When Lauren was diagnosed with scoliosis, the 13-year-old competitive swimmer was afraid it meant the end of her hopes to one day compete in the Olympics. After spine surgery with the CD HORIZON LEGACY™ Spinal System, Lauren was soon back in the pool and today at 16 is back on track for Olympic gold.
At the age of 10, Lauren discovered the joys of swimming. By 13, she was on her way to becoming one of the top competitors in her area, seriously working toward attaining the elite level of performance that could take her all the way to the Olympics.
That year, when her doctor discovered a slight but rapidly progressing curve in her spine—a condition called scoliosis—and recommended that she soon have surgery to correct it, she was afraid this was not only the end of her dream of making it to the Olympic trials, but also her days of swimming competitively at all.
Three months after her surgery with the CD HORIZON LEGACY™ Spinal System, however, Lauren was able to get back in the pool and today, at 16, is back on track for a shot at Olympic gold.
"I feel very blessed to be where I am today," she says. "Before my surgery, I told my mom I was afraid I wouldn't ever be able to swim again, and I was really upset. At the time, I thought that if I could just get in the water again, that would be enough, so I feel really happy and amazed at how far I've come after my surgery."
Scoliosis is a condition in which the spine develops one or more abnormal, side-to-side curves that in turn may affect the body's overall balance and alignment, as well as possibly lead to other physical and health problems. While the condition may develop at any age, it most frequently—as in Lauren's case—appears during adolescence, and is more prevalent in girls than in boys. Although genetics, congenital conditions and disease can contribute to the development of a spinal curve, most are considered idiopathic, meaning there is no known cause. For many patients, the condition is not painful. In fact, Lauren did not even know she had scoliosis until she underwent the routine physical required by her school's swimming program.
"My doctor asked me the usual questions, and then told me to bend forward so she could check my flexibility," Lauren says. "She noticed that one of my shoulder blades was higher than the other and that my hips were also uneven. So, she referred us to a spine specialist, who met with me and my parents. That's when I learned I had scoliosis."
"Before my physical, I didn't have a clue," Lauren continues. "I've heard that for some people scoliosis can be painful and their posture's really off. But my curve was so slight at the time—it was caught really early—that I hadn't felt any pain or noticed anything was wrong."
The spine specialist confirmed Lauren's diagnosis using diagnostic tools such as X-rays, computed tomography (CT) and magnetic resonance imaging (MRI) to examine her back. To determine the extent to which a curve has progressed, it's measured using the Cobb Method and categorized in terms of degrees. Lauren's testing revealed she actually had two curves: one in her thoracic spine (mid-back) and another in her lumbar spine (low back).
Treatment of scoliosis depends on the severity of the curve, along with other factors such as the patient's age and physical condition. Non-surgical treatment, such as bracing, is often the first line of defense, and many scoliosis curves never progress to the point where surgery is necessary. Over the next year, Lauren's curves were monitored. Because the degree of curvature continued to increase to the point where her curves were no longer considered mild, but severe, her doctor eventually recommended that she have spine surgery for scoliosis; specifically, spinal fusion.
Lauren and her family understood and agreed that surgical treatment of Lauren's scoliosis was necessary; however, they were also concerned about what effect spinal fusion might have on Lauren's ability to pursue her dreams in the sport she loved. Spinal fusion involves placing bone graft material between vertebrae so they will join together, or fuse. This creates a solid vertebral unit which can, depending on the location, interfere with the spine's ability to flex in that area. And in competitive swimming, spinal flexibility is key, not only to perform the various swimming strokes but also to do flip turns—that underwater somersault and kick-off from the wall that swimmers do at the end of each lap to return to the other side. While Lauren's spinal health was the No. 1 priority, the goal, if at all possible, was to find a surgical treatment that would allow her to continue to perform as an elite-level athlete.
Lauren and her family learned all they could about the surgical treatment of scoliosis, and consulted with several spine surgeons, all of whom recommended fusion for both Lauren's upper and lower curves. Through a teammate of Lauren's who had moved to Missouri, Lauren's family learned about Dr. Lawrence Lenke, with the St. Louis Children's Hospital. "My friend joined a team there and met a girl who had scoliosis," Lauren says. "Dr. Lenke had been her surgeon, so when I told my friend and her family about my condition, they referred us to him because they'd heard he was really good.
"So we traveled to Missouri, and when we met with Dr. Lenke we liked him right away. He knew I was a swimmer, and that I didn't want to stop competing. He said he was going to do a procedure after which, because only a part of my spine would be involved, I'd still be able to do flip turns—I'd still have the flexibility to bend the way I needed to. This made the decision to have surgery much easier for me."
