What is Scoliosis and What Causes It?

A Brief Overview of Scoliosis and its Causes from OSC

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The medical term Scoliosis is derived from the Greek word, “skolios” which means “crooked”. Scoliosis is simply an unnatural curvature of the spine, which can curve to the side or be curved in the middle of the spine. Although it can develop at any age, there is a higher prevalence of the condition during the high growth periods associated with childhood and is more commonly seen in girls. It is observed less often in infants or in very young children.

The causes of scoliosis are as follows:
• A problem with the formation of the spine while in the womb or as a young child grows (approximately 15% of cases)
• As a secondary result of a disease like muscular dystrophy, polio, cerebral palsy or polio (approximately 10% of cases)
• From an unknown or idiopathic cause (approximately 65% of cases).
• A genetic link has been theorized, but not yet proven to exist.

In the United States, approximately 7 million persons are affected with Scoliosis.

Call Orthopaedic and Spine Center on (757) 596-1900 for a consultation today

A Day In the Life of an Orthopaedic Physician Assistant

by Orthopaedic & Spine Center’s Tonia Yocum, PA-C

(Physicians Assistant – Certified)

On a typical surgical day, I am up and out of bed at 5:15 AM. I leave the house at 6:00 AM and normally arrive at the hospital around 6:30 AM. I usually change into surgical scrubs when I arrive, although I wear a lab coat when rounding on our post-operative patients.

Orthopedic Physicians Assistant - CertifiedTonia Yocum

My days in the hospital are divided into two distinct parts: (1) rounding (visiting and evaluating) patients who have already had surgery and; (2) assisting Dr. Jeffrey Carlson with his orthopaedic surgical cases in the operating room.

Upon arrival at the hospital, I usually complete rounds (evaluations) on post-operative patients. When I am in a patient room, my activities include:
• Asking the patient how they are feeling while checking the surgical area for any abnormalities (if I find anything of concern, I report it to Dr. Carlson immediately)
• Answering any questions they may have about their surgery and recovery
• Outlining expectations of what will happen during the day at the hospital & helping them feel comfortable with the planned therapies (mainly ambulating with physical therapy),
• Reviewing their lab results, vitals and writing SOAP (Subjective, Objective, Assessment Plan – medical format) notes in their chart.

Orthopaedic & Spine Center's medical facility in Newport News VA

OSC's State of the Art Orthopaedic Facility

Around 7:30 AM, I report to operating room for first surgical case of the day. Part of the surgical P.A.’s job involves pre-operative preparation. I spend time with each of our surgical patients before surgery and these are some of the responsibilities I have:
• Speaking with the patient before surgery to answer any last minute questions and to reassure the patient if they are anxious about their surgery
• Discussing post-operative instructions
• Listening to patient’s heart and lungs
• Assessing vital signs
• Asking the patient pre-operative questions (Example: Did you have anything to eat or drink after Midnight?)

OSC Spinal Surgeon Dr Carlson

If everything checks out okay with the patient, I then pull together all of the information necessary for Dr. Carlson to proceed with the surgery. This includes patient demographical information, their history & physical and MRI images. Dr. Carlson will review this information before the surgery and may refer to it during the surgery.

At this point, the patient has been prepared for surgery and has been seen by the anesthesiologist, who has started an IV and sedated the patient to help them become less anxious. The patient is wheeled into the OR and I then begin to assist with the surgery. Some of the duties I perform are:
• Helping the surgical team transfer patient to O.R bed
• Standing-by during patient intubation
• Positioning the patient properly on O.R table
• Scrubbing- in for the surgical case
• Opening surgical instruments
• Making sure all necessary equipment is available and ready
• Draping the surgical patient
• Performing suction, retraction, tying, suturing during the operation
• Applying dressing to surgical area

At 10:10 AM, we finish our first surgical case. The patient is extubated and transferred back to a hospital bed. I write post-operative notes & orders specific to our patient that will be used by the nursing staff while the patient remains in the hospital. I then assist with transferring the patient to recovery room.

At 10:25 AM, I start the process over again with our second surgical patient of the day. My evaluation lasts until 10:40 AM. I then start writing some orders and grab a quick snack before returning to the OR.

Dr. Carlson and I have successfully completed 5 surgical cases today. I did get to grab a bite of lunch after our second surgical case and another quick snack around 5:00 PM. Today, my day at the hospital ends at 7:15 PM. I now leave for my second job, being a wife and mother!

How Active Can I Be After Spine Surgery?

OSC’s Dr Jeffrey R. Carlson, MD Explains What You Can Do After Surgery on Your Spine

Patients often ask about the activities that they will be allowed to participate in after they have spine surgery. Many fear that they will not be able to return to their previous level of activity and are doomed to a miserable future as an overweight couch-potato. Spine surgery can be concerning enough without the patient worrying about the consequences of the surgery itself.

OSC Spine Surgeon Dr Jeffrey Carlson MD

Dr Jeffrey Carlson preps for surgery

There was a school of thought that suggested that patients who undergo spinal surgery should never participate in sports and should change jobs to less heavy labor positions. Now, there are several studies that show professional football players are able to return to their original starting positions on the field after disc removal, or microdiskectomy. Obviously, these are some of the top athletes in the country who should have better pre-operative fitness than the average patient. There is currently a study in the journal SPINE, which looks at patient’s perceptions of spinal surgery and their post-operative activities. As the physicians in this study found, patients who were more fearful of moving after surgery, had more pain and dysfunction after surgery than those patients who were more confident in their attitudes about moving.

OSC spinal surgery center

Evaluation for Spine Surgery

One of the goals for most spine surgeries is to restore the patient’s activity levels to normal. The spine specialist should address any expected limitations after surgery, before the surgery is performed. This conversation should include the ability to walk, bend, lift, turn and any type of brace that will be needed. For example, after a typical spinal fusion, there will be some limitation in lifting and exercise for the first 6 weeks from surgery. After the first 6 weeks, patients should be allowed to return to their normal activities. Depending on the patient’s pre-operative health and fitness, physical therapy may be needed to get the patient back to their normal routines and exercise.

As a practical matter, if the spine surgeon does not present a surgery that will return you to your previous level of activities, the surgery should not be performed.

Dr. Jeffrey R. Carlson attended medical school at George Washington University, completed his residency at Harvard University Combined Orthopaedic Program in Boston, MA and has fellowships in Orthopaedic Spine Surgery and Orthopaedic Trauma Surgery. Dr. Carlson currently practices as an Orthopaedic Spine Specialist at the Orthopaedic & Spine Center in Newport News, VA.

Spondylolisthesis – A Fancy Name for a Common Spine Problem

Did you know that back pain and leg pain will cause about 20% of our population to see a physician each year? Although most back pain is minor and will usually resolve on its own,  there are many different diagnoses that can cause lingering lower back pain.  About 10% of the patients that see an orthopaedic spine specialist for their back pain are diagnosed with a condition where the bones in the spine have slipped or changed position slightly.  In medical terminology, this is called spondylolisthesis.

There are several different reasons that the bones may slide or change position.  The most common is degenerative disease of the discs that cause the bones of the spine to sit more loosely on each other and allows shifting to occur.  Children may also have a failure to form a complete connection in the spine.  This lack of connection allows the bones to slip on each other.

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