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Thread: Dr. Douglas Kiester develops implant that stretches ligaments to treat Scoliosis

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    Dr. Douglas Kiester develops implant that stretches ligaments to treat Scoliosis

    Special thanks goes out to Ballet Mom for finding this.

    A Patent was awarded for Dr. Kiester’s Scoliosis Treatment Device.

    Dr. Douglas Kiester’s surgically implanted device that treats scoliosis in children by internally stretching the spine was awarded a US patent in July of 2011. With this device in place, a child’s spine can “grow” (be lengthen) in the doctor’s office without sedation or anesthetic to either accommodate growth or improve the scoliosis. This device is not available yet in the United States, It has preformed well in international placement in patients.

    Scoliosis (a sideward bending of the spine) in adolescent children is called Adolescent Scoliosis. Dr. Kiester has shown with animal models, computer 3D radiographic analysis, specimen analysis, using 3D computer simulations, and surgical experience that adolescent scoliosis is mechanically caused by a tight ligament that doesn’t stretch enough to allow for normal growth. The spinous processes are bony prominences that you can touch in the middle of your back. Scoliosis is cuased by the ligament these spinous processes together. Dr. Kiester’s device allows a doctor to stretch those ligaments slowly, by degrees, over time.
    Dr. Kiester has said, “I use very special Swiss-made screws. The screw thread is based on the same principles as an ice skate. Most screw threads have a sharp, pointed edge. The screws I use have a flat-topped thread, where the edges of the flat top are sharpened like an ice skate. This allows the thread to be shorter. The shorter thread makes the core of the screw larger for the same-sized screw. Thus my screws are stronger, resist being pulled-out better, resist being push sideways better, and will stay inside the bone better than other screws when they are inserted. This also decreases the risk of damaging a nerve during surgery.”

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    Here is a link to my 2009 interview with Dr. Douglas Kiester

    My interview with Dr. Douglas Kiester

    Scoliosis is not just a lateral bending of the spine. It is a lateral bend linked with rotation. For rotation to occur there must be an axis of rotation in the midline. I proved this with growing rabbits and a dog while I was still in training. What happens is while the spine grows, the back of the spine is tethered by the ligaments, while the front (where the vertebral bodies are which support the weight) grows without restraints. Eventually there is too much length in the front, and very tight structures in the back. The spine then pops off to the side creating a spiral around the tight structures in the back (which stay almost straight). As such it is growth that powers the curve. If the posterior structures can be stretched-out by hormones of pregnancy, exercise, sleep, etc. or the anterior structure shorten by dehydration of the disk, aging, hormones, etc.; then the curve would be expected to improve. After a certain amount of curve, gravity prevents spontaneous correction.

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    This study found that rotation "the rib hump" and the ligaments of the spine are closely connected.

    A biomechanical study on the effects of rib head release on thoracic spinal motion.
    Eur Spine J. 2011 Oct 13. [Epub ahead of print]

    PURPOSE:
    Idiopathic scoliosis is generally treated by surgical derotation of the spine. A secondary goal of surgery is minimization of the "rib hump" deformity. Previous studies have evaluated the effects of surgical releases such as diskectomy, costo-vertebral joint release, facetectomy, and costoplasty on spine mobilization and overall contribution to thoracic stability. The present study was designed to evaluate the biomechanical effects of the rib head joints alone on axial rotation, lateral bending, and segmental rotation, without diskectomy or disruption of anterior or posterior elements.

    METHODS:
    Four female cadaver thoracic spines with intact sternums and rib cages were mounted in an Instron servo-hydraulic bi-axial MTS. In a 12-step sequence, the costo-vertebral and costo-transverse ligaments were released, first unilaterally from T10-T7, then bilaterally until complete disarticulation between the rib heads and the vertebral bodies. After each release, biomechanical testing, including axial rotation and lateral bending, was performed. Vertebral body displacement was also measured using electromagnetic trackers.

    RESULTS:
    We found that rib displacement during axial rotation was significantly increased by unilateral rib head release, and torque was decreased with each successive cut. We also found increased vertebral displacement with sequential rib head release.

