cordless phone - TV remote Back to work?

TLSO

The Equation for Success Comprehensive Pre-op planning + Patient Education +Patient Cooperation + a Positive Mental Attitude An Excellent Surgical Result

Thank You Daniel Benson, MD “Turk” Darrington Diane Gums, RN Tony Seibert, Ph D