Page 8 of 13 FirstFirst ... 678910 ... LastLast
Results 106 to 120 of 188

Thread: Scott's Vertebral Body Tethering Thread

  1. #106
    Join Date
    Sep 2011
    Posts
    371
    Hopefully VBT will go some way to stop the endless charlatans from alternative medicine from peddling their suits and miraculous hand on solutions that mysteriously they cannot provide evidence for.

    VBT sounds like one solution for the early onset scoliosis cases and after that the possibilities are endless. I don't think it will be decades in US. Already Insurance companies are funding it in some cases- depending on what the surgeon puts on the forms I understand.
    Last edited by burdle; 11-08-2018 at 07:24 AM.

  2. #107
    Join Date
    Mar 2009
    Location
    Arizona
    Posts
    1,058
    Quote Originally Posted by titaniumed View Post
    The easiest procedure would probably be something like stitching up a cut. I had around 15 stitches from a head wound (skiing) when I was 15, and I have to scratch this area multiple times per day. That was 45 years ago.

    Scar tissue can present problems. Sometimes easy, sometimes not so easy. Scratching is easy.

    Ed
    Ya know about 20 years ago I had some stitches in my head and to this day I still get red bumps around the stitch area once in a while. Maybe a little less each year but it still happens.

    Medical science definitely does not have 100% knowledge about the human body.

  3. #108
    Join Date
    May 2008
    Location
    reno,nevada
    Posts
    3,974
    Quote Originally Posted by Dingo View Post
    Medical science definitely does not have 100% knowledge about the human body.
    Oh, where do I start?

    I had a friend die of cancer back in the 60's,(9 years old) and my mom got cancer a half century later. I waited for better scoliosis hardware over the years, and when the pedicle screw was introduced, I thought that was great, but that was a long time ago and only addresses a very small part of the overall scoliosis package. The human body is incredibly complicated.....My dad died of ALS 19 years ago and where are they on ALS? Perhaps another water bucket challenge?. ALS survivors don't get too excited over these things since I was run over by the truck. Run over by the Cancer truck, ALS truck, Scoliosis truck, Kleinfelters truck. I've been hit a few times, and I am tired of waiting. If anyone wants something to happen NOW, its me.

    The last tethering study you posted is a 7 year study....and of course this is good news, but I want a miracle NOW! When you age, you get greedy for time. I don't have the time anymore and things are getting harder. With me, I ignore pain, but the dizzies and the headaches and being lethargic all seem to point in the direction of my spinal cord (in my neck). I have CNS related symptom's. Tingling and numbness are all part of the advanced scoliosis package. Many elder scoliosis patients know what I am talking about.

    I got the flu on Oct 1st. Got the shot on Oct 4th while I was sick, which is a double whammy. The flu has been a constant problem for me over the last 3 years, I guess I have to move to the tropics. There is no influenza in the tropics but they have Dengue fever. Ha ha "The skeeters are after me!" I have to have some sort of joke....

    Scientific medical study is something I consider to be an emergency. A national emergency, a global emergency. This is no joke.

    We don't need another ice bucket challenge, we need a global Niagara Falls challenge. Increase the effort's 1000 fold. The money is out there....Also, medical students shouldn't have to be burdened with HUGE DEBT coming out of med school. This is seriously wrong and needs change right away. Why is this happening????

    And in talking about a 1000 fold, here is an example of some good that's happening, I just had to mention. (Young people, you take charge!!! Do it now!)
    https://www.theoceancleanup.com/system001/
    https://www.cnn.com/2018/09/10/healt...rnd/index.html

    Boyan is 24 years old.....He is setting a fantastic example.
    https://en.wikipedia.org/wiki/Boyan_Slat

    There are answers to medical dilemma's in the ocean. It's there, and we need to find it. Lets not destroy this opportunity and use a new school of thought moving forward.

    I am a diver. I also grew up and worked in highly toxic Superfund sites. I really hate pollution, and I hate disease, and they go hand in hand.

