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Thread: 2-Year Outcomes of Spinal Growth Tethering vs. Posterior Spinal Fusion for Scoliosis

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  1. #1
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    2-Year Outcomes of Spinal Growth Tethering vs. Posterior Spinal Fusion for Scoliosis

    http://www.srs.org/UserFiles/file/IM...final-4web.pdf

    6. 2-Year Outcomes of Spinal Growth Tethering vs. Posterior
    Spinal Fusion for Scoliosis – Flexibility vs. Reliability†
    Peter O. Newton, MD; Dylan G Kluck, MD; Wataru Saito, MD, PhD; Burt Yaszay,
    MD; Carrie E. Bartley, MA; Tracey P. Bastrom

    Summary
    17 patients who underwent anterior spinal growth tethering (ASGT) were
    compared to 14 patients of similar age and comparable curve type/magnitude
    and skeletal maturity who underwent posterior spinal fusion (PSF). PSF had
    a greater operative time and estimated blood loss (EBL). At 2-year follow-up,
    ASGT resulted in larger residual curves, but avoided PSF in the majority of
    patients. The tether cohort had a higher reoperation rate. SRS-22 scores were
    similar pre-op and at 2 years post-op.

    Hypothesis
    ASGT will lead to similar scoliosis correction with comparable revision rates vs
    PSF at 2yrs.

    Design
    Retrospective cohort study
    Introduction
    ASGT has been shown to alter spinal growth with the potential to correct
    scoliosis while maintaining spine flexibility. Clinical experience with ASGT is
    limited, and there are no studies comparing 2yr outcomes between ASGT and
    PSF.

    Methods
    From 2011-2013, 17 patients with thoracic major scoliosis underwent
    thoracoscopic ASGT. 14 patients with PSF during a similar time period
    with comparable age, curve type/magnitude and skeletal maturity were
    retrospectively identified. Pre-op and 2-year post-op parameters and SRS-22
    scores were analyzed.

    Results
    All patients had Lenke 1 or 2 curve types and most were idiopathic. Age at
    tether was 11y (range 9-14y) vs 12y (range 11-14y) for PSF (p=0.04).
    Tether patients were Risser 0 and PSF patients were Risser ≤1. Pre-op Cobb
    was 5210 in tether vs 547 in PSF (p=0.6). Operative time in ASGT
    was 19435min, EBL 84ml (range 30-100ml) vs 27868min, EBL 939ml
    (range 300-2000ml) in PSF (p=0.001, p<0.001). ASGT had 5.80.5
    vertebrae tethered with a 5.51.4 day hospital stay vs 101 levels fused and
    a 5.51d stay in PSF (p<0.001, p=0.9). 2-year post-op Cobb after ASGT was
    2718 with 61% correction (range 5-173%) vs 148 with 73% correction
    (range 38-90%) in PSF (p=0.02, p=0.3). Revision surgery was performed
    in 7 tethers (4 removals due to complete/over correction, 1 lumbar added, 1
    replaced, 1 PSF). PSF was indicated in 3 additional patients due to progression.
    There were no revisions after PSF. SRS-22 total score at 2 years post-op was
    4.70.2 in tether (n=5) vs 4.60.3 in PSF (n=12) (p=0.3).

    Conclusion
    Although most patients still had some remaining skeletal growth, ASGT resulted
    in a large range of percent curve correction compared to PSF at 2 years postop.
    Operative time and EBL were greater with PSF, but reoperation rates were
    higher with ASGT. SRS-22 scores were similar. It is clear that the tether affects
    spinal growth and, importantly, avoided fusion for most patients at 2 year
    follow-up.
    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."

  2. #2
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    The fact that 7 of 17 tether patients required revision surgery within 2 years is a bit of a red flag. Hopefully, they'll continue to follow these patients so we can see what happens to them as they mature.
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Dilbert
    I'm sarcastic... what's your super power? --Unknown
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    If you've signed up and are having trouble posting, please check your spam folder. An email was sent to the email address which you subscribed. You have to follow the instructions in that email. Done that and still having trouble posting? Contact Joe O'Brien at jpobrien@scoliosis.org.

  3. #3
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    Well yes but at 2 year most has avoided fusion. If that holds for the out years then maybe it is work it.
    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."

  4. #4
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    55. Anterior Vertebral Body Tethering for the Treatment of
    Idiopathic Scoliosis: Feasibility, Outcomes, and Complications
    Firoz Miyanji, MD, FRCSC; Luigi Aurelio Nasto, MD, PhD; Eva Habib, BSc;
    Andrea M. Simmonds, MD, FRCSC

    Summary
    Spinal fusion remains the gold standard for progressive IS, however concerns
    about the long-term effect of spinal fusion have led to the development of
    growth-modulation techniques. We present early preliminary results in a cohort
    of 32 consecutive patients treated with AVBT and found the technique effective
    in preventing curve progression and obtaining curve correction with most curves
    reaching a clinical success of ≤30.

