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Thread: Fusionless Surgery / Wedge Osteotomies

  1. #1
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    Fusionless Surgery / Wedge Osteotomies

    I'm starting a new thread on this since I don't think there has been one, at least not for some time. Here are the links hdugger (thank you!) dug up about it. From what I gather it has only been used on growing kids so far, but I'm trying to understand why this wouldn't be a nice option for the skeletally mature as well.

    http://www.spineuniverse.com/conditi...vertebral-body

    http://www.spineuniverse.com/profess...osis-2-15-year

    Here's an article that succinctly summarizes the current (at least up until a few years ago) thinking as to the reasons to go this way: http://www.scoliosisjournal.com/content/3/1/6

    Does anyone have any more info on this or personal experience with it? Are other doctors performing it? What about for adults?
    1993, Age 13, 53* Right T Curve w/ Left L compensatory
    2010, Age 30, 63* or 68* (depending on the doc) Right T Curve w/ Left L compensatory

    http://livingtwisted.wordpress.com/

  2. #2
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    Nov 2010
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    San Diego, CA
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    The Vertebral Body Stapling website has a list of physicians, many seem to be pediatric specialists but some look like adult and pediatric surgeons.

    www.vertebralstapling.com/Physician_List.html

    I'm just starting to look into this as a possibility for my daughter. From my understanding VBS is only indicated in a growing child up to a point in terms of their cobb angle and skeletal maturity status.

    It's worth looking into though! Best wishes to you!
    Resilience

    treated w Milwaukee Brace FT for 3 yrs
    currently 46 with 35 LL and 40 RT curves

    8 yr old diagnosed w Scoli 8/10 with 27 LL and 27 RT
    11/10 TLSO Full Time
    4/11 22 LL and 24 RT on waiting list for VBS at Shriners Phila
    12/11 curves still in the 20s but now has some rib cage changes from the brace
    VBS 4/25/12 with Dr. Samdani. Pre Op: 29 RT and 25 LL Post Op: 17 RT and 9 LL
    10/13: 15 RT and 10 LL

  3. #3
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    Thanks! I was under the impression that VBS was for growing kids and is only semi-permanent. But I guess I haven't done much research on it for that reason. I was more interested in the part about wedge osteotomies and wondering why that isn't more widely used. Is it that the correction achieved isn't as great?
    1993, Age 13, 53* Right T Curve w/ Left L compensatory
    2010, Age 30, 63* or 68* (depending on the doc) Right T Curve w/ Left L compensatory

    http://livingtwisted.wordpress.com/

  4. #4
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    Quote Originally Posted by hdugger View Post
    I had the sense from the articles that the wedge osteotomies were still in the exploratory stage. They talk about using them for patients with spinal injuries or those who are paralyzed, which suggests to me that they're a little concerned that they might do damage if they did them in an uninjured spine.
    That makes sense. I was trying to understand this sentence:

    To avoid fusion for patients with paralysis, for whom maintaining spinal flexibility and mobility is more desirable, fusionless, vertebral wedge ostetomies are developed for the treatment of progressive paralytic scoliosis of skeletally immature children with spinal cord injury or myelodysplasia [25]
    http://www.scoliosisjournal.com/content/3/1/6

    I don't know enough about paralysis to understand why flexibility is more desirable. I would think it's more desirable for everyone. But even if they are using paralyzed patients as a test group, it seems that they are still all children.
    1993, Age 13, 53* Right T Curve w/ Left L compensatory
    2010, Age 30, 63* or 68* (depending on the doc) Right T Curve w/ Left L compensatory

    http://livingtwisted.wordpress.com/

  5. #5
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    Location
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    Ok, I fail for reading comprehension. Both the links you posted seem to be about the skeletally mature. How do I find a doc who is doing this?
    1993, Age 13, 53* Right T Curve w/ Left L compensatory
    2010, Age 30, 63* or 68* (depending on the doc) Right T Curve w/ Left L compensatory

    http://livingtwisted.wordpress.com/

  6. #6
    Join Date
    Nov 2010
    Location
    San Diego, CA
    Posts
    104
    Janet is Dr. Betz's Physician Assistant and has set up an email to connect with potential patients. She wouldn't mind if you contacted her by email with your question.

    janetcerrone@comcast.net
    Resilience

    treated w Milwaukee Brace FT for 3 yrs
    currently 46 with 35 LL and 40 RT curves

    8 yr old diagnosed w Scoli 8/10 with 27 LL and 27 RT
    11/10 TLSO Full Time
    4/11 22 LL and 24 RT on waiting list for VBS at Shriners Phila
    12/11 curves still in the 20s but now has some rib cage changes from the brace
    VBS 4/25/12 with Dr. Samdani. Pre Op: 29 RT and 25 LL Post Op: 17 RT and 9 LL
    10/13: 15 RT and 10 LL

  7. #7
    Join Date
    Nov 2010
    Location
    Los Angeles
    Posts
    139
    Quote Originally Posted by Resilience View Post
    Janet is Dr. Betz's Physician Assistant and has set up an email to connect with potential patients. She wouldn't mind if you contacted her by email with your question.

    janetcerrone@comcast.net
    Thank you! I was ready to start with the main number for the hospital tomorrow am!
    1993, Age 13, 53* Right T Curve w/ Left L compensatory
    2010, Age 30, 63* or 68* (depending on the doc) Right T Curve w/ Left L compensatory

    http://livingtwisted.wordpress.com/

  8. #8
    Join Date
    Aug 2004
    Location
    ny
    Posts
    1,809
    Quote Originally Posted by hdugger View Post
    The vertebral staples are permanent, I believe, in the sense that you don't have to remove them. But I would guess that once a child has stopped growing they could be removed without losing the correction. But, I haven't really researched them enough to know that.
    That's pretty much the case - originally, the plan was to perhaps remove the staples but since they have not caused any issues over the past decade or so that they have been in use, nobody is rushing to remove them since it would require another surgery.

    And, yes, even though Dr. Betz treats children, he recently recommended an adult doctor in NY for a friend of mine. These guys all seem to know each other which isn't surprising when you think about it.
    mariaf305@yahoo.com
    Mom to David, age 17, braced June 2000 to March 2004
    Vertebral Body Stapling 3/10/04 for 40 degree curve (currently mid 20's)

    https://www.facebook.com/groups/ScoliosisTethering/

    http://pediatricspinefoundation.org/

  9. #9
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    Los Angeles
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    Just wanted to share the info I got back from Dr. Betz's office... apparently after the initial study 10 years ago using adolescents with paralytic scoliosis, no further progress was made, which seems to be a funding issue. I couldn't find a date on the article from Spine Universe so who knows when that was posted. So at least in the US no one is currently practicing this method, although there was also a Japanese study that seemed successful.
    1993, Age 13, 53* Right T Curve w/ Left L compensatory
    2010, Age 30, 63* or 68* (depending on the doc) Right T Curve w/ Left L compensatory

    http://livingtwisted.wordpress.com/

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