    Ed
    49 yr old male, now 60, the new 55...
    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

  4. #109
    Join Date
    Jun 2005
    Posts
    105
    Quote Originally Posted by Dingo View Post

    Can The Cords Break?
    Yes. They can and do break. Over a long enough period of time they may all break. That shouldn’t be a problem after growth is complete because the spine will have remodeled into a healthy shape.
    Would you mind showing any proof and evidence for this, that the "spine would have remodeled into a healthy shape".
    I have asked spineassociates about this very question, and their response was "we don't know yet", and judging by the fact that most VBT surgeons decide to leave the implants in the spine and not say if and when they will take it out, and as backed up in your published studies you posted, have shown multiple times that when the implants do fail at 1-2 yr point they get replaced not removed, with some even ending up with fusion.

    So I'm confused as to why you say the spine actually remodels into a healthy shape and stays that way with removal of the implants, sounds too good to be true. That's essentially curing the scoliosis. As we have known in the past, an unfused spine with the hardware removed, always remits back to its original scoliotic state. What difference do tethers make compare to fusion based implants to change the course of that?

    Also if you look for the answer of the spine surgeon regarding VBT from this video here, https://www.youtube.com/watch?v=k4xz-tgn1Us
    he seems to imply that by leaving the VBT implant in the body proves the inconfidence of the surgeon to restore motion for the patient, and that there will still be a restriction of motion regardless of. A tethered spine in the thoracic region is really no better than a fused one in the thoracic region. The only benefit is in the lumbar, but motion is still restrictive nonetheless with the chance of deteriorating the lumbar discs or breaking the implants.
    Last edited by Jinseeker; 11-02-2018 at 07:27 AM.
    31 yr old male with non-progressive Idiopathic scoliosis

    15-37 degrees- upper thoracic ( w/ left shoulder trap higher, head tilted more to the right)
    45-52 degrees- mid thoracic (to the right, w/ rib hump)
    25-30 degrees- lumbosacral curve (to the left w/ lumbar hump, right pelvis is higher than left)

    currently doing schroth exercises and counter postural techniques("side shifting")
    using rib and lumbar support belts. still contemplative about surgery.

    >>My X-ray<<

  5. #110
    Join Date
    Sep 2011
    Posts
    371
    Quote Originally Posted by Jinseeker View Post
    Would you mind showing any proof and evidence for this, that the "spine would have remodeled into a healthy shape".
    I have asked spineassociates about this very question, and their response was "we don't know yet", and judging by the fact that most VBT surgeons decide to leave the implants in the spine and not say if and when they will take it out, and as backed up in your published studies you posted, have shown multiple times that when the implants do fail at 1-2 yr point they get replaced not removed, with some even ending up with fusion.

    So I'm confused as to why you say the spine actually remodels into a healthy shape and stays that way with removal of the implants, sounds too good to be true. That's essentially curing the scoliosis. As we have known in the past, an unfused spine with the hardware removed, always remits back to its original scoliotic state. What difference do tethers make compare to fusion based implants to change the course of that?

    Also if you look for the answer of the spine surgeon regarding VBT from this video here, https://www.youtube.com/watch?v=k4xz-tgn1Us
    he seems to imply that by leaving the VBT implant in the body proves the inconfidence of the surgeon to restore motion for the patient, and that there will still be a restriction of motion regardless of. A tethered spine in the thoracic region is really no better than a fused one in the thoracic region. The only benefit is in the lumbar, but motion is still restrictive nonetheless with the chance of deteriorating the lumbar discs or breaking the implants.

    You would probably do better to discuss with VBT surgeons rather than non-VBT surgeons. The non-VBT surgeons still comment on a procedure that they don't fully understand yet. The principle of the remodelling is based on Heuter-Volkmann Law.

    It is accepted that a fused thoracic puts more pressure on a lumbar curve often leading to extension of fusion. VBT is intended certainly in the thoracic to leave the spine flexible unlike fusion. Any preservation of flexibility is to be welcome, I cannot understand why you would conclude that a tethered spine in the thoracic region is really no better than a fused one in the thoracic region? The screws in a VBT procedure are placed in the vertebral bodies and not in the pedicle thus preserving the disks themselves. The human spine is meant to move.

