Case Study: Congenital Scoliosis in an 18 Month-old Boy

, , , , News, Scoliosis
baby scoliosis surgery

18-month old Arannya Adhakary with congenital scoliosis waiting for his surgery

Operation Straight Spine (OSS) is an annual mission trip to Kolkata, India, where doctors, nurses and spinal monitoring technicians from the US, England and India treat patients with spinal disorders. During the 2017 trip, Dr. Jeffrey McConnell and the OSS team treated an 18-month old boy with congenital scoliosis.

Arannya Adhakary, 18 months old, was the youngest patient treated during OSS 2017.  He was diagnosed with congenital scoliosis when he was just 3 months of age.

 Congenital scoliosis can be caused by a number of different defects in the development of the spine during the first trimester of fetal growth. Abnormalities occur when part of a vertebra fails to form or several vertebra fail to separate during the very earliest stages of fetal development when the spine and other major organs are starting to form. Patients can have a single abnormality or multiple defects throughout the spine. 

Arannya’s congenital spine defect was known as a hemivertebra, which occurs when the vertebra is triangular in shape instead of the normal rectangular shape.   This type of congenital defect has a very high propensity to cause a severe and progressive deformity of the spine, usually a kyphosis or scoliosis,  as the child grows.

Arannya’s hemivertebra was located at the 11th thoracic vertebra, approximately in the middle of his spine. Hemivertebra are best treated at an early age by removing the abnormal vertebra, correcting the deformity and fusing the growth plates above and below the hemivertebra so the deformity does not recur. Arannya’s surgery consisted of removal of the T11 hemivertebra, correction of the local kyphosis and scoliosis, and limited fusion from T10 to T12.  To stabilize the spine and help fuse where the hemivertebra was removed, two small screws and a single 3.5mm diameter rod was placed from T10 to T12 on the right side.

Arannya did amazingly well after surgery, a testament to his young age, and by the 4th postoperative day was going on walks in the courtyard, smiling, carried in his mother’s arms.

scoliosis deformity xray

Pre-operative MRI of the thoracic spine showing the T11 hemivertebra and acutely angled scoliosis deformity.

scoliosis postop xray

Post-operative X-ray after removal of the T11 hemivertebra and placement of spinal screws and rod.

india scoliosis

Four days after surgery on walk with his mother.

Case Study: Severe Scoliosis in an 11-Year Old Girl with Rare Syndrome

, , , , News, Scoliosis

Shruti Sharma during her pre-operative evaluation with the OSS 2017 team.

Kolkata, India,  January 25, 2017

During their annual mission trip to Kolkata, India, Dr McConnell and the other members of the Operation Straight Spine (OSS) team were faced with a very challenging case of severe scoliosis in an 11 year-old girl.

Shruti Sharma was diagnosed with Prader-Willi syndrome (PWS) at a young age.  PWS is a complex genetic disorder affecting approximately one in 15,000-30,000 individuals. The disorder results in short stature, disorders of metabolism, cognitive disabilities and behavioral problems. One of the hallmarks of the disorder is insatiable appetite and obesity which often leads to childhood diabetes mellitus (Type 2 diabetes).  Due to low muscle tone, patients will often develop spinal deformities such as scoliosis. Shruti was certainly the most challenging case the OSS team faced this year, not only from a medical management standpoint, but also by the severity of her spinal deformity.

Shruti originally presented to the OSS team in 2016 for consideration of corrective surgery for her thoracic scoliosis, however her diabetes was newly diagnosed and poorly controlled. The team thought it best to delay her surgery until their return trip in 2017 so that her diabetes could be brought under better control. By 2017 her left thoracic scoliosis curvature had progressed to 92 degrees.

Pre-operative X-ray showing severe, 92 degree thoracic scoliosis

Shruti’s scoliosis surgery

After Shruti was placed under anaesthesia, blood started collecting in her right lung for unknown reasons. This delayed her surgery for several hours. The bleeding eventually stopped and she was stable enough to complete the procedure, which lasted about 6 hours. It consisted of a posterior correction of the scoliosis and the placement of spinal rods and fusion from the 2nd thoracic vertebra to the 3rd lumbar vertebra. Due to her relatively small size, small 4.5mm rods and implants were used. Then, special bands resembling zip ties, known as  “Jazz Bands”, were attached to several vertebra. By slowly tightening the Jazz Bands the severe curvature of Shruti’s spine was gradually straightened and anchored to the spinal rods.

