Straightening Scoliosis -- Full-Length Doctor's Interview

[antiquity]

Straightening Scoliosis -- Full-Length Doctor's Interview

Oct. 14, 2002 (Ivanhoe Newswire) --
Ivanhoe Broadcast News Interview with
Alexis Shelokov, M.D., Orthopedic Spinal Surgeon,
Consulting Orthopedists, Plano, Texas,

TOPIC: Straightening Scoliosis

What type of work do you do?

Dr. Shelokov: I'm an orthopedist who specializes in pediatric and adult scoliosis surgery. Since my days in Boston doing predominantly pediatric spinal deformity, my practice has changed rather dramatically. Now, it has flipped in the other direction. I do about 70 percent adult spinal deformity and only about 30 percent pediatric spinal deformity.

What I found after I left the university setting was that adults were really given short shrift or largely ignored, certainly in our training in Boston, they were ignored. We were told that adults with scoliosis had no pain, had no greater disability than anybody else, and there was really nothing to do for them. What I and some others around the world found was that number one, they do have significant levels of disability -- both back pain, problems with their lungs, right heart failure, and eventual significant inability to live their lives. Number two, with the change in spinal instrumentation, there were very effective operations that we could perform that we could give them hope, that we could improve the quality of their life, that we could change the quality of their life. As a wonderful byproduct, we could also improve them cosmetically.
So it was really a win all the way around. It has been an exciting last decade.

My practice is both a clinical private practice, then I have an academic appointment at the university and the children's hospital, and I'm actively involved in research in spinal deformity and scoliosis in adults and children around the world.

I was taken back to find out that only 24 doctors are actually performing these surgeries.

Dr. Shelokov: It's interesting. There are many orthopedic surgeons that perform pediatric spinal deformity surgery and scoliosis and then again, there's a very good children's hospital in most major cities in the country. What there are not is a wide variety of surgeons available who operate on adult spinal deformity exclusively or in significant numbers. When you go to one of the meetings of the specialists, like myself, it's a very small group and you usually see the same faces. Twenty or 30 people from around the country and around the world do a lot of spinal deformity. In fact, in Europe and in Asia, there's much less emphasis in reconstructive surgery in general, whether it be total joints, total knee replacement, any of those sorts of procedures. The preponderance of spinal deformity surgery is done here in the states. It's interesting to note that my practice has many patients from Europe, Asia. I had a young woman from Moscow in the other day with an immense deformity that people I know in St. Petersburg really could not fix and they sent her to us for evaluation.

It must be rewarding for you because you really see not only a physical change, but you see a mental change in your patients. You see their lives improve along with their lifestyle.

Dr. Shelokov: It's interesting that you mention that. Orthopedists are viewed as a whole as people who use hammers and bolts and chisels and really don't want to have a lot of contact with their patients. I think that's a misrepresentation. I'm lucky enough to have a very exciting practice. We do an operation, we correct the patient, but I get to know the family, I get the know the setting, I get to know many, many details of their lives and watch these people evolve and hopefully return to much more functional lives than they began with. There are times that I describe my practice as one of being a psychiatrist with a knife.

It's an odd way to put it, but any time you're doing a procedure that changes the way a person looks physically and the way they feel physically, you can't do that effectively without dealing with the patient emotionally, dealing with them as a person rather than just a collection of bones.

Give me the non-technical language of exactly what this is. You're straightening the spine, you're straightening their spirit, and you're giving them more time, right?

Dr. Shelokov: You put it more succinctly than I could have. We're straightening their spines. We do that in a variety of ways. The techniques aren't really the focus. We're changing their outward appearance and it would be false to say that outward appearance to human beings, to us, is not important. I see many young adults and middle aged people who come in and say, 'You know, I never said this to anybody, but I feel not only awkward but I feel different, I feel deformed.' If you can change that while you're treating their underlying problem, it's a great byproduct. It's not the reason we do the surgery, but it's fabulous to be able to offer them relief of their pain, protection of their lung and their hearts, and as a wonderful byproduct, have them look better. I have a very rewarding job. I get to go to work everyday and do things that are both technical with my hands and emotional with the hearts, so it's a very rewarding job.

We were talking about how a lot of these patients experience anger after they realize that something can be done for their condition. What was the belief before people like yourself starting correcting adult scoliosis?

Dr. Shelokov: What we were taught 20 years ago, and what was actually the prevailing belief among many physicians around the country, is that there is nothing that can be done for adult spinal deformity. When you meet a new patient who has chronic pain or who has early pulmonary or lung problems, and you say, look, I can correct your spine, I can provide significant pain relief, their first emotion is elation. But, often to my surprise when I started doing this a decade ago, is the second emotion is anger. 'Why didn't somebody tell me? Why have I seen six doctors, why have I seen eight doctors, why have I been to five clinics and nobody told me this was a possibility?' Eventually that anger gives way to, 'When can we get this done so I can get on with my life?' As I think I've told you, one of the patients that I operated on about five years ago was a nurse here in this town from a very prestigious institution. She's one of a very high-level management personnel. She'd been seen by no less than nine different physician surgeons and told there was nothing to do for her adult deformity. She came to see me, she had the surgery, she went through the same emotional responses that we've talked about, she returned to the wards and to her administrative job four weeks after surgery. That's just a delightful reward for me, seeing somebody who has gone through the appropriate emotions and has gone back to productive life.

