Medical History

Preop'1972-age 17. Approximately 133° curve.

Post-Op' 1973 after Halo traction, multiple osteotomies with two Herington rods implanted, 76°.

Frankie Bush

MEDICAL HISTORY

Before Surgery 2001

(click above to enlarge)

After Surgery 2001

I was originally born in Greenville, South Carolina a seemingly healthy, normal baby boy with no abnormalities noted at birth. However, my mother was only 14 years old when I was born and I have never met my biological father. And for the first 10 years of my life I was raised by my now deceased grandparents. For approximately the next seven years I was a normal, active child doing all the same things any other seven-year-old boy would be doing. However, about the same time it was noticed that I was having a slight left-sided tilt in my posture as well as beginning to drag my right leg behind me when I walked. This was the first time in my life our family doctor diagnosed me as having a slight scoliosis. I was then taken to a very progressive chiropractor who placed me into my first Milwaukee back brace. This was not the new kind of Milwaukee back brace or other back braces that they have today with the new light plastics and technology. It was very hot leather on my hips and very heavy steel bars with a shoulder strap underneath my left arm and a right rib strap to hold in my right rib cage. I was supposed to wear the braces 24 hours a day until I was through growing.

After wearing the back brace for approximately five years with no results and only worsening scoliosis, I was taken to Walter Reed military hospital in Washington, DC. (my biological mother married a lieutenant in the Army and I was adopted by him from my grandparents who had been raising me.) At the time my stepfather was in Vietnam and I was admitted to the hospital to what was supposed to have been my first scoliosis spinal fusion. But first I was to wear a COMPLETE BODY CAST which surrounded my head going all the way down past my knees. I laid in the body cast for several weeks as the doctors would come into the children's ward and every few weeks "jack up" the right side of my cast by first removing a couple inches of plaster and replacing it with larger wedges. This was the way they had decided to increase the traction the cast was meant to give my spine. (This was before halo traction was used). I was approximately 12 years old and my spine was very flexible, and therefore the body cast did get very good correction, basically giving me a perfectly straight spine. However, there were a tremendous amount of Vietnam casualties coming into the hospital and they were understandably first priority. Therefore the surgical team made a decision that they could not undertake performing such a large surgery with so much follow-up care that would be needed. And so after about five months the cast was removed and I was simply sent back home to South Carolina to return wearing another Milwaukee back brace as I entered junior high school.

Around the age of 14 my scoliosis had continued to progress to approximately 76° and I was taken to Dr. Wood Lovell in Atlanta Georgia at the Georgia Baptist hospital. There Dr. Lovell did approximately six weeks of preoperative halo traction followed by a spinal fusion with no instrumentation. I then wore a body cast for approximately nine months. There were no complications whatsoever with General anesthesia and the surgery itself went well. Unfortunately nine months later when the cast was removed the fusion did not hold and my spine curved almost instantaneously back into 76 degree position instantaneously. This was the first time my life that I actually felt pressure that left me breathless as my lungs were compressed very rapidly as the cast was removed. Once again I was sent back home and told that there was nothing more than they could do until I was through growing.

At 17 I was in high school going to a very large public school, singing in a rock band, while at the same time performing as a single artist, playing my guitar and singing in various clubs and events where we lived in Columbus, Georgia, also known as Fort Benning Georgia, where my father was stationed. I knew that my scoliosis was getting worse rapidly as things were extremely difficult for me as I tried to keep up the pace with my friends trying to have a normal teenage life style. I knew that my parents were very concerned but had also resided themselves in believing that there was nothing more that could be done to help me until I was through growing. I started secretly going out to Fort Benning for physical therapy where I saw an orthopedic specialist that took x-rays and measured my scoliosis at being approximately 133°. He strongly suggested that I tell my parents and that we go back to see Dr. Lovell in Atlanta. Shortly thereafter my father took me to Atlanta where Dr. Lovell referred us to Dr. Robert Winter at the Twin Cities Scoliosis Clinic in Minneapolis, Minnesota.

