(upbeat music)
- I'm Dr. Arlet, I'm an orthopaedic spine surgeon.
- I'm Dr. Ozturk, I'm a neurosurgeon here at Penn Medicine.
And today we're going to be talking about
adult spinal deformity.
When people think about scoliosis,
they usually think of younger patients,
but in fact, it's extremely common in adults.
A lot of these are nonsurgical and they're asymptomatic,
but many can progress and become very painful,
and they are amenable to surgery.
- People older than 70 years of age
have a 70% chance to have a 15 degree scoliosis.
So I have lots of people around us
who have scoliosis
and it's very common in the adult population.
- If it progresses oftentimes past a curvature
of 30 degrees, 40 degrees, it can be very painful,
leading to a curve of the spine and sometimes
with a patient listing towards one side.
There can also be deformities in the sagittal plane
which Dr. Arlet can tell us about.
- Yes, we see a number of patients who have
what we call a flat back,
that means they are not able to stand up straight
and they stand up stooped forward.
They cannot stand up straight and this is very painful,
very demanding on the back.
We have another category of patient we see
quite often, is a patient who had multiple spine surgeries
done elsewhere,
and whether the surgery didn't address the initial problem
or whether the surgery got a complication
or whether it's a natural history of the aging process,
they need to address this new problem,
so to relieve that pain and get them straighter
with a better balance.
As the spine gets older, the discs lose some of their height,
they may collapse to one side.
So causing asymmetry either to the side or forward,
then you get a nerve impingement.
The nerve gets pinched to some extent
creating spinal stenosis.
So patients come with a complex situation
where you have a spinal stenosis and curvature of the spine.
- It's the price we pay for being upright
after 70 years, people are living longer and longer.
But as Dr. Arlet mentioned,
it tends to be an asymmetric degeneration
of the adult spine,
which can lead to a curvature of the spine
either to the side or forward.
All of which can be very painful.
We have special x-ray machines here with our EOS machine,
which takes a picture of the entire skeleton
of the human body
and it really lets us appreciate the alignment.
We frequently get both CAT scans, MRIs, electromyography,
which is a clinical test
that our neurologists help us perform
and most importantly, the clinical history
and the physical exam.
We have to put all these together
to make sure that we're operating on a correct diagnosis.
- The one thing that patients should know
about this EOS machine is that the amount of radiation
that's delivered with this machine is one fifth.
So that means the people who come to Penn to get these x-rays
have 80% less radiation
than conventional x-rays done elsewhere.
- I think probably one of our biggest assets
is the experience of the entire hospital
and the team, from our anesthesiologists
to our electrophysiologists, to our surgeons,
to the nursing care, to the ICU care.
I think we're all used to dealing with this
and that's probably our biggest asset.
In the operating room, we have the ability to monitor
the function of the patient's nerves.
So if we're doing anything to irritate the nerves
of the spinal cord, we have immediate feedback.
We have intraoperative CAT scanners, x-rays,
a lot of safety mechanisms that are nice to have in place
to make these operations safer.
- You should see the OR at Pennsylvania Hospital
where we have a huge number of spinal surgeries
that are done every year,
we're doing more than 2000 spine surgeries every year.
And so whether it's the scrub tech who is helping us out,
the spine technologist who is helping us out,
everybody knows how we work, everybody knows what their role is
and this makes the surgery very successful, it goes faster.
Many places we hear about surgery that lasts 12 hours,
when we know we do them in six, seven hours here.
- I think this is the sort of surgery
that you probably would be ill-advised to have it
in a place that does a few a year.
We do at least several a week.
- And the important thing is that
patient expectations are real
and we meet the expectations of the patient
when we talk to them so they can be happy
when we've done the treatment or we operate on them.
- This is one of the rare conditions
that I think that we can actually call it a cure
if done properly and if the spine is properly realigned,
and it's extremely gratifying
to see these patients back in my clinic, oftentimes
they give you a big warm hug and it's very satisfying.
If you need more information
about our adult spinal deformity program,
please visit the Penn Medicine website.