Interviewer: What types of patients do you see on a regular basis?
Dr. Thomas J. Morrison, III: I see a lot of patients that have complex spinal problems, which include things from lumbar deformity, kyphosis and scoliosis or herniated discs in their lower back. I’ll see patients with conditions that are straight-forward and non-operative that do well with conservative care, to things that are incredibly complex that require multiple hour surgeries to correct their deformity.
Interviewer: What types of treatments are available for the patients you see?
Dr. Morrison: Some patients that we see will get better with conservative treatments, like physical therapy or aquatic therapy. Sometimes we see dramatic improvement with injections from pain management doctors, like our physiatrist Dr. Mangrum. The last thing we consider is the option for surgery. The low percentage of people that we see that need surgery typically fare very, very well. Again, that’s the very last option.
Interviewer: You were just talking about scoliosis and kyphosis. How many patients do you see with those conditions?
Dr. Morrison: Well, let’s start with the difference between scoliosis and kyphosis. Scoliosis is a rotatory disease of the spine that causes you to be tilted from one side to the other. When we examine a patient, we can tell they might have scoliosis due to the curvature of their spine. Because of that curvature, a person could have multiple problems. When a person becomes an adult, the problem they often face is that they develop a degenerative disease in their spine. That disease causes them to have pain. Kyphosis is a problem when you see a patient, and they’re tipped forward. Patients with kyphosis are unable to stand up straight and their shoulders lean over their pelvis. Kyphosis is very, very highly correlated to pain. Many times we’ll see that kyphosis is the result of natural degeneration but it can happen in people that have had prior surgery, and their spine can degenerate further. Kyphosis after a prior surgery is one of the most common issues we see. And then, some people have congenital, or natural, forms of kyphosis. I’ve seen some people who have kyphosis and scoliosis (sometimes called “kyphoscoliosis”) where they have a combination of both. Those patients also tend to have already been through many conservative measures. They’re coming to see me because they know they’re reaching a time when surgery is the best option. As far as total number of patients we see, it’s only about 15% to 20% that will require a surgical option.
Interviewer: So, to clarify, scoliosis is where the spine has more of an S-curve, while with kyphosis the spine is more tilted forward?
Dr. Morrison: That’s correct.
Treatment can begin with traditionally conservative measures, like aquatic therapy.
Interviewer: How has scoliosis treatment changed over the years, especially within your scope of practice and how long you’ve treated patients?
Dr. Morrison: The most common form of scoliosis is adolescent idiopathic scoliosis, or AIS. It’s seen in teenagers, and most of them are girls. Normally, it’s a genetic predisposition to have AIS. With the advent of new technologies and ways to correct it, many of the previously affected young adults are receiving treatment at a young age. Fortunately, young people who receive treatment will not likely have the same kind of adult scoliosis problems that people in their 50s, 60s, and 70s display. It might be because surgery wasn’t as historically available nor it did not have as favorable of an outcome as it does today. People who did not receive treatment in their teens can see back pain problems and leg pain problems later in life. For those who were not treated, scoliosis becomes more exaggerated because the forces on their body become extreme as their body is not in the normal position. As a result, their joints can see excessive wear and impact.
Interviewer: Diagnostically, how would you see if someone has scoliosis?
X-ray demonstrating the “S-curve” of the spine present in scoliosis
Dr. Morrison: It can be simple. We can take an X-ray that takes an entire view of your spine. We call that a 36-inch cassette, or a scoliosis series. Nowadays, we can do it digitally. First, we look to see if the patient’s shoulders are balanced over their pelvis. Some people may have scoliosis, and they have a curve in their thoracic spine and also a curve in their lumbar spine, but it balances out, and they’re doing very well. But other people can be out of balance, and their shoulders do not rest over their pelvis and this can cause them a lot of pain. The same holds true for kyphosis, but only in another plane. If the patient’s shoulders are tipped forward, and in front of their pelvis then they have kyphosis. If they’re not, they have normal stature.
Interviewer: What is one of the predictors of whether a patient will do well with scoliosis surgery?
Dr. Morrison: If the treatment is just limited to purely scoliosis, it’s often relative to how significant the curve is in the spine, how much associated degeneration the patient has, and if there is nerve compression. If there is nerve compression, the curve is greater than 50 degrees, and if there is associated degeneration, we’ve seen those patients do extremely well with surgery.
Interviewer: How is surgery used to help patients with kyphosis or scoliosis?
Dr. Morrison: The goal for surgery for adult deformities is essentially to correct the spinal misalignment and restore the natural curve to a person’s spine. Historically, the goal was to get a 50% correction in the spine curvature, but today we see at least 80%, if not more, correction in their curvature. Those people see a dramatic difference in their function, too. If you look at the people with kyphosis, there’s that large group that has both kyphosis and scoliosis, the kyphosis group typically does extremely well. They normally do well when you realign their lumbar lordosis, or their curve in their lower back, with their pelvic incidence. The pelvic incidence is the shape of how the legs and pelvis attach. There’s an angle at the pelvis, and that angle has to match the natural curve of the spine. When those numbers get out of balance, those people have horrible back pain. There’s no way that the patient’s back pain can get better until we bring that angle closer together. We can bring that angle back into alignment with surgery, and those patients see a dramatic benefit. The benefit comes in a reduction of pain, but even more importantly it comes in improvement in what we call functional disability. Following surgery, they’re able to do a lot more of the regular things that they weren’t able to do before. We see patients that can’t stand more than five or ten minutes. After surgery, they can stand as long as they want — even go shopping in the mall. Whereas, before surgery, it was an impossibility. They can now go to a soccer game or a football game that their child or grandchild is playing in. They experience a dramatic improvement in their functional quality of life.
Interviewer: For a patient who might have been diagnosed in their teenage years with mild scoliosis but did not require a correction, what can change in their spine with age that can cause them to need surgery or have real problems with that scoliosis later in life?
Dr. Morrison: Most people who have mild scoliosis as a child do not get corrected. They’ll normally do very, very well for an extended period of time. If they’re going to have a problem, they don’t typically have problems until they’re in their 50s. As we age, we go through the normal degenerative process. With these early onset cases of spinal curvature, added with later forces of age degeneration on the spine, the curvature can sometimes get greater. And that can be a problem. We typically see a worsening of their scoliosis just through the degeneration.
“HANDS DOWN, THE BEST PART OF MY WORK IS WHEN I SEE A DRAMATIC IMPROVEMENT IN THE QUALITY OF A PERSON’S LIFE.”
– Thomas J Morrison III, MD
The bigger problem is that the forces that are exerted against spine are not running symmetrically through the joint because the joint is not in the normal position. As a result, the joint will develop arthritis in the places that take excessive force. Those places where there is excessive force will then cause the patient to have pain. We’ll then attempt traditionally conservative measures, like aquatic therapy, physical therapy, and injections. However, if the pain persists, it may sometimes require surgery. If surgery is needed, we want to correct the deformity so that the pain and problems do not continue.
Interviewer: What would you say is the most rewarding aspect of your specialty of adult deformity correction?
Dr. Morrison: Oh, the most rewarding aspect is definitely the fact that the patients get such a dramatic improvement in their quality of life. That is it — by far. When I’m able to help a patient who can’t stand or walk more than a few minutes, or they can’t walk out to their mailbox. And following treatment, they can walk for long periods of time and they can stand for hours at a time, and they have no problems with it. They can play basketball with their kids again. It dramatically improves their quality of life. That’s absolutely the best. Hands down, the best part of my work is when I see a dramatic improvement in the quality of a person’s life.
Interviewer: Thank you so much, Dr. Morrison.