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

2. Normal Spine

4. 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

5. Congenital Scoliosis

6. 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

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

9. Types of Curves

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

11. 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

12. 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

13. 98 Degrees

16. 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

17. Restore normal contour

18. The Pre-Op Process

19. 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

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

23. Upright is best Sitting Non-supported

24. Upright Lateral in the wheelchair

28. Sidebending Film

29. Out of Balance!

30. Sidebending Be sure my pelvis is flat before you shoot!

31. Pulmonary Function Test The Body Box

32. Pre-op CXR

33. Pulmonary Compromise

34. The Surgical Experience

37. Spinal Monitor

39. Through the Endoscope

40. Post - Op & Recovery

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

42. Post-op Day 1

43. 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,...

44. Before & After

46. Post Op correction 29 degrees

47. 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?

48. TLSO

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

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