Shruti’s postop and recovery

Shruti’s postoperative course was somewhat stormy.  She remained intubated in the ICU for the first 24 hours. as her blood pressure was unstable and she ran a high temperature. On post-op day #1 the breathing tube was removed, but her right lung had filled with fluid and she required aggressive manual pulmonary therapy to help clear the lung. Ultimately, Shruti did very well and by the 4th post-op day she was smiling, walking, and coloring pictures.

About 3-4 weeks after her scoliosis surgery, Shruti had a slight setback when part of her spinal incision came open and developed an infection.  Luckily, Dr Ujjwal Debnath, based in India, was able to re-operate on Shruti’s back, wash out the wound and clear the infection. She required additional hospitalization and antibiotic therapy but ultimately recovered.

Post-operative X-ray showing excellent correction of the scoliosis deformity.

Shruti walking on 4th post-op day with OSS team member Bethan Salmon, RN

cervical replacement surgery

Two Level Cervical Artificial Disc Replacement Superior To Fusion

, Cervical Disc Replacement, Degenerative Discs, Herniated Disc, News

 

eurospine conference

During the recent Eurospine meeting in Berlin, Germany,  a paper co-authored by Dr Jeffrey McConnell was presented, which explored the results of one of the longest follow-up studies on cervical total disc replacement to date.

“Long Term Clinical and Radiographic Results of Two-level Cervical Total Disc Replacement from a Level 1 Prospective, Randomized, Clinical Trial”, compared patients who received fusion surgery vs patients who received artificial disc replacement surgery. The highlights:

  • After 7 years, patients who received the Prestige-LP two level artificial disc replacement had superior overall clinical results when compared to the fusion patients.
  • Subsequent surgeries were required 3 times less often in patients who received the two-level artificial disc replacement.
  • Patients who had cervical fusion required surgery at adjacent disc levels twice as often as the patients who had disc replacement.

These long term clinical results demonstrate the effectiveness of total disc replacement at 2 contiguous levels in the cervical spine and the importance of maintaining motion in the cervical spine.

 

The Prestige-LP two level artificial disc replacement.

Cervical artificial disc replacement is a type of joint replacement procedure. An artificial disc, such as the Prestige LPTM cervical disc made by Medtronic, is placed between two adjacent cervical vertebrae to replace a diseased cervical disc. It is designed to maintain the distance between two adjacent cervical vertebrae.

Cervical total disc replacement has been demonstrated to be a very effective alternative to the traditional surgery of fusion for painful herniated discs in the neck.  Total disc replacement in the neck is more successful because it maintains normal motion in the neck while fusion eliminates motion.  This preservation of motion is key to minimizing the degeneration of adjacent cervical discs.

Learn more about cervical disc replacement.

Laser Spine Surgery: Trick or Treat?

, , Back pain, Herniated Disc, News, Spine & Back Health

laser-back-medical1Contrary to popular belief, laser spine surgery is not better than currently accepted surgical techniques when it comes to treating common conditions affecting your spine.

Lasers have been used in medicine since the 1960’s and have proven to be very effective in treating many conditions – for example, LASIK surgery to correct common vision problems or treating certain skin conditions. But due to insufficient evidence,  lasers in spine surgery are not endorsed by most large health authorities like the Mayo Clinic and the National Institutes of Health (NIH). Lasers are more often used as a marketing tool by some clinics that promote “laser spine surgery” as being minimally invasive or noninvasive and risk-free.

There are no well-controlled clinical studies documenting the benefits of laser spine surgery. In fact, in one study comparing percutaneous lumbar laser discectomy (PLLD) with more traditional forms of discectomy (surgical removal of the whole or a part of an intervertebral disc), the results of PLLD were inferior.

The most accepted method to remove a herniated disc in the lumbar spine is to make a small incision, open the spinal canal (a laminotomy), visualize and protect the compressed nerve root and remove the herniated disc material with small mechanical instruments.  Lasers are also ineffective in treating spinal stenosis because lasers cannot cut bone to open the spinal canal or remove bone spurs compressing the nerves.

