For those needing/wanting info on VBS

[amandap]

Hi Everyone,

I just wanted to take a quick second to let everyone know that I along with a few other parents (Maria and Cara) have created a new website dedicated to informing parents about Vertebral Body Stapling. From the new website everyone can also access the new VBS discussion forum.

The new web address is www.vertebralstapling.com

Our hope is to help educate and inform parents of alternatives to bracing.

Amanda

[WNCmom]

Questions about VBS

Question I've had for a while, and I haven't seen the answers in any literature I've found:

1. If a curve has progressed beyond the limits of eligiblity for VBS (but the child is otherwise a candidate), and then the curve is reduced via some kind of therapy to within the limit and stabilized for at least a month or more, would the child then become eligible again for the procedure?

2. Does VBS work because the clips hold the outside of the vertebrae and keep them in place, thus keeping the curve from progressing, or does bone growth on the inside (unclipped side) of the vertebrae keep the curve from progressing because the clips retard growth where they are placed and the unclipped sides grow more?

Anyone who can help me me wrap my brain around this?

Mary Ellen

[HaleyMom]

Hi Amanda
I also had a question about VBS. When I recently asked our ortho about the procedure, he didn't have a very positive response. He felt that while it helps straighten the curve, it does nothing to address the rotation.

So my question is - are young children still good candidates if they have a significant rotation? This may have been answered in previous posts, but I missed it.

Thanks

[mariaf]

Hi Amanda
I also had a question about VBS. When I recently asked our ortho about the procedure, he didn't have a very positive response. He felt that while it helps straighten the curve, it does nothing to address the rotation.

So my question is - are young children still good candidates if they have a significant rotation? This may have been answered in previous posts, but I missed it.

Thanks

Hi Haley Mom,

If your ortho said that VBS does "nothing to address rotation" - that's definitely not true. I don't know about all cases, but I know about my son's. At his initial appt. with Dr. Betz in Dec. 2003, Dr. Betz wrote that David had "significant rotation but only very modest rib prominence".

Just recently, Dr. Betz and I were looking at that xray from 2003 and comparing it to a recent film, and we could both SEE that the rotation had lessened by looking at the pedicles. I can also tell you that I can see the cosmetic improvement with regard to the rotation. So VBS CAN definitely decrease rotation - at least in some cases.

If there is anything else I can answer, please let me know and as Amanda suggested, the website is full of information as well as parents willing to share their experiences.

Take care,

[mariaf]

Question I've had for a while, and I haven't seen the answers in any literature I've found:

1. If a curve has progressed beyond the limits of eligiblity for VBS (but the child is otherwise a candidate), and then the curve is reduced via some kind of therapy to within the limit and stabilized for at least a month or more, would the child then become eligible again for the procedure?

2. Does VBS work because the clips hold the outside of the vertebrae and keep them in place, thus keeping the curve from progressing, or does bone growth on the inside (unclipped side) of the vertebrae keep the curve from progressing because the clips retard growth where they are placed and the unclipped sides grow more?

Anyone who can help me me wrap my brain around this?

Mary Ellen

Hi Mary Ellen,

With regard to question #1 (great question by the way), my guess is that it would have a lot to do with how flexible the curve was at that point. Most times, they like the curve to bend to 25 degrees or less. That's a great indicator of how successful VBS will be - of course there are other factors based on each individual case, which is why the best thing for anyone considering VBS is to get a consult in Philly. There is nothing to lose

With regard to #2, BOTH issues are addressed with VBS - (a) the staples hold the spine in position; and (b) they also inhibit growth on the side of the verebtrae that is growing too much (thus causing the problem) so that the other side can "catch" up.

So, what happens usually is that on the operating table some correction is usually achieved due to (a) above; then as the child grows more correction CAN be achieved due to (b) above.

Hope that makes sense

[WNCmom]

Thanks, Maria. That's very helpful.

Mary Ellen

[Carmell]

Mary Ellen,

I'm not sure this is helpful at all, nor if this is the right place to share this information, but... Drs. Betz et al in Philly are working with some kids now where they do VBS and VEPTR combined. This is for kids who have larger curves at a young age who may not respond to VBS alone the way they'd like. Each patient is very different and each requires unique care. Hopefully more and more orthos are willing to consider newer options for these very young children who have so much growth remaining. The long term effects of fusion are being realize more and more - not a good option for many.

[WNCmom]

Sorry--I don't know what VEPTR stands for. Can you elaborate?

Mary Ellen

[mariaf]

VEPTR stands for Vertical Expandable Prosthetic Titanium Rib. It is also referred to sometimes simply as the Titanium Rib.

It is a completely different surgery than VBS. However, in unusual cases, the doctors have started using both VBS and VEPTR together when they feel the VBS alone would not work.

VBS is somewhat less invasive than VEPTR and requires only one surgery. VEPTR requires additional expansion surgeries. So, if VBS alone is likely to work, then they'd just do that. However, if the doctors feel VBS alone would not work for a particular child, they may use it in conjunction with VEPTR.

Hope this helps.