    VBT is being performed in many countries now and in UK there are trials beginning. The idea will be that instead of waiting until fully grown and then performing fusion that the scoliosis is addressed earlier thus preserving growth and flexibility. Surely this is to be welcomed? I do not think Dingo is quite right in that they intend to take out the tethering - I think currently the thinking is that leaving it in does no harm. It has nothing to do with lack of confidence.

    Surgeons like Betz, Cuddihy and Antonacci etc are hardly ever doing fusion now which says something about their confidence in VBT.

  6. #111
    Join Date
    Jun 2005
    Posts
    105
    Quote Originally Posted by burdle View Post
    You would probably do better to discuss with VBT surgeons rather than non-VBT surgeons. The non-VBT surgeons still comment on a procedure that they don't fully understand yet. The principle of the remodelling is based on Heuter-Volkmann Law.

    It is accepted that a fused thoracic puts more pressure on a lumbar curve often leading to extension of fusion. VBT is intended certainly in the thoracic to leave the spine flexible unlike fusion. Any preservation of flexibility is to be welcome, I cannot understand why you would conclude that a tethered spine in the thoracic region is really no better than a fused one in the thoracic region? The screws in a VBT procedure are placed in the vertebral bodies and not in the pedicle thus preserving the disks themselves. The human spine is meant to move.

    VBT is being performed in many countries now and in UK there are trials beginning. The idea will be that instead of waiting until fully grown and then performing fusion that the scoliosis is addressed earlier thus preserving growth and flexibility. Surely this is to be welcomed? I do not think Dingo is quite right in that they intend to take out the tethering - I think currently the thinking is that leaving it in does no harm. It has nothing to do with lack of confidence.

    Surgeons like Betz, Cuddihy and Antonacci etc are hardly ever doing fusion now which says something about their confidence in VBT.
    Despite of that Law, there is no evidence or published outcome yet I could find of someone getting tethered, then getting it removed and ending up with the corrections made happily ever after. I'd like you to show me published evidence. The only ones I could find are negative, with a great percentage ending up re-tethered or fused in a matter of 2-4 yrs. I don't think you'd want to keep going under the knife and worrying when a tether breaks, especially when you do not know if you remove the tethers the spine will remain straight. In this case fusion IMO is still a much more sane and rational option since at least you do know what to expect and don't expose the child to double the risk of more surgeries as a result.

    I do not claim to think a tethered thoracic spine is no better than a fused one, I can only assume in the long run it is. There was a published survey online of which I could not find anymore for one of Baron Lonner's patients deciding whether he should fuse or do VBT on her. And a comment from Dr Bridwell hinted that in this patient's case, a selective thoracic fusion would be no better than VBT for physical activities since the thoracic part of the spine does not really affect flexibility and movement that much anyway. Bridwell also stated the dangers of instrumenting an unfused spine may eventually lead to breakage or wear and tear of the discs WITHIN the construct not the discs of the uninstrumented segments below, a video published on youtube from Dr. Baron Lonner himself ( https://www.youtube.com/watch?v=Q6mb4x5gZxE ) indicates this same concern about VBT. In his video explaining VBT you can clearly see, that no "remodeling" was even explained, and it seems the tethers are to remain for as long as ever and not meant to break, but yet it seems in the discussion here, the parent while certain of eventual breakage seems to have no qualms with it happening because she is reassured that her son will be totally fine when the spine will remain straight after it is finished remodeling when growth is complete.

    On retrospect there was already an attempt to do the same, just look at this article here that tried to remove the growing rods after age 14 for children hoping that the spine will stay in place. https://www.ncbi.nlm.nih.gov/pubmed/28926385
    Unfortunately it didn't. I know they were age 14 when the surgeons tried to hope for it, but still it doesn't sound promising even for someone age 18 or 20.

    I also don't think you should underestimate the knowledge of non VBT practicioners, since after all they are surgeon themselves and have much more knowledge on mechanics and build of the human spine than you or I. They probably have researched VBT or have some knowledge about it before stating their opinions online.