I was then sent to Minneapolis where I met with Dr. Robert Winter. I told Dr. Winter that I did not care about or expect to be perfectly straight. But that all I really wanted to do was to be able to not have to walk with having to place my hand on my left hip to hold myself up. This was extremely exhausting. Dr. Winter thought that this was very reasonable and proceeded with multiple osteotomies followed by another six weeks of halo traction again. After the halo traction they did a spinal fusion with instrumentation of two Harrington rods. There were no complications with general anesthesia or the surgery. I was then on complete bed rest for a period of six to nine months in a halo body cast. However I did manage to get up early and began walking with two canes. I became engaged to a nurse in the hospital and was very anxious to get on my life and music career. Of course most people thought I was nuts.

The fusion corrected the scoliosis from 133° to approximately 76°. And I was delighted that even after the cast was removed the correction held, where I was finally told that I could get on with my life with very little restrictions. For the next five years there was a yearly follow-up examinations with complete x-rays. The fusion was seemingly holding well and I really never had time to complain about any particular back pain because my career was going very well and I was very busy on the road working, always living a very fast-paced lifestyle. However, I was noticing that my balance was seemingly getting worse and that my right hand was becoming more and more stiff with spasms in both my right leg and hand. I mentioned this too Dr. Winter and my neurologist, and they concluded that my scoliosis was caused from "a slight cerebral palsy" that must have went undetected during my childhood. I had never this before, but I was also told that cerebral palsy would not increase, so I went on with my life even though I was very suspicious about the diagnosis.

In 1978 while performing in Canada I first noticed that I was beginning to have double vision (diplopia) and this truly frightened me, but then I thought I was probably just going to need glasses. I was able to complete my contract and return to the states where I immediately contacted my neurologist. They performed a battery of tests from my "very first-ever myelogram" to an angiogram, CAT scan, EKG, EEG and just about everything else you can imagine. After all these tests my neurologist concluded that the diplopia my eyes were either somehow stress-related or possibly the supposedly cerebral palsy had finally weakened the right six nerve muscle in my right eye. And therefore referred me to an ophthalmologist for a "muscle tightening procedure in my right eye." After the surgery I wore an eye patch for several days, but when it was removed I was extremely happy that my vision was back to normal. The ophthalmologist told me however that he had his doubts because he had never seen someone that was 23 years old that had a sudden onset of lazy eye or diplopia. So I went on back to work and continue on with my plans for my life.

In the fall of 1979 I noticed that my balance was continuing to become worse, to the point where I could barely walk down a hallway or to my car without stumbling as though I w as intoxicated, but I do not drink or smoke. Then one day suddenly out of the blue while reading the newspaper my "right" eye suddenly turned back in to my nose, all you could see was the white of my eyeball. I had his horrible echoing sounds throughout my head where every sound would be amplified and reverberate throughout my skull. It was HORRIBLE! My neurologist was completely baffled, stating that he still believed it was all stress-related. I thought this was nonsense and began doing everything I could try and accurately diagnose whatever in the world was happening to my body. I even so much as went to my dentist and had him extract ALL of my wisdom teeth, because I thought that just possibly that may be causing some pressure. I did not know, I felt that I was dying, and I was grasping at straws. My dentist told me "Frankie we only live 80 miles from the Mayo Clinic why don't you go there?" So the very next day I went to the Mayo Clinic where I met Dr. Burton M Onofrio, he was the head of orthopedic neurological surgery. They ran another battery of tests including another completely new myelogram. Dr. Onofrio came into my room and said "Mr. Bush, you have a very serious condition called hydromyelia that extends from your tailbone to your brainstem with an extended Hydrobulbubia. It has been there basically since birth but was gone misdiagnosed. It is the hydromyelia that caused your scoliosis as well as your lack of balance and other neurological deficit. You do NOT have cerebral palsy, never have had cerebral palsy. And we would like to perform surgery where we place a shunt into the spinal cord at the base of your brainstem to relieve the pressure and drain fluid from the fluid filled cavity. Hopefully within time at least your eye and other sensations that have just recently come on will return to normal. But it is a high-risk operation and we would like to do it tomorrow morning. I was in shock, flabbergasted, but still willing to do whatever had to be done.