    CONCLUSIONS:
    Our results show that sequential costo-vertebral joint releases result in a decrease in the force required for axial rotation and lateral bending, coupled with an increase in the displacement of vertebral bodies. These findings suggest that surgical release of the costo-transverse and costo-vertebral ligaments can facilitate segmental correction in scoliosis by decreasing the torso's natural biomechanical resistance to this correction.
    Last edited by Dingo; 11-29-2011 at 01:26 AM.

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    Here is a graphic of rib head joints.
    Rib Heads Graphic

    Here is a graphic of the paraspinal muscles
    Paraspinal muscles graphic


    You can see in these images that the paraspinal muscles are positioned directly on top of the rib head joints.

    Torso Rotation Strength Training directly works the paraspinal muscles and is the only type of exercise that has been shown to have a significant effect on Scoliosis.
    Last edited by Dingo; 11-29-2011 at 01:22 AM.

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    This explains why the posterior release coupled with tractionon Elisa's son caused his curve to go from 110* to 60* in a matter of days. I asked this question on another thread, but I will ask it again here. Why don't they routinely do this in adult surgeries of lesser magnitudes? It seems that they settle a LOT for only about a 50% correction in many adults. Couldn't they employ this with the other techniques used such as discectomy, osteotomies, laminectomies, etc? Would this result in ribs being more easily dislocated? This frustrates me. If I have surgery, I want 100% correction. I understand that this isn't always possible due to the stretch that can be put on the spinal cord. After all it has been in a misconfigured state for a very long time and the vertebrae eventually end up deformed, as I'm sure do the nerve root outlets. But you would think that much better corrections could be attained. It would make sense to me, that snipping these ligaments would also make a less painful recovery, as the ligaments aren't forceable stretched by the rods. Maybe there is some other reason why that is not routinely done with adults.

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    Here's the link to the other thread that talks about the surgeries using Dr. Kiester's invention.

    http://www.scoliosis.org/forum/showt...ved-spine-quot

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    This is certainly an interesting concept/idea/device. I wish he would have published the tethering studies he did during his training. We'll keep a look out for future studies or results.

    I don't know how patents work or the strategy involved in obtaining one, but I question motives when there are patents that mention data but no peer-reviewed published articles. Maybe it's the speed at which you can obtain a patent versus the speed of conducting and publishing a good study. It certainly wouldn't surprise me if a patent is relatively easy to obtain compared to a clinical trial. I know it's possible to do both, but I might not fully understand the timing or cost involved in doing that. Anyone have any potential explanations?

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    Quote Originally Posted by Kevin_Mc View Post
    This is certainly an interesting concept/idea/device. I wish he would have published the tethering studies he did during his training. We'll keep a look out for future studies or results.

    I don't know how patents work or the strategy involved in obtaining one, but I question motives when there are patents that mention data but no peer-reviewed published articles. Maybe it's the speed at which you can obtain a patent versus the speed of conducting and publishing a good study. It certainly wouldn't surprise me if a patent is relatively easy to obtain compared to a clinical trial. I know it's possible to do both, but I might not fully understand the timing or cost involved in doing that. Anyone have any potential explanations?
    My brother works for the patent office but not in medical devices. My impression is that they tend to deny almost everything, often for being obvious or something like that. Also, if you change one little thing, you can potentially get a patent. I am guessing there are probably many magnetic growing rods and that it is is not likely that the one in the article is Kiester's particular one.

    I agree with your remarks. Many patents go nowhere fast because they are not peer-reviewed. It's a patent and they hold it but it means nothing.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

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    Quote Originally Posted by Kevin_Mc View Post
    This is certainly an interesting concept/idea/device. I wish he would have published the tethering studies he did during his training. We'll keep a look out for future studies or results.
    I agree but for now the cadaver study is good enough for me. It proves that ligaments are a significant part of the problem.... and that might turn out to be an understatement.
    Last edited by Dingo; 11-30-2011 at 12:32 AM.

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    He is my surgeon's partner. He is ,also, a very nice guy
    Melissa

    Fused from C2 - sacrum 7/2011

    December 8, 2014 - Another Broken Rod Surgery

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    Quote Originally Posted by rohrer01 View Post
    Why don't they routinely do this in adult surgeries of lesser magnitudes? It seems that they settle a LOT for only about a 50% correction in many adults.
    Maybe they are aware of the phenomenon but they don't fully understand it and there isn't a specific protocol. The 2011 cadaver/ligament/rotation study is listed as ahead of print.
    Last edited by Dingo; 11-30-2011 at 12:43 AM.