    It is also important to note that even with the tethers, saving the lumbar levels below from degeneration is still a theoretical one and not a certianty, an instrumented spine will never be the same pre-op. There's this video of Julia, a dancer from Britain's Got Talent and posterchild of spine associates who got VBT, although she is still flexible, she stated she couldn't do one of the backbend dance moves anymore after VBT. I also doubt how well can tethered patients twist with their spines not just bend compared to pre op.
    Last edited by Jinseeker; 11-02-2018 at 01:01 PM.
    31 yr old male with non-progressive Idiopathic scoliosis

    15-37 degrees- upper thoracic ( w/ left shoulder trap higher, head tilted more to the right)
    45-52 degrees- mid thoracic (to the right, w/ rib hump)
    25-30 degrees- lumbosacral curve (to the left w/ lumbar hump, right pelvis is higher than left)

    currently doing schroth exercises and counter postural techniques("side shifting")
    using rib and lumbar support belts. still contemplative about surgery.

    >>My X-ray<<

  7. #112
    Join Date
    Mar 2009
    Location
    Arizona
    Posts
    1,058
    Quote Originally Posted by Jinseeker View Post
    Would you mind showing any proof and evidence for this, that the "spine would have remodeled into a healthy shape".
    This is the first reported case of tethering.
    Study: Growth modulation by means of anterior tethering resulting in progressive correction of juvenile idiopathic scoliosis: A case report

    While the concave side grew 2.4 cm, the convex side grew 1.6 cm, demonstrating the effect of tethering on the convex side.
    As demonstrated on the radiographs, the vertebral wedging that existed preoperatively corrected with time, apparently through growth modulation of the end plate physes.
    Children grow/change so fast which is why tethering makes sense for them. I believe the ideal tethering candidate has 2 or 3 years of growth remaining. More time than that and you risk over-correction, less time and you won't get enough correction.

    At least to me tethering doesn't appear to make a lot of sense for adults. The cords break in a few years and if the bone hasn't grown/remodeled the curve will probably go back to its original shape.
    Maybe if they had a material that could last 10 or 20 years it might make more sense in adults. They're probably working on that right now.
    Last edited by Dingo; 11-02-2018 at 03:48 PM.

  8. #113
    Join Date
    Mar 2009
    Location
    Arizona
    Posts
    1,058
    Quote Originally Posted by Jinseeker View Post
    Despite of that Law, there is no evidence or published outcome yet I could find of someone getting tethered, then getting it removed and ending up with the corrections made happily ever after. I'd like you to show me published evidence. The only ones I could find are negative, with a great percentage ending up re-tethered or fused in a matter of 2-4 yrs. I don't think you'd want to keep going under the knife and worrying when a tether breaks, especially when you do not know if you remove the tethers the spine will remain straight. In this case fusion IMO is still a much more sane and rational option since at least you do know what to expect and don't expose the child to double the risk of more surgeries as a result.
    The tethers aren't commonly removed. They aren't long lived and simply break after a few years.

    Although the initial results have been promising tethering is still an experimental procedure. Less than 1,000 children around the world have had VBT and only a handful of surgeons that work in the research community perform it. Long term studies are many years away.
    Last edited by Dingo; 11-02-2018 at 04:25 PM.

  9. #114
    Join Date
    Jan 2008
    Location
    NC
    Posts
    9,196
    Quote Originally Posted by Jinseeker View Post
    As we have known in the past, an unfused spine with the hardware removed, always remits back to its original scoliotic state. What difference do tethers make compare to fusion based implants to change the course of that?
    That's an interesting point, Jinseeker. They always used to say that once fused, the hardware can be removed. But I think I recall articles on how much the spine will recurve/retwist. IIRC, the twisting (axial rotation) was the major change. As for tethers, who knows. I hope there is no autofusion like with growing rods. I doubt there is because motion in at least one plane (front to back) is well preserved. The side-to-side is not well preserved and was worse than even staples in that one pig spine study IIRC. But this is not relevant to thorax I suspect and is mainly relevant to lumbar. I posted an article about how people can bend quite a bit through their thorax but I think there is no reason in real life to do so if you are not a contortionist. This is why my daughter was unaware she had lost ROM in her thorax until I asked her to bend sideways. She still thought that was normal until I showed her how much I can bend to the side (about twice as much as she could). The point is she feels normal and does not perceive any loss of ROM in day to day life with her T4-L1 fusion. This is why I would choose fusion again for a child over any experiemental method if a T fusion that can end at L1 or above.