The first craniotomy was on January 2, 1979, the surgery was performed in a supine sitting position and there were no problems with general anesthesia. However, the plastic tube that they inserted in my spinal cord became infected and I caught meningitis/infection within the spinal cord. I ran a fever of approximately 105° for two weeks while every day they would come into my room and wake me up with a spinal tap, drawing fluid from my spinal cord. Then they would hang the vials of fluid up on my bedroom wall so they could compare each day to see if the blood and infection was clearing from the spinal fluid. After about three weeks they put me on a high dosages of steroids and the fever suddenly broke and I was feeling great! Within a week I was back home, driving and rehearsing a new band for a new show. Dr. Onofrio told me that I needed to take it easy for about eight weeks before I returned to work. In the meantime I was to slowly taper off the steroids. Finally my last day came for my last pill in medication. I thought I was home free. But later that night I woke up drenched in sweat as my fever and chills return with a vengeance. I was immediately rushed back to the Mayo Clinic. Dr. Onofrio performed an emergency laminectomy where they went inside and removed the infected shunt, leaving behind Staples to keep the already well healed draining hole opened. About one week later I was sent home and began feeling great, as I was on another course of steroids. (This is why you may noticed that in the "Johnny Cash come back video clip that I am extremely bloated and swollen, this was from the steroids).

In April of 1979, exactly eight weeks after my second laminectomy I went back to work performing, it was my opening night and as said I was eight weeks post-op from the previous laminectomy. The band was cooking and I was sitting in a director style type of chair, wearing tinted glasses to cover my still turned in eyeball and a custom hat to cover my have shaved head from the surgery. I started to sing slave for body scans that opening song but when I reached up for the microphone I felt this TREMENDOUS electrical shock shoot down my left arm from my neck all the way down through my fingertips. Consequently I fell off the stage laying on the floor with my entire body going into spasms. Again another emergency ride back to the Mayo Clinic. By the next morning I was basically paralyzed from the chest down. Dr. Onofrio came into my room extremely disappointed, (a very compassionate man and wonderful surgeon) and simply told me that there was nothing more that he could possibly do to help me. The only thing he conclude that happened was that when I sing I exert a tremendous amount of pressure from my diaphragm to have the voice that I do, and possibly consequently this great pressure suddenly collapsed the empty cavity that was within my spinal cord causing catastrophic nerve damage. After all I had been through my body simply did not have enough time to adjust to having the new empty space in the spinal canal. In other words the hydromyelia was drained but there was still an empty cavity. And instead of slowly over the years getting used to it, with my work and ability to have a very strong diaphragm the cavity collapsed under pressure. Again this was just a theory.

I returned home to Minneapolis and began going to intensive physical therapy five days a week, and within a few years I was able to walk independently with a walker and continue my career singing and traveling throughout the country. There were no further problems or complications until 1989 where my lumbar spine begin causing me enormous pain like I have never known before. I had a lumbar spinal fusion performed at the Hennepin County Medical Center in Minneapolis, which was supposed to have connected the upper fusion that was done previously when I was 17 by Dr. Robert Winter to the lower spine, making basically my entire spine one solid fusion. There were no complications with general anesthesia and I was actually up in my hospital bed the following day. Within just a few weeks I was once again walking with the aid of a "walker" which was perfectly fine with me, as that is what I had been using since the previous laminectomy with the hydromyelia in 1979. I remained very active, continuing my career, traveling and was just happy to be out of pain.

By 1992 I had moved to Marina del Rey, California where shortly thereafter I once again began experiencing horrendous lower lumbar pain that was like a knife cutting into my nerves going down my left leg. At this Time Dr. Robert Bradford, orthopedic surgeon and Dr. Robert Pashman performed a second lumbar spinal surgery in Los Angeles where they found that one of the hooks from the previously inserted Harrington rods, had come loose and was actually cutting into my nerves. Also that since the second 1972-73 spinal fusion was so long, that over the years it acted like a long "rocker arm or hinge" on the remaining few lumbar vertebrae. And logically the years simply began to wear down the disc in the lumbar area. Plus, in the first lumbar fusion I was told that they somehow overlooked fusing the last remaining vertebrae and this meant that now the entire upper spinal fusion was hinging only upon one single vertebra. Dr. Bradford And Dr. Pashman are both excellent surgeons and at least in my case made a tremendous team in relieving me of pain and assuring that the aftercare was top-notch. I was in physical therapy for about one month, after which I returned home. There were absolutely no complications with general anesthesia or the surgery..