The key to success in any spinal surgical procedure is an accurate diagnosis and the application of clinically proven procedures performed by qualified, experienced, board certified surgeons.

Learn more about lumbar discectomy surgery.

cervical total disc replacement

Can Artificial Total Disc Replacement in the Neck Prevent Problems at Adjacent Discs?

, Cervical Disc Replacement, Degenerative Discs, Herniated Disc, News, Spine & Back Health

Thursday, October 27, 2016 | Boston, MA, USA

Artificial total disc replacement surgery for painful herniated discs in the neck is an alternative to the traditional treatment of discectomy and fusion.  img_6372

While fusion surgery is generally successful for treating herniated discs in the neck it comes at the expense of lost motion between two vertebra.  Lack of movement  at one disc will increase stress and strain at the adjacent discs.  The disc adjacent to a fusion can degenerate faster and may become painful and require additional surgical intervention.

Dr McConnell recently reported the long term beneficial effects of total disc replacement in the neck at the North American Spine Society Meeting in Boston.  The presentation was entitled:  Motion Preservation at the Operative Level and the Incidence of Symptomatic Adjacent Segment Disease after Treatment with Secure-C or ACDF.  This study followed 380 patients with herniated discs treated with either total disc replacement (Secure-C artificial disc) or fusion to see what happened to the adjacent discs after 7-years.  Of the patients  who had fusion in their neck 17.4% had additional surgery at an adjacent disc while only 4.2% of the patients treated with Secure-C had adjacent disc surgery.  After 7 years, patients treated with fusion surgery in the neck for a herniated disc were 4 times more likely to require surgery at any adjacent disc level then patients treated with an artificial disc.   These results were significant and highlight the benefits of total disc replacement in helping to prevent accelerated degeneration of adjacent discs and the importance of maintaining normal motion in the neck.

 

Read more about cervical total disc replacement.

 

The Scoliosis Research Society 23rd International Meeting on Advanced Spine Techniques

Cervical Disc Replacement, Degenerative Discs, News

Friday, July 15, 2016 | Washington, DC, USA

At this leading and prestigious scientific meeting on spinal surgery, Dr. McConnell presented the 7-year results of the clinical study involving the Prestige-LP cervical disc arthroplasty device. The FDA investigational device exemption (IDE) clinical trial compared the Prestige-LP total disc device to replace two consecutive discs in the neck versus the traditional surgery of two level disc fusion. At 84 months follow-up, patients who received the Prestige-LP two level artificial disc replacement achieved superior overall clinical results when compared to the fusion patients. At 7-years patients who received the two-level artificial disc replacement required 3-times fewer subsequent surgeries at the treated disc levels.  Patients who had cervical fusion were twice as likely to require additional surgeries at adjacent disc levels.  These longer term clinical results continue to demonstrate the efficacy of total disc replacement at 2 contiguous levels in the cervical spine.

Learn more about cervical disc replacement.

 

 

screen-shot-2016-10-03-at-6-17-10-pm

 

screen-shot-2016-10-03-at-6-19-54-pm

screen-shot-2016-10-03-at-6-20-22-pm

Case Study: Congenital Spinal Deformity

, , , News, Scoliosis

During Dr. McConnell’s  yearly mission trip to Kolkata, India to support Operation Straight Spine he will often see cases of congenital spinal deformities.  This past year was no exception.  Congenital spinal deformity is caused by an abnormality in the growth of one or more spinal vertebra and occurs before birth.  After the child is born and during their most rapid periods of growth the spinal deformity can become quite severe and produce significant disability if not corrected early.

This is a case of a 22-year old man with severe congenital kyphoscoliosis who came to us complaining of back pain and progressive weakness in his legs.  The 3D CT scan of the spine pictured here shows just how severe his congenital deformity had become over the years.  The deformity was causing pressure on his spinal cord resulting in the weakness of his legs.