    A tethered spine in the thoracic region is really no better than a fused one in the thoracic region. The only benefit is in the lumbar, but motion is still restrictive nonetheless with the chance of deteriorating the lumbar discs or breaking the implants.
    This does seem to be the case. I suspect the ROM side to side of tethering is close to that for fusion but is much greater than fusion for front to back. For thorax where people don't bend through the thorax in normal life, I suspect both fused and tethered folks feel normal like my daughter. The real issue is and has always been lumbar and fusions that go below about L1.
    Last edited by Pooka1; 11-02-2018 at 10:07 PM.
    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."

  10. #115
    Join Date
    Jan 2008
    Location
    NC
    Posts
    9,196
    Quote Originally Posted by burdle View Post
    It is accepted that a fused thoracic puts more pressure on a lumbar curve often leading to extension of fusion.
    That's true for fusions that go below about L1. If they end at L1 and above and the compensatory lumbar straightens enough, both Boachie and our surgeon say it can be a one and done T fusion. No extension required. My one daughter is a one and done. The other, though her fusion ends at L1, still has ~25* compensatory lumbar . For her I am hoping tethering will be ready if she needs it.

    VBT is intended certainly in the thoracic to leave the spine flexible unlike fusion. Any preservation of flexibility is to be welcome, I cannot understand why you would conclude that a tethered spine in the thoracic region is really no better than a fused one in the thoracic region? The screws in a VBT procedure are placed in the vertebral bodies and not in the pedicle thus preserving the disks themselves. The human spine is meant to move.
    Because there is more data on fusion and the ROM in the thorax is probably indistinguishable in real life between fusion and tethering.

    I think currently the thinking is that leaving it in does no harm. It has nothing to do with lack of confidence.
    But if even fused spines revert to some degree if the hardware is removed, wouldn't a tethered spine also revert somewhat?

    Surgeons like Betz, Cuddihy and Antonacci etc are hardly ever doing fusion now which says something about their confidence in VBT.
    If they aren't doing fusions it is because the volume of tethering has crowded it out due to demand. I don't view their not doing fusions as a decision that tethering is always better.
    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."

  11. #116
    Join Date
    Jan 2008
    Location
    NC
    Posts
    9,196
    Quote Originally Posted by Jinseeker View Post
    In this case fusion IMO is still a much more sane and rational option since at least you do know what to expect and don't expose the child to double the risk of more surgeries as a result.
    As a parent, I agree with you if talking about a T fusion that can end at L1 or above and the lumbar is expected to straighten. Then it is said to be one and done. I would choose that over tethering at present for that set of circumstances. I would choose tethering for all other circumstances.

    And a comment from Dr Bridwell hinted that in this patient's case, a selective thoracic fusion would be no better than VBT for physical activities since the thoracic part of the spine does not really affect flexibility and movement that much anyway.
    This appears to be the case based on my daughter's comments. She feels normal because people don't normally bend through the thorax. Even when she could only bend to the side about half as much as I could, she thought that was normal for people. So either she doesn't remember what it was like before fusion or she never has to bend beyond her fused ROM. She does scientific field work and has never noted a deficit. In fact I suspect the only time she realized she had a deficit was when I asked her to bend to the side. I feel a little guilty over that. She could have gone the rest of her life thinking she had normal ROM had I not done that.

    I also don't think you should underestimate the knowledge of non VBT practicioners, since after all they are surgeon themselves and have much more knowledge on mechanics and build of the human spine than you or I. They probably have researched VBT or have some knowledge about it before stating their opinions online.
    I agree with this. Lonner stated he sat out for FIVE YEARS watching VBT because he had serious concerns about the discs. Only then did he jump on the bandwagon.

