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Teen from China Finds Help and Hope at HSS

“Dear Dr. Blanco:
Do you remember me? I am your patient Xiu Qin Chen. I did my scoliosis surgery in June. Today is Thanksgiving. For this special day, I want say “thank you” to you. Thank you for giving me a new life.”

John Blanco, MD, pediatric orthopaedic surgeon at Hospital for Special Surgery, received Xiu Qin’s email message (excerpt above) at a time that not only underscored the meaning of Thanksgiving, but also emphasized the impact of modern medical technology. “Her message reinforced how we, as physicians and surgeons, can make a tremendous difference in the lives of our patients.”

A Long Journey

Diagnosed in China with scoliosis at age 14 years, Xiu Qin suffered from impaired mobility and constant pain. For Xiu Qin, regular activities of daily living, such as lifting, bathing, sitting and walking, became more difficult over time. She was unable to stand erect and depended on others for mobility. Compromised healthcare resources in her region of China precluded Xiu Qin from appropriate medical care.

“We were told that Xiu Qin should have surgery, but that it was too risky,” explains Xiu Qin’s mother, “I wished so much for my daughter to have a healthy and happy life.” In 2008, this mother’s hope for her child became possible, when the Chen family immigrated to New York City and learned of the expertise at HSS.

Referred to the Hospital by her family physician, Xiu Qin received a thorough evaluation by a multidisciplinary team, including orthopedics, genetics, and rheumatology. “She came to us complaining of chronic back pain, but it was much more complicated,” recalls Dr. Blanco. “Xiu Qin presented with a severe scoliosis that we do not commonly see, requiring a comprehensive team approach to her care.”

Scoliosis is a progressive curvature of the spine seen in both children and adults. The condition is considered severe, and surgical intervention is recommended, when a spinal curve is greater than 50 degrees. In Xiu Qin’s case, the curvature was over 90 degrees.

Dr. Blanco recommended surgery for Xiu Qin as the best option for correcting her spine and alleviating pain. “Traditionally, the goal of scoliosis surgery was to prevent the curve from getting worse, but now we can dramatically improve the spinal deformity during surgical correction,” explains Dr. Blanco. Dr. Blanco also points out that in patients like Xiu Qin, in which scoliosis measures more than 80 degrees, lung and heart function also may be compromised. For this reason, spine correction not only can improve a patient’s quality of life, but also preserve it.

Extremely frail and underweight, Xiu Qin began a year-long process of preparing for surgery, with the assistance of many HSS patient services, including language services, food and nutrition, patient education, and social work. “What comes to mind is the dedication of Xiu Qin’s family and their endless cooperation” says Amy Silverman, LCSW, ACC, Social Worker in Pediatrics. “In particular, I was struck by their level of patience with all the steps needed to make sure that Xiu Qin had her surgery.”

Formula for Success

Although anterior and posterior surgery of the spine is often performed simultaneously, Xiu Qin’s scoliosis condition and her weakened constitution required two operations which included nearly 10 days of recovery time in between procedures.

“Same-day front and back operations are long, about 14 hours, but lead to less overall time spent in the hospital,” explains Dr. Blanco. “For Xiu Qin, however, the magnitude and duration of the operation, the amount of blood loss anticipated, combined with her still frail medical condition presented too great a risk.”

At 16 years of age, Xiu Qin underwent her first operation on June 3, 2009. The procedure consisted of releasing the ligaments and discs in the front of the spine to increase the flexibility of her curve. During the second operation, on June 12, Dr. Blanco attached two metal rods to Xiu Qin’s spine, using hooks and screws attached to the vertebral bodies. Rods attached to the spine ensure that the backbone remains corrected while the spinal fusion takes place. Bone graft material is used to solidly fuse the spine. The rods remain attached to the spine for the rest of a patient’s life.

Due to the complex nature of the surgical procedure, Dr. Blanco requested the assistance of Dr. Michael LaQuaglia from Memorial Sloan-Kettering’s Pediatric Surgical Service. Dr. LaQuaglia is a leading specialist in anterior spinal surgical approaches. His expertise ensured that the vital organs surrounding Xiu Qin’s spine were carefully manipulated during surgery and blood loss was tightly controlled. Following the operations, Xiu Qin was transported next door to the Pediatric ICU at NewYork-Presbyterian Hospital-Weill Cornell Medical Center for intensive monitoring.

“From initial evaluation to post-operative management, cases like Xiu Qin’s truly speak to the multidisciplinary, cross-institutional approach to patient care at HSS.” says Dr. Blanco. “It is extremely important that we share expertise and resources to achieve the best possible outcomes for our patients.”

Rehab and Recovery

Xiu Qin was on her feet and taking the first steps toward rehabilitation the day after her second surgery. With a height gain of three inches (from 5'3" to 5'6"), she was among the few patients who required temporary post-operative bracing to provide extra support to the spine due to her weakened bones. Xiu Qin was sent home only one week after the second surgery. She then began a comprehensive program of pain management, nutrition, and physical therapy—a regimen which continues today.

 
Getting back in action: Xiu Qin Chen at work with HSS physical therapist, Lisa Cannegieter

“At the start of post-operative therapy, Xiu Qin presented with a great deal of weakness and decreased endurance. She lacked flexibility and looked down while walking," recalls Lisa Cannegieter, PT, DPT, a rehabilitation specialist at HSS. “Now she is moving with greater ease, better control, and is standing proud.” Xiu Qin’s twice weekly rehabilitation includes a consistent routine of balance and strength training as well as low-impact cardiovascular activity and a daily home exercise program.

Alongside rehabilitation, Xiu Qin also receives treatment for an underlying rheumatologic condition discovered during her initial evaluation. She pays regular visits to HSS pediatric rheumatologists Alexa Adams, MD, Emma MacDermott, MD, and Laura Barinstein, MD who carefully monitor and manage joint pain, stiffness and musculoskeletal issues associated with her rheumatic disease, while also collaborating with orthopedics to ensure a comprehensive continuum of her care.

The need for further surgery remains to be seen, but thus far Xiu Qin’s prognosis is promising. “The progress Xiu Qin has made since her first visit has been remarkable,” says Dr. Blanco. “Her body and will to succeed are strong and getting stronger everyday.”

Today, at 18 years, Xiu Qin is a successful high school student in Brooklyn, where her family has established their new home. “I owe my second life to Dr. Blanco and everyone who helped me at the Hospital,” says Xiu Qin. “As the Chinese saying goes, ‘sunshine always follows the storm.’”

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