Lateral 3D CT image

Lateral 3D CT image

AP 3D CT image

AP 3D CT image

AP Post-op X-ray

AP Post-op X-ray

img_5182

Surgery was performed to straighten his spine and relieve pressure on the spinal cord.  The procedure involved removing two of the deformed vertebrae and inserting a cage to replace them. Spinal rods and screws were inserted to stabilize and keep the spine straight while the area fused together with bone graft.
Lateral Post-op X-ray

Lateral Post-op X-ray

img_5181

The patient had complete recovery of his leg weakness and was very pleased with his post-operative condition.

To learn more about Operation Straight Spine please visit our website at www.healingspines.org

Case Study: Degenerative Disc Conditions

Degenerative Discs

Meet Bob – a Coopersburg resident and father of three. For most of his adult life, Bob suffered with chronic neck and back pain. As if his chronic pain wasn’t enough to alter his life, his condition was also associated with numbness and tingling in his left arm and hand, and sciatic pain down his left leg. After years of suffering, Bob looked to Dr. Jeffrey McConnell of OAA’s Spine Center of Excellence to IMG_0644perform surgery on his spine. “Finding Dr. McConnell was one of those life changing experiences I want anyone suffering from similar pain to hear about,” said Bob.

A previous surgical patient of Dr. Hawk, Bob was in his office for a checkup on his shoulder when Dr. Hawk suggested that he schedule an appointment with Dr. McConnell to address the pain in his neck and back. Knowing that he has complete trust in Dr. Hawk, Bob decided to listen to him and get Dr. McConnell’s opinion despite already having an operation scheduled with another surgeon.

Dr. McConnell looked at Bob’s MRI and EMG tests and saw him for an appointment several days later. After a thorough in-office exam, Dr. McConnell was not in agreement with Bob’s original diagnosis from another surgeon, and scheduled him for a CT scan to confirm his suspicions. “I was beginning to realize just how lucky I was in following through with Dr. Hawk’s suggestion,” Bob recalled. At another appointment to go over the findings of the CT scan, Dr. McConnell’s suspicions were confirmed, and he explained to Bob what the CT scan, MRI, and his symptoms were telling him about Bob’s condition. “I knew I found the right doctor,” said Bob, “not only did he tell me what was causing my pain, he showed me.”

Dr. McConnell has been a spine surgeon for 24 years, and has subspecialty interests in scoliosis surgery, total disc arthroplasty in the cervical spine, and minimally invasive spine surgery. When asked about Bob’s condition, Dr. McConnell noted, “Pain from a pinched nerve is one of the worst kinds of pain a patient can experience. Once the nerve compression is relieved with surgery, patients will typically experience complete pain relief and a corresponding significant improvement in quality of life. Bob had not just one nerve being pinched, but three, therefore his pain and disability were even greater.”

Dr. McConnell and Bob weighed the pros and cons of various surgical approaches. “Dr. McConnell explained to me how each option would benefit or detract from the outcome he was seeking. This is how medicine should be practiced! He put my mind at ease and I knew he was prepared to handle whatever was needed to alleviate my years of pain and suffering,” said Bob.

When asked about the surgery, Dr. McConnell explained, “Bob’s condition was secondary to multilevel degenerative disc disease and bone spurs which were compressing several nerves to his left arm. To treat his condition, we had to perform anterior discectomy and interbody fusions at C4-5, C5-6, and C6-7.” In other words, Dr. McConnell removed the collapsed discs in Bob’s neck, which then allowed him to remove the bone spurs that were compressing the nerves to Bob’s arm. To further restore the opening between the vertebra and to provide additional space for the nerve roots, spacers were placed between the vertebra to hold them apart. Then, to lock the spacers in place and to bind the vertebra together, small plates were inserted into the vertebra. Patients like Bob are a constant reminder as to why Dr. McConnell became a spine surgeon – “I enjoy solving problems and having the opportunity to improve patients’ lives through surgery,” Dr. McConnell affirmed.

Reflecting back to the day of surgery, Bob said, “It is hard to put into words the times in one’s life that are mystical; like when you are there for the birth of a child, or when other miraculous things happen, but I can tell you waking up after surgery and immediately noticing feeling in your hand without any numbness or burning is one of those spiritual moments you will never forget. I will be forever grateful to Dr. McConnell, his staff, and Dr. Hawk for his suggestion to see Dr. McConnell. They should be proud of what they do and how they do it – we are all better off because of them!”