1994 I relocated to Las Vegas leading a very active and pain-free lifestyle even though my scoliosis was still very severe. I was able to walk still using a walker except for airports or malls etc. I would use an electric scooter for mobility. Over the next few years I was noticing in my bathroom mirror that my scoliosis appeared to be worsening, however, when you live with scoliosis your entire life neither you nor your friends sometimes notice subtle changes or differences about your body or scoliosis. I am not the type of person that complains very much about pain unless it becomes absolutely intolerable, and I'm usually so very busy I would never think about my scoliosis was increasing but rather wanting to believe I was just tired rather than a worsening of the scoliosis. Yet I was quite sure that my posture was becoming again more curved. I also had a incident where a car and ran into my scooter in 1996, but since it did not seem to be a serious accident, in that the scooter did not turn over or anything like that, I was not at first very concerned. Then in 2001 through the television program "Good Morning America" my mother saw Dr. Alexis Shelokov saying that there were several new advances that had been made in the field of reconstructive scoliosis surgery. I flew into Houston, Texas and took a taxi to Plano, Texas where I met with Dr. Alexis Shelokov.

He explained to me that a procedure as complex as mine would usually consist of two different surgical stages, but in my case he would perform only one "modified version" of a reconstruction surgical procedure. I was told that everything went very well, basically no major complications during the long surgery. Dr. Shelokov came from the operating room where he told my father he was extremely pleased with the outcome and that everything had gone better than even he had expected. However, the next 10 days that followed while I was in the intensive care unit, intubated, unable to speak, I developed a large bed sore on the back of my head. For some reason the intensive care nurses did not notice (neglected to notice) the pressure that was being caused to the back of my head. In the operation they placed a cage around my spine bringing it forward. The skeletal response to this was equivalent to (bowing my spine backwards) severely tilting my head in a backward position, where I am now constantly having to look upward, which has limited and changed my life and independence drastically

The bed sore became so bad and infected with Mercer that I was quarantined. Then a few weeks later it was decided that I needed a surgical flap over the bed sore in the back of my head and over the lumbar part of my spinal incision where the skin was now paperthin. This was supposed to have been a very minor surgery, however, this time there was a completely different anesthesiologist from the first surgery, and he did not allow me to swallow the intubating tube myself down my throat, (while I was still awake in a twilight sleep), only then were they supposed to have placed me completely under. Instead they put me completely under anesthesia but then could not get the intubating tube down my throat, this of course almost caused my death. (Therefore any anesthesiologist who might be reading my web site, please know, that for many years I have been completely capable of swallowing the intubating tube down my throat just before I am actually put under while still in a twilight state of consciousness and there has never been any problems with general anesthesia in my entire life other than the last situation that I have mentioned in this paragraph).

A few weeks later the flap surgery was rescheduled and successfully completed. However, to this date I have not yet received the second stage of the spinal reconstructive surgery which has left my spine and posture in such a truly dysfunctional position that it has changed my life more than anything I have ever experienced. I have not seen or ever been referred to another scoliosis specialist since Dr. Shelokov. I really do not even know where to start looking for "THE BEST" that might possibly be able to help me complete the second stage so I might at least get my head back up to where it used to be prior to my last operation. This is my only main concern simply getting my head back up to where it was prior to my last surgery. . I am still relatively young and in good health, and I know that if I can get this done it will improve the quality of my life immensely... It will be my dream come true. Thank you for any hope for consideration that you may give my case,Frankie Bush April, 2005

LAST REVISION OPERATION JANUARY 2001

1. Anterior spinal osteotomy/CPT 22224, 22226 x two, T12-L1,
2. L2-3.
2. Posterior spinal osteotomy, 22214, 22216 x two, T12-1, T1-T2-3.
3. Anterior interbody cage, 22851, T12 to L2.
4. Correction of kyphosis/CPI 22819
5. Fusion anterior, T12 to L2.
6. Fusion posterior, T11 to L3, 22558, 22558-50 × four.
7. Posterior instrumentation T12 to L3/, 22842.
8. Anterior instrumentation T12 to L3/CPT 22845.
9. Exploration of old fusion mass/CPT 22830.
10. Removal of old hardware/CPT 22852.
11. Anterior thoracolumbar radical diskectomy, T12-L1, L1-2.
12. Use of allograft morcellized, 20930.
13 Thoracoabdominal approach to the anterior spine, 32100-62; and harvesting of right 12th rib/CPT 21600.
14. Vertebrectomy L1-2 anteriorly.

DESCRIPTION OF PROCEDURE:

The patient was taken to the operating room prepped and

draped in the left lateral decubitus position.

