Spinal Fusion Surgery Takes Athena to New Heights

Well, this was odd, wasn’t it? Forrest and his 13-year-old daughter, Athena, were standing almost eye to eye—or roughly eye to nose. How was it possible that 24 hours earlier she only came up to his neck?

No, Athena hadn’t been slouching all this time, but rather had been kept from standing fully upright by a severe case of scoliosis, an abnormal curvature of the spine. And now she was experiencing the immediate, dramatic benefit of having the curve straightened by Children’s Hospital Los Angeles orthopedic surgeon Michael Heffernan, MD.

“We always measured her every month,” Forrest says. “She hadn't grown any in seven, eight months at least.”

The measurement taken in Athena’s hospital room the day after the procedure confirmed that her growth drought was over: Before the surgery, she was 5 feet 7 inches; after, 5 feet 9 ¼.

As one of three spine specialists at the Children’s Spine Center, part of CHLA’s Jackie and Gene Autry Orthopedic Center, Dr. Heffernan and his colleagues perform more than 300 surgeries a year, so he sees this outcome regularly. He says he once saw a patient sprout 6 inches after he corrected her curve.

“If you take a crooked road and make it straight,” he says, “that’s what happens. Kids get taller.”

‘It just came on so fast’

Athena’s case, if not astonishing, was still striking. At her 12-year-old annual checkup, her pediatrician was going through the customary steps of the assessment when she asked Athena to stand and bend at the waist. This was the standard test for a curvature in the spine. Unexpectedly, she found one.

The result jolted Forrest and Athena, who hadn’t experienced any symptoms of scoliosis other than growing a bit winded during exertion, which she and her dad wrote off to either puberty or the greater demands of middle school P.E.

“We didn't realize it was an actual physical impairment,” Forrest says. “There had been no sign of it the previous year.”

But soon enough, he couldn’t unsee it. “It became obvious once it was pointed out to me. It just came on so fast.”

It turned out that Athena’s breathing was affected during exercise because the curve in her spine was bearing down on both her lungs.

The pediatrician sent Athena and Forrest to the Children's Hospital Los Angeles specialty care center in Santa Clarita, near their home. The substantial curve in her spine got her case forwarded straight to Dr. Heffernan at the Sunset campus in Hollywood, where in July 2023 Athena was diagnosed with adolescent idiopathic scoliosis. Translated: What set off the growth of the curve in her spine is unknown.

But what doctors do know, Dr. Heffernan says, is once that curve starts, it tends to advance during periods of growth, which explains the rapid progress of Athena’s scoliosis between ages 11 and 12.

“It's possible that at her 11-year-old checkup she had a mild curve, but it wasn't enough to be detected during a physical exam,” he says. “Then as she went through a growth spurt, her curve got significantly worse.”

S marks the spot

Athena was hoping for the same remedy a friend with scoliosis received—a back brace. But braces are for milder curves between 20 and 40 degrees. At her first visit to CHLA, Athena’s curve measured 70 degrees, already beyond the 50-degree threshold for surgery, and it was accelerating.

“Once your curve hits 50 degrees, we expect it to progress by 1 or 2 degrees per year, even after you're done growing,” Dr. Heffernan says. “So as the curve slowly gets worse, your lung function is increasingly impacted. Then, in adulthood, your pulmonary issues worsen as a result of the spine invading one of your lung fields. That’s the primary reason we end up correcting these curves—to prevent long-term issues.”

As Athena’s curve advanced, the physical evidence of it and its effects could not be missed. “Her spine was shaped like an S,” Forrest says, noting that the upper portion of it—the cervical spine—had moved under her right shoulder blade.

The scoliosis derailed Athena’s very active life as a middle schooler, which included ballet, swimming and her school's drama class. Her inability to arch her back affected her dancing and also impaired her in the pool.

There was no letup in the curve’s progression. By the time Athena got to the operating room in December, it had advanced from 70 degrees to 78.

“Whenever I walked, I could feel my posture getting worse because one of my shoulders was higher than the other,” Athena says. “And whenever I had my backpack on my back, I would be hunched over or leaning. I could feel how my body was curved.”

Dr. Heffernan assured Athena that there were techniques he could use during the surgery to preserve her ability to dance and perform. “He knew what was important to her,” Forrest says. “She didn't want to give up musical theater.”

All straightened out

The operation took place in December 2023, the last week of Athena’s seventh-grade fall semester, giving her three weeks to recuperate over winter break.

During scoliosis surgery, doctors straighten the spine by fusing together the individual vertebra, and then holding them in place with two rods and a series of screws. The spine heals in its new alignment and is prevented from curving again.

If you take a crooked road and make it straight, that’s what happens. Kids get taller.

Orthopedic surgeon Michael Heffernan, MD

To keep Athena’s low back loose so she could return to performing, Dr. Heffernan did not extend the rods down to the lower spine—the lumbar portion—leaving that area of the curve intact.

“We skipped the bottom part of her spine and left that free,” he says, which he attempts to do in most cases. “We try hard to avoid fusing the lower lumbar spine to allow for kids to flex forward and to extend back.”

Since the surgery, Athena’s recovery is right on track. By the fourth day, she was experiencing the benefits of the procedure.

“I could feel my shoulders were evened out, and generally life was less strenuous,” Athena says.

She has recovered virtually all of her physical capacities. 

The only casualty of the surgery was her ability to do a reverse somersault in the pool, so she has settled for somersaulting forward.

Now in eighth grade, Athena is thriving again in her drama class. She can dance just as she did before, while her singing has gotten stronger now that the curve in her spine isn’t constricting her lungs and inhibiting her ability to project her voice.

She reports less excitement over her return to P.E. class, from which she got a semester off following her surgery.

“I still don't like it, but not for the same reasons,” she says. “The reasons before were that I was getting constantly winded. My back would not let me do all the exercises that we were doing.”

And now? “Now it's just because I do not like that sort of thing. I never liked P.E.”

She’ll manage. After how quickly her scoliosis came on and the surgery she endured to fix it, her father is sure of it. “She has come out of it very strong,” Forrest says. “Now she knows she can handle anything.”