We're going to talk about what you actually do to the spine. How do you actually correct it?

Dr. Shelokov: Correcting the spinal deformities involves two general principles. Number one, make a spine that is rigid more mobile and you do that by taking away the constraints, the parts that are holding it -- ligaments, tendons, disks that are keeping it rigid. The second concept, or the second component of the surgery is then placing the spine where is beings, holding it in position with a series of rods and then fusing it in that position with the patient's own bones.

Those are the general principles. In practice, it requires surgery sometimes from the front or the side of the spine and surgery from the back to be able to approach all of those structures, all the restraints. To do it safely, you need a flexible spine. There has been a trend toward what we call minimally invasive surgery in the United States. Unfortunately, this is not minimally invasive surgery. There are risks, but those risks are well tolerated. Of course, with any surgery, there are risks. The risk of a major neurologic event is less than 1 percent for the average scoliosis surgery that's done. The other concerns for us as physician and patient are infection, are blood clots in the legs and surprisingly, failure to fuse. Yes, of course there are complications in any surgical procedures. The good news is those complications are well managed and are of reasonable magnitude.

What are some of the risks?

Dr. Shelokov: Of course. With any surgery, there are risks. Those risks however can be managed. In general, the risk of neurologic injury, which I think is one of the important ones that people want to know about, is less than 1 percent in the average scoliosis surgery. Then there are risks of infection, blood clots and pneumonia. But all those things can be managed at a reasonable level.

If I have scoliosis and I need to be corrected. How much is it going to cost me? Is my insurance going to cover it?

Dr. Shelokov: Well, the good news is that insurance does cover it. It is considered an appropriate medical problem. In fact, our experience in this practice in dealing with 120 health plans around the country is that they are very helpful, that they don't stand in the way of appropriate care for patients.

We have a staff of people in the next office who do nothing but deal with insurance companies. Again, to soapbox a little bit, doctor's offices should be and is responsible for dealing with insurance companies. The individual patient has no ability to negotiate, to deal or to communicate effectively. So that is a service that is offered by our practice.

Aren't there serious complications that come out of scoliosis -- shortness of breath, heart problems?

Dr. Shelokov: Scoliosis is a profound medical condition. The incidence is small -- two or three per thousand. Of those, there is a small percentage that go on to have progressive scoliosis. Those are the ones who need to be treated and they need to be treated to avoid very large curves, which are debilitating in their own right. They need to be treated to avoid chronic mechanical back pain, which is debilitating. And they also need to be treated to avoid the lung and heart complications that can lead to early death.

Patients come to you from all over the world, basically. Why are they coming from such distances? I understand that there's only 24 of you that are actually doing this. But, why are people traveling so far?

Dr. Shelokov: In my practice, many people travel a significant distance. As I've told you, we saw a young lady from Korea, who we operated on last year. She was here early last week. We saw a young woman from Moscow. We see people from all over the United States. It's not only unfortunate, but it's a terrible situation that individuals have to travel that far, but the services we offer are offered in only a few places in the country. Those patients come for several reasons.

First, they have pain that is not manageable with traditional narcotics, with anti-inflammatories, or with benign neglect. Second, they have problems with their lungs or with their heart that make them a poor candidate for treatment in areas closer to them. I tend to be sent patients who are marginal candidates medically sometimes because of the experience we have here at this center. I think the most common reason that people come here, however, is they have chronic back and leg pain that nobody has been able treat. That pain is limiting the quality of their life and they can't get relief from it.

What would you say to someone that's watching this, that sees this, that has scoliosis but doesn't realize this existed?

Dr. Shelokov: I think I have a message of hope. There is hope for treatment. You can be treated effectively. We, as physicians, have not done a good job of telling our patients there is effective treatment -- that you can be made straight, that your back pain can be alleviated, that you can be more productive, that you can have a better time in your life, that you can have more fun with your kids, that you don't have to live with chronic back pain, with chronic depression, and with the view that your life is very limited.

They're willing to go to any length to get their condition corrected?

Dr. Shelokov: Again, we see patients from all over the country and from all over the world and these patients come because they are frustrated. They are really at the end of the line. My practice has been one in which we care for patients and operate on patients that some people in other communities can't or don't care for. So, when those patients come, they are really at their wit's end and they're willing to take reasonable risk for significant benefit.

The statistics are rather terrifying. If you have a curve of 100 degrees and are over age 45, the mortality, that is the chance of dying in any one year, is 100 times greater than an individual without scoliosis. There is a significant medical problem here that is underemphasized by physicians.

END OF INTERVIEW

http://63.111.57.23/story/p_newsflash.cfm?storyid=4584

[whiterabbit11]

I appreciate the article. I'd give anything to sitstraight and relieve the constant pain. I hope this guy in Rapid City is one of the 24 Dr. Shelokov is talking about. WR

[antiquity]

WR, I can't sit for very long without support before the pain starts either. I have a hard molded back now that looks and fits like a TLSO from the back which has been a godsend for me. I would suggest you pursue a hard brace option or a custom back before you consider surgery. It's something you'd need to discuss with a PT or an orthotist though.

[alan]

Any of these 24 doctors in Baltimore?

[Them Bones]

Does anyone have any recent experience with anything like this? Any updates on other treatments for early scoliosis?

[SCI-Nurse]

I am not aware of any new treatment. Lets see what others have to say.

AAD