By the time Lauren met with Dr. Lenke, the curve in her upper back measured 59 degrees; the curve in her lower back was 56 degrees. Dr. Lenke agreed that surgery was necessary—and that it should be done very soon. However, rather than fusing both curves, he offered Lauren another option. "After a thorough evaluation, we recommended she have a selective thoracic fusion, in which we would instrument/fuse only her upper curve, thus leaving her lower curve unfused, mobile and hopefully in good balance," Dr. Lenke explains.
Instrumentation is a critical element of spinal fusion. Implanted along the treated vertebrae, it creates an "internal cast" to support the vertebral structures and redirect stress properly along the spine during the healing process. Dr. Lenke would perform Lauren's procedure using the CD HORIZON LEGACY™ Spinal System, a universal, low-profile, top-loading deformity correction/stabilization system with a design based on groundbreaking Cotrel-Dubousset (CD) technology. "The CD HORIZON LEGACY™ System was perfect for Lauren," Dr. Lenke explains. "It allowed me to correct her rib prominence/torso misalignment while keeping her thoracic, instrumented spine balanced to the unfused lumbar spine below."
Although Lauren understood why she needed surgery and was confident in Dr. Lenke's abilities as a surgeon, she admits she was scared going into it. "Hey, I was just 13 and facing major surgery!" she says. Talking with other friends who'd experienced the same thing helped. "One of my friends had had surgery to correct her scoliosis the year before. It's kind of ironic; she came back and talked to me about it, then a month later I found out I had it. Even though my surgery was going to be different, I talked to her about it a lot, which made me feel better.
"The main thing I was afraid of was not being able to swim again, but I was really trying to keep a positive attitude."
Lauren went in for surgery early in the morning. She was put to sleep with general anesthesia for the duration of the procedure, which took several hours. "After surgery, I spent nine days in the hospital," Lauren recalls. "On the third day, they got me out of bed to walk. Trying to walk again that first time was kind of different; it was hard, because I'd been in bed for a few days. I started out at about 5-10 minutes then gradually added more time. Soon, I was walking around the hallways. By the ninth day, I could stand up straight and I felt like I was back to normal."
Lauren didn't have to wear a brace after her surgery. One of the benefits of corrective surgery with CD technology is that it eliminates the need for external stabilization; until a few decades ago, scoliosis patients often spent months encased in plaster casting and strapped into a brace or frame after their procedures. "When I was lying in bed, they put pillows around me to keep me from rolling over, but that's all the bracing I got," Lauren says.
After her surgery, Lauren also found she gained an inch and a half in height and, as she says, really great posture. "Before surgery, I'd kind of slouch over when I was sitting," she admits. After surgery, I'd be sitting up in bed with the straightest back. I was like, "It's going to be so easy to keep my posture now." Early in her recovery, Lauren admits she was in a great deal of pain at the incision site, but says she was able to manage it with pain medication through the healing process.
During her recovery, Lauren's mind was still very much at the pool, and anxious about when she could get back in the water. At first, Dr. Lenke advised her not to swim for a year. "But then I told him about how much I missed it, so he said that once my incision healed I could get in the water," Lauren says. "At three months, I was able to get in the pool, but still couldn't do anything that would hurt my back. No flip turns, or even any strokes that would put pressure on my spine.
"About five months after surgery, I started to swim again, using my arms normally. It was a lot sooner than we expected, but Dr. Lenke saw that I was making a lot of progress. I think it helped that my muscles were already in good shape before my surgery and used to being active. I was so happy to get back to it, because swimming was my life. And it was really good to see all my friends again."
Today, Lauren's back in top competitive form, training four hours a day, six days a week. "We have Sunday off, unless there's a swim meet. Then it's all weekend. I compete in everything, but mainly in backstroke; I've almost made a National cut in the 100-yard backstroke. If I can do that, it's on to the Olympic trials. I almost have the qualifying time for the Nationals, so I'm really close. I would really love to go to the Olympics, or at least be able to say that I made it to the Olympic trials. But right now, my goals are to make the National cut, then get a great swimming scholarship for college—and they've already started sending me letters!"
Three years after surgery, she says she rarely experiences any pain. "Some days it'll hurt, but that's usually just from an overly intense workout or if I slept on it wrong," she says. "But normally, it's just fine—I don't feel a thing."
Dr. Lenke also is pleased with Lauren's progress. "From my perspective, she's done absolutely perfect," he says. "Her X-rays show ideal correction and balance, her clinical exam is also optimal for this type of condition and procedure, and she's asymptomatic. She has full lumbar motion, which has allowed her to continue swimming at a very high level.
"I expect her to continue to function at this level, and wish her well in her Olympic bid!"
After reading this please keep in mind that all treatment and outcome results are specific to the individual patient. Results may vary. Complications, such as infection, blood loss, or nerve damage are some of the potential adverse risks of spinal surgery. Please consult your physician for a complete list of indications, warnings, precautions, adverse events, clinical results, and other important medical information.