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    Question) Although bracing isn’t an ideal or foolproof solution it’s the only treatment option available and it has helped many children avoid fusion. However are there certain types of cases where bracing may actually make curves worse?

    Dr. Kiester) It is my belief that bracing does make adolescent scoliosis worse. It is very helpful for neuromuscular scoliosis (http://www.espine.com/scoliosis-neuromuscular.htm), but it is rare that I would recommend bracing for adolescent scoliosis.

    -----------

    Note how he said it was his belief and that he never claimed to have evidence. He is being very careful with words as he should be.

    But also note especially that he has probably read every bracing study out there because he is an orthopedic surgeon and he comes to the conclusion that bracing makes AIS worse. I have to hand it to him for going on the record with the bracing literature being a train wreck though I am curious why he didn't just conclude it had no effect and doesn't change natural history as is the null hypothesis at the moment. He went one better that bracing makes AIS worse. I am skeptical the bracing literature, train wreck that it is, can be used to support the hypothesis that bracing makes AIS worse. As largely nonsense, it can't support anything, pro or con about bracing.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

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    Kevin_MC

    In the cadaver study the surgeons derotated the spine by cutting the ligaments on the rib head joints.

    To me that is conclusive evidence that ligaments play a significant role in Scoliosis.

    However is there an obvious, alternate interpretation of the study? Could ligaments be excluded from the etiology of Scoliosis despite this phenomenon?

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    Quote Originally Posted by Dingo View Post
    Kevin_MC

    In the cadaver study the surgeons derotated the spine by cutting the ligaments on the rib head joints.

    To me that is conclusive evidence that ligaments play a significant role in Scoliosis.

    However is there an obvious, alternate interpretation of the study? Could ligaments be excluded from the etiology of Scoliosis despite this phenomenon?
    I'll need to look at the cadaver study a bit more closely. While it does show the obvious effects the ligaments have on spine stability, from a purely scientific point of view, it's of course possible that this plays no role in the progression of scoliosis. Tight ligaments can cause an experimental scoliosis and cutting ligaments can derotate a segment, but these are still models. Kind of like removing the pineal gland. It causes a "melatonin-less" model of scoliosis but how much does it tell us about AIS patients? Maybe a lot, maybe not so much. Regardless, this does provide some good evidence for continued study, just like the pinealectomy has done. I'd love to see this type of device in the pinealectomized chickens. Alternatively, treat the tethered rabbits/dogs with melatonin. If we induce one type of scoliosis, can we control it using a different treatment?

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    Quote Originally Posted by Pooka1 View Post
    I am guessing there are probably many magnetic growing rods and that it is is not likely that the one in the article is Kiester's particular one.

    The magnetic rod in the original article of this thread is indeed different from Dr. Kiester's patent. I was thrown by the MAGEC video link that Titanium Ed posted below that post. The MAGEC device is Dr. Kiester's. Dr. Kiester's magnetic rod is also the one in the article I posted from the Daily Mail link that was from Britain. You can see the difference between the two devices if you look at the article I posted and this link about the Portland Shriners surgery.

    http://www.kptv.com/story/16003910/n...with-scoliosis


    There appears to be a race going on and it will be interesting to see who has come up with the better device. Dr. Kiester's device has just been awarded a pretty nice award.

    November 15, 2011 06:00 AM Eastern Time

    Ellipse Technologies, Inc. Receives the 2011 Best New Technology in Spine Care Award

    IRVINE, Calif.--(BUSINESS WIRE)--Ellipse Technologies, Inc. (“Ellipse”) today announced the Company’s unique MAGECTM Remote Control Spinal Deformity System has been awarded the 2011 Best New Technology in Spine Care Award. This award was sponsored by Orthopedics This Week Publications. The winners were selected by a panel of orthopedic spine surgeons based on their innovation and clinical relevance. Orthopedics This Week is the most widely read publication in the Orthopedics industry and this award recognizes exemplary and innovative spine surgery products and the engineering teams and inventors who create them.

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