A posterior incision was made in the bed of the old multiple surgery. Sharp dissection was carried down after fluoroscopic guidance was used to identify the appropriate level. The subperiosteal dissection was very difficult due to the significant scarring and fibrosis of the muscles. The left side of the Harrington rod was identified, was cut with a diamond wheel and a segment removed. Next, a posterior spinal osteotomy from T12 to L2 was carried out using a Zimmer autotome with a number bur as well as a Hall drill with a mustard bur. The spinal fusion was osteotomized followed by removal of lamina facets, transverse process with underlying spinal cord exposure.

Next, a right thoracacoabdomimal approach with a thoracotomy and takedown of the diaphragm at the T11 (eleventh) rib. The psoas was identified. It was elevated subperiosteally and the apical disks were identified. Anterior radical diskectomy was carried out at T12- L1, L1-2, L2-3 after fluoroscopy showed the position.

Next, exploration of the fusion anteriorly was undertaken. Anterior spinal and anterior and right lateral osteotomy was carried out including a vertebrectomy of L1 and L2. A complete vertebrectomy was carried out. Circumferential vessel control was obtained using malleable retractors under the vessels and complete vertebrectomy was carried out to be posterior longitudinal ligament and spinal cord. The back wall of the vertebra were removed. By now circumferential control of the spinal cord was obtained anteriorly on the right lateral and posteriorly through osteotomy and vertebrectomy.

Next, the remnants of the vertebrae on the patient's left side were cut using the Hall drill. Next, correction was obtained and as correction was obtained, the patient had a profound compromise of blood pressure on two separate occasions with pressure in the 20s. The patient was stabilized. Fluoroscopy was brought into play and correction of the kyphosis was carried out using a biplane osteotomy. The patient was thrown into extension to place the head over the pelvis.

Next, a 32 mm Harms cage was packed full of autograft and allograft, and this was placed in the interior body position anterolaterally on the left to keep the left side of the osteotomy open. Compression instruments were applied from T11 to L3 posteriorly. A 11 mm open and closed hooks were placed into the fusion mass which had been previously osteotomized. Hook placement sites were made by drilling into the cortical margins. Compression was applied to correct kyphosis and to compress the cage which had been placed anterolaterally on the left. Anterolaterally on the right, a thoracolumbar plate was selected, placed on the vertebral body under fluoroscopic guidance and attached to the vertebral body with six screws which were bicortical in nature. Please note fusion anteriorly was performed from T12 to L3 autograft and osteoTec paste were used to perform fusion. fluoroscopy showed good position of the instruments circumferentially as well as about 50 degree correction through this osteotomy.

The wounds anteriorly and posteriorly were irrigated copiously with gentamicin containing fluid and closure was begun. The right chest had been closed which is dictated under a separate heading. The posterior wound was irrigated. A train was placed in the depths of the wound. The muscle was closed with a 0 Prolene. The subcu was closed with a 2-0 undved Prolene and the skin was closed with clips. Dry sterile dressing was applied. The needle, sponge, instrument, and pledget counts reported correct twice by the nurse to the doctors. The patient returned to intensive care in stable condition.

It is now April 2007 and by all measures the quality of my life has severely deteriorated since the last previous surgery, which I believe was the wrong approach at the wrong time in my life. It is now my hope that someone might be to help me regain even just a small portion of the quality of life I once had. By this I mean to simply be able to have MY HEAD UP ON MY SHOULDERS REASONABLY STRAIGHT would be a tremendous blessing in my life! I do not fear or mind the possibility of being wheelchair-bound or unable to walk if I can have some pressure relieved from my lower spine, as well as the heaviness of having to hold my head upright. Ultimately it would be just a dream if I can return to work singing professionally on stage, possibly touring again. I could easily do this from a wheelchair if necessary as long as some pressure might be taken from my lungs being so compressed by the scoliosis..

I DO NOT SMOKE and never have smoked. I take only regular extra strength Tylenol and a ambient at bedtime. Occasionally if I have many muscles spasms I will take 2 1/2 milligram of diazepam. And I do have daily vitamin regimentwith water therapy. So anyway, I'm trying, I've been trying my entire life, and it sure would be nice if I can just WIN for a little while longer so I can hang around to write and sing a few more songs. Plus I also have a 16 year old son, I sure would like to make him proud of me, just one more time.