    It is also important to note that even with the tethers, saving the lumbar levels below from degeneration is still a theoretical one and not a certianty, an instrumented spine will never be the same pre-op. There's this video of Julia, a dancer from Britain's Got Talent and posterchild of spine associates who got VBT, although she is still flexible, she stated she couldn't do one of the backbend dance moves anymore after VBT. I also doubt how well can tethered patients twist with their spines not just bend compared to pre op.
    According to that one study using pig spines and comparing normal to stapled to tethered, the side to side motion with tethered was less than staples IIRC. It was less than normal but I think it is more than fusion. Anyway none of it matters for thorax in my opinion.
    Last edited by Pooka1; 11-03-2018 at 09:05 AM.
    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."

  12. #117
    Join Date
    Jan 2008
    Location
    NC
    Posts
    9,196
    Quote Originally Posted by Dingo View Post
    At least to me tethering doesn't appear to make a lot of sense for adults. The cords break in a few years and if the bone hasn't grown/remodeled the curve will probably go back to its original shape.
    Maybe if they had a material that could last 10 or 20 years it might make more sense in adults. They're probably working on that right now.
    If I was my daughter and faced with needing to do something in my lumbar years from now, I would choose tethering that may need to be redone several times over fusion of the lumbar.
    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."

  13. #118
    Join Date
    Jan 2008
    Location
    NC
    Posts
    9,196
    Here is a study showing decreased lateral bending away from the tether that agrees in general with the other pig spine study.

    https://pdfs.semanticscholar.org/59f...2be612aeb4.pdf

    The other study showed tethers had about half the side to side ROM as staples (note large error bars).

    https://www.ors.org/Transactions/57/0827.pdf
    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."

  14. #119
    Join Date
    Sep 2011
    Posts
    371
    Quote Originally Posted by Pooka1 View Post


    Because there is more data on fusion and the ROM in the thorax is probably indistinguishable in real life between fusion and tethering..
    This thoracic flexibility is precisely one of the reasons that they do VBT





    [QUOTE=Pooka1;170788]
    If they aren't doing fusions it is because the volume of tethering has crowded it out due to demand. I don't view their not doing fusions as a decision that tethering is always better[QUOTE=Pooka1;170788]


    I don't think it is so much demand as insurance companies still not completely on board. I think it is more that the patients they see are all eligible for VBT and if they are eligible it is a better option
    Last edited by burdle; 11-05-2018 at 05:55 AM.

  15. #120
    Join Date
    Sep 2011
    Posts
    371
    Quote Originally Posted by Jinseeker View Post
    I also don't think you should underestimate the knowledge of non VBT practicioners, since after all they are surgeon themselves and have much more knowledge on mechanics and build of the human spine than you or I. They probably have researched VBT or have some knowledge about it before stating their opinions online.

    It is also important to note that even with the tethers, saving the lumbar levels below from degeneration is still a theoretical one and not a certianty, an instrumented spine will never be the same pre-op. There's this video of Julia, a dancer from Britain's Got Talent and posterchild of spine associates who got VBT, although she is still flexible, she stated she couldn't do one of the backbend dance moves anymore after VBT. I also doubt how well can tethered patients twist with their spines not just bend compared to pre op.
    I disagree- I think the opinions of the non-VBT practitioners will be based on a lack of upto date information as is what is being demonstrated over and over again. I prefer to listen to the expert fusion surgeons like Betz et al who are now doing VBT. At the recent SRS meet there was very favourable response from the scoliosis community I am told from Alanay presentation.

    Also the Julia Carlisle reporting is inaccurate- I have actually heard her say in interview that she could do everything she could before. what you may have heard is that she could do everything BUT one move almost immediately after surgery- emphasising how successful the surgery immediately was- but now months out she can do everything.

    I personal think its a shame that VBT is being sort of suggested for kids who want to be gymnast or dancers but if you don't then preserving thoracic flexibility is not so important. I believe preserving as much natural movement of the spine is paramount because we don't know what is 'down the line' in our lives.

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •