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Thread: Scott's Vertebral Body Tethering Thread

  1. #166
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    Also here is Newton making the point I made about whether tethering preserves significantly more ROM than fusion...

    https://ryortho.com/breaking/study-t...oliosis-cases/

    “Despite these challenges, a spinal fusion has been prevented in the majority of cases. However, the ‘true’ benefit of the retained motion relative to what would have likely been an isolated thoracic fusion can certainly be questioned. The differences in global trunk motion appears to be only modestly affected by a thoracic spinal instrumentation and fusion.”

    “There is growing interest in fusion-less treatment for scoliosis. Internet sources and social media in my view often paint a picture praising tethering and damning fusion. This is biased and inaccurate. Patients need clear and balanced information on the pros and cons of tethering vs. fusion. My hope is this paper will offer some of the facts required to inform such discussions.”

    “In my view, tethering is reasonable for the growing patient with a scoliosis beyond 45 degrees. They need to understand an attempt to avoid fusion with a growth modulating tether will be less reliable and have a higher revision rate than posterior spinal fusion. Some will value motion over the absolute correction or the greater chance of revision. Others will value the most reliable approach at the expense of a modest loss of motion. Shared decision making is mandatory.”
    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. #167
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    Quote Originally Posted by Pooka1 View Post
    I don't see where that is written. Also it sounds like either the tether broke in 3 places or broke and was replaced 3 times.
    From the same study linked above:

    Table II: Broken Tether Data

    Number of broken levels per patient
    1 level: 7
    3 levels: 1
    He was very clear at our first meeting that he believed the tethers would not be long lived. In his study they started snapping at 18 months.

    From the same study,

    A more robust implant would be ideal, although an implant with a fatigue life of decades rather than years seems unlikely. Further development is necessary.
    It's only going to last a few years.
    Last edited by Dingo; 11-23-2018 at 07:39 PM.

  3. #168
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    Table II: Broken Tether Data

    Number of broken levels per patient
    1 level: 7
    3 levels: 1
    That means the one tether broken at three locations. That is because it is anchored at every level so the whole thing doesn't lose tension if it breaks. The residual tension broke it in two other places. That one kid obviously had a curve that was determined to progress.

    Did Newton tell you there were 7 short tether segments? All the photos seem to show one long tether and the descriptions all indicate one long tether that is tensioned.
    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. #169
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    By the way as I watch this video Pooka is correct. It's one long tether separated into segments by metal implants.

    Video: New Procedure to Treat Scoliosis at BC Children's

    Scott's 6 month checkup is in about 3 months. I'll ask Dr. Newton if every level will eventually snap. Based on our first conversation I believe the answer will be yes. The tether deteriorates and is not long lasting.

  5. #170
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    In the commentary on Newtons article, they said the concept has been proven. I think the game is over and tethering will eventually replace most fusions.
    Now it is just a game of minimizing/avoiding complications.
    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."

  6. #171
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    Quote Originally Posted by Pooka1 View Post
    In the commentary on Newtons article, they said the concept has been proven. I think the game is over and tethering will eventually replace most fusions.
    Now it is just a game of minimizing/avoiding complications.
    For us tethering made sense because it allowed Scott's spine and chest to continue growing. So even if it failed and he was eventually fused it wouldn't be until after he was full grown.

    I think eventually tethering will make sense for most kids with Scoliosis but it might not be mainstream for a decade or two.

    From the study,
    The ultimate potential benefit (or harm) of attempting to avoid spinal fusion with ASGT for patients with scoliosis may not be evident for decades.
    Also if a child (like Scott) is fused before he is done growing his curve may continue to progress until he reaches maturity.

    Vertebral growth after posterior spinal fusion for idiopathic scoliosis in skeletally immature adolescents. The effect of growth on spinal deformity.
    From one year after surgery to the latest review, the percentage anterior disc height decreased by nearly one-half and the percentage posterior disc height by nearly one-third in the fused segments (p < 0.001). There was a 4 degree increase in mean Cobb angle (p < 0.001), 11 patients (37%) having an increase of between 6 degrees and 10 degrees. There was a significant increase in mean apical rotation by 2 degrees (p = 0.003), and four patients (13%) had an increase of between 6 degrees and 16 degrees. There was little change in kyphosis.

  7. #172
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    Tiny update.

    Scott lives about 1 mile from high school. Without prompting he decided that jogging home from school would be fun.

    He's done it two days in a row and both times he said his back felt fine.

    Before surgery he had a hard time standing for more than a few minutes let alone running.

    So in his case VBT caused a huge reduction in back pain.

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