    Hypothesis
    Anterior vertebral body tethering (AVBT) may be limited in effectively
    preventing curve progression and obtaining curve correction to ≤30

    Design
    Retrospective single center review

    Introduction
    More recently AVBT has sparked interest as a possible alternative in the
    management of progressive idiopathic scoliosis (IS).To date limited available
    PAPER ABSTRACTS = Whitecloud Award Nominee Best Clinical Paper
    * = Whitecloud Award Nominee Best Basic Science Paper
    IMAST FINAL PROGRAM 2017 79
    data exists regarding the efficacy and complication rate with AVBT. The aim of
    our study was to evaluate the clinical, radiographic and perioperative outcomes
    and complication rates to determine the efficacy of AVBT in skeletally immature
    patients with IS.

    Methods
    A retrospective review of all consecutive patients treated with AVBT between
    2012 and 2016 was conducted after IRB approval. Demographic data was
    collected from chart review. Preop and most recent f/u radiographic parameters
    were measured by an independent reviewer. Periop outcome variables and
    complication data were obtained from chart review. Clinical success was set a
    priori as major coronal Cobb ≤30 at most recent f/u.

    Results
    32 patients with 34 procedures were analyzed. Mean age at surgery was
    13.61.4years with majority female (93.8%). Mean Risser grade was
    0.770.79 with a mean f/u of 9.4 10.9 months. Mean major pre-op
    Cobb of 50.68.6 improved to mean 18.39.5 at most recent f/u(%
    correction:64.3%, p<0.001).Significant spontaneous curve correction was
    also observed in the un-instrumented curves on average by 48.724.2%
    (p<0.001).Thoracic axial rotation significantly improved on average from
    15.0 4.2 to 8.04.1(p<0.001) as measured by scoliometer.
    Average number of instrumented levels was 6.80.9 with a mean OR time
    of 348.484min. Average EBL was 252.883.4cc with no patient requiring
    allogeneic blood. Length of hospital stay was mean 5.31.0 days with 84.3%
    of patients returning to full activity at 3 months. Clinical success was noted in
    94.1% of patients at most recent f/u. We noted a 23.5% complication rate
    however there were no re-admission to hospital or re-operations in this cohort.

    Conclusion
    AVBT is effective in obtaining clinical success in skeletally immature patients
    with IS. Early results appear promising, however longer-term follow-up is
    needed to determine the true clinical benefits of this technique.
    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."

  5. #5
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    7 out of 17 really is a red flag.....damn....with 4 of those being over corrected. Incorporate the Magec system to adjust the tethers and this problem would be eliminated....If you can adjust a rod, you can adjust a tether. This is worth a try, and Magec has got the bulk of it already done.

    The re-operative rates are higher with tethering.....but the tethering concept is worth the effort, and in looking back at the evolution of scoliosis treatment, these things take a long time....hopefully they can juggle through all the issues.

    I am positive on this idea but not because of my whole spine is fused....Most think that fusion is the worst thing, and I don't agree. As long as there is no pain, I am happy.....Most would think that Ray Charles was handicapped because he was blind, but his trust was set up for the deaf. He didn't think blindness was a handicap, but deafness was considerably worse.

    Ed
    49 yr old male, now 58, the new 53...
    Pre surgery curves C12,T70,L70
    ALIF/PLIF T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion
    http://www.scoliosis.org/forum/showt...on.&highlight=

    My x-rays
    http://www.scoliosis.org/forum/attac...2&d=1228779214

    http://www.scoliosis.org/forum/attac...3&d=1228779258

  6. #6
    Join Date
    Sep 2011
    Posts
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    The tethered patients could still have fusion if they need it later. So although another surgery it is an option. Overcorrection seems to occur when the tethering takes place too early in the growth cycle. ( risser 0)

    I don't think enough studies have been done on the outcome of fusion patients. Once you get to a certain age fusion or non fusion doctors seem to deal with pain in the same way- i.e. relatively poorly

  7. #7
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    Location
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    Quote Originally Posted by titaniumed View Post
    7 out of 17 really is a red flag.....damn....with 4 of those being over corrected. Incorporate the Magec system to adjust the tethers and this problem would be eliminated....If you can adjust a rod, you can adjust a tether. This is worth a try, and Magec has got the bulk of it already done.

    The re-operative rates are higher with tethering.....but the tethering concept is worth the effort, and in looking back at the evolution of scoliosis treatment, these things take a long time....hopefully they can juggle through all the issues.

    I am positive on this idea but not because of my whole spine is fused....Most think that fusion is the worst thing, and I don't agree. As long as there is no pain, I am happy.....Most would think that Ray Charles was handicapped because he was blind, but his trust was set up for the deaf. He didn't think blindness was a handicap, but deafness was considerably worse.

    Ed
    Ed...

    The current trend in medicine is reduction of cost. I doubt we'll see too many American doctors working to combine two techniques.

    --Linda
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Dilbert
    I'm sarcastic... what's your super power? --Unknown
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    If you've signed up and are having trouble posting, please check your spam folder. An email was sent to the email address which you subscribed. You have to follow the instructions in that email. Done that and still having trouble posting? Contact Joe O'Brien at jpobrien@scoliosis.org.

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