Case Study: Scoliosis

Scoliosis

This is a 15-year-old girl with a progressive right thoracolumbar scoliosis which had become painful and resulted in an unsightly deformity of her back. The curve was corrected with surgery using spinal instrumentation which includes two titanium rods attached to the vertebra with screws and a novel device utilizing soft Dacron straps placed beneath the lamina of the vertebra which then allows the spine to be pulled straight against the rods.

 

Click here to learn more about adolescent scoliosis >>

Pre-Operation Condition

Side_By_Side_Scoliosis

 

Post-Operation Results

Case Study: Alana Andersen

Scoliosis

Alana_Pageant_01Meet Alana – OAA’s May Patient Ambassador, as well as the first-runner up in the Miss Pennsylvania Teen USA pageant. Prior to her surgery with Dr. Jeffrey McConnell, Alana suffered from the signs and symptoms of scoliosis. The pain and strain of this condition made everyday tasks, including sleeping, difficult. Her condition also kept Alana on the sidelines of some of her volleyball games. “Sometimes after strenuous activity, my back would hurt so badly, I had trouble standing up straight,” says Alana. In addition to these physical hardships, Alana was also impacted emotionally. “I was self-conscious of my disfigured torso and the way clothes looked on me.”

Scoliosis is a deformity of the spine where the spine predominantly bends or curves to the side. Most cases of scoliosis are known as “idiopathic” where the curve occurs in otherwise healthy adolescents. Idiopathic scoliosis is an inherited or genetic condition where it tends to occur in people where there is a family history of the disorder. The curvature is usually diagnosed after the age of 8 and before the age of 16. This form of scoliosis is actually quite common; however in most cases the curvature of the spine is mild and never requires any treatment. Approximately 15-20% of cases will progress to a point that may require treatment and the potential of surgery.

Alana was one of the 15-20% of individuals that required surgery to correct her spine, and she sought the expertise of Dr. Jeffrey McConnell of OAA’s Spine Center of Excellence. Dr. McConnell has been a board certified orthopaedic surgeon for 22 years and devotes his entire practice to treating disorders of the spine. “I have a subspecialty interest in treating spinal deformities like scoliosis and performing motion preservation surgery, particularly disc replacement surgery in the neck,” says Dr. McConnell. Dr. McConnell is also the founding member of Operation Straight Spine – a nonprofit organization that has been providing much needed care to the many indigent patients from Kolkata, India and surrounding regions, who suffer with spinal disorders.

Dr. McConnell performed a five hour surgical intervention on Alana’s spine. Her spine was straightened by using two rods attached to multiple vertebrae. Following the surgery, Alana was prepared for a long road to recovery. “The recovery after surgery was extremely difficult the first couple of weeks, but that was expected after a surgery of such severity. I was in the hospital for about a week until I returned home for the holidays. Having some issues with my medication, Doctor McConnell took time out of his Thanksgiving Day festivities to talk with me on the phone about my issues and pain level.” After about a month, Alana started to see some significant progress in her recovery, and finally returned to school after two months. Several months after that, she started living her normal life – including participating in athletic activities.

Alana_Pageant_02When asked if Alana would recommend OAA Orthopaedic Specialists to family and friends, she stated: “Absolutely. Thanks to Doctor McConnell, I was able to compete in the Miss Pennsylvania Teen USA Pageant. I was actually going to compete the year prior, but needed the surgery instead. Once my back was straightened and I felt more confident, I was able to compete to represent all of Pennsylvania and ended up placing First Runner Up in my first beauty pageant ever. My on-stage interview questions dealt with my surgery and my recovery and therefore, I was able to talk about how something so positive came from something so negative. I had the chance to tell the judges, audience, and other competitors my success story and that all thanks were due to Doctor McConnell and his expertise.”

It is remarkable to hear how Alana’s surgery has impacted her life in such a positive way. It is patients like Alana that make Dr. McConnell and his colleagues at OAA so passionate about their work. “I enjoy the challenges I am faced with in diagnosing and treating many different spinal disorders, but what I enjoy most is making a difference in someone’s life through corrective surgery,” says McConnell.

1 2 3