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Scott's Vertebral Body Tethering Thread

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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."

    Comment


    • 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, 06:39 PM.

      Comment


      • 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."

        Comment


        • 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.

          Comment


          • 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."

            Comment


            • 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.

              Comment


              • 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.

                Comment


                • Dingo

                  I see he is roughly 4 months now....time flies, does he feel any of the hardware at all. In any positions?

                  Is he completely recovered now? 100%?

                  Ed
                  49 yr old male, now 63, the new 64...
                  Pre surgery curves T70,L70
                  ALIF/PSA 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

                  Comment


                  • Originally posted by titaniumed View Post
                    Dingo

                    I see he is roughly 4 months now....time flies, does he feel any of the hardware at all. In any positions?

                    Is he completely recovered now? 100%?

                    Ed
                    He just got home from school so I asked him how he felt at the 4 month mark.

                    Laying down) 0% pain
                    Standing) 0% pain
                    Walking) 0% pain
                    Exercise) 0% pain
                    Jogging) 0% pain
                    Sitting) If he sits for a long time his back can start to get sore. He pointed to the area and it's roughly the area of the tethering.

                    In addition on the front of his chest there is a small area on a rib that is slightly numb. Around that area is some soreness that is noticeable if he touches it. It's been that way since the surgery.

                    So basically movement feels great. Sitting can become irritating if it's for a long time.

                    Comment


                    • Sounds pretty good.....

                      Numbness can happen after surgery. Some of it is predictable, some isn't . Peripheral nerves do heal, so its a wait and see thing. The spinal cord is a different story.

                      Sitting can be difficult for us. Sometimes, its EXTREMELY painful..... I had a lot of trouble sitting in the car before my surgeries. I also didn't sit down much at work, which means you have to work twice as fast before you pass out.

                      For many of us, we can only get a break by laying down.

                      Its nice to see this positive experience with Scott.

                      Ed
                      49 yr old male, now 63, the new 64...
                      Pre surgery curves T70,L70
                      ALIF/PSA 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

                      Comment


                      • Originally posted by titaniumed View Post
                        Sounds pretty good.....

                        Numbness can happen after surgery. Some of it is predictable, some isn't . Peripheral nerves do heal, so its a wait and see thing. The spinal cord is a different story.

                        Sitting can be difficult for us. Sometimes, its EXTREMELY painful..... I had a lot of trouble sitting in the car before my surgeries. I also didn't sit down much at work, which means you have to work twice as fast before you pass out.

                        For many of us, we can only get a break by laying down.

                        Its nice to see this positive experience with Scott.

                        Ed
                        Yeah I hope that sitting gets better as his back slowly corrects as he grows. (crossing fingers)

                        The tiny irritation on one rib is no big deal at all. He doesn't care about it and I believe it has slowly improved over the last 4 months.

                        We lifted weights tonight and he's getting physically stronger (and a little bigger) each week.
                        Another year and he'll be bigger than me. 8-)

                        Comment


                        • Over the years before my surgeries, I was a "fidgety" sitter, requiring movements for various reasons. I was an extremely active individual....The old aches probably had something to do with this, perhaps due to soft tissue and muscular imbalance problems. Many of us have this aching, stiffness and binding which can present itself in younger years living with scoliosis. The binding is what drove me to a Chiropractor when I was 28. (A long time ago) I don't know if smaller scoliosis curves (10-30 degrees) produce any binding. (In adults, over 18)

                          If one has the underlying contributing factors of scoliosis, and they get corrected with a tether, will this continue? It would seem that tethering patients would be good candidates for before and after EMG studies. I am not seeing too much about this online.

                          Do the imbalanced muscle systems correct themselves after scoliosis tethering? If so, how much?

                          Ed
                          49 yr old male, now 63, the new 64...
                          Pre surgery curves T70,L70
                          ALIF/PSA 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

                          Comment


                          • Scott had his 6 month post-op checkup yesterday in San Diego. His curve measured 28° which was the same as his 2 week post-up. His 2 week and 6 month x-rays looked almost identical except (to my eyes) perhaps his lumbar was slightly improved at 6 months. His rotation measured 14°. I'm not certain what his rotation was at 2 weeks post-up but I believe it was 20° before tethering. It was a very happy visit and a tremendous relief that everything worked.

                            Stuff I learned:

                            1) The tethers aren't attached to produce an even force. At surgery the tethers near the apex of the curve are attached very tight to produce an immediate effect. However the tethers on either side are purposely left with slack. As Scott grows the slack on either end will tighten up and begin to force a correction along the entire spine. They do this to avoid over-correction and to reduce unnecessary stress and pressure on the disks in the spine. So put simply Scott has 8 segments but after surgery maybe only 2 or 3 near the middle were pulled tight. As he grows additional segments will pull tight until eventually all 8 segments are fully engaged and a correction is forced along the entire spine. Dr. Newton mentioned that for this and other reasons corrections occur at their own, seemingly random pace. He has had patients after their 2 week post-up see little correction for a long time and then suddenly the correction takes off. When the pressure reaches the right level it begins to work and every kid is different. They can't predict it yet.

                            2) The pressure caused by a segment never exceeds a certain level. Growth will continue until the tension on the tether increases to the point that growth is stalled. Once growth has stopped the tension won't increase. It hits a balancing point where everything stops.

                            3) Although the tethers aren't designed to last a lifetime it is unknown if some might. So far they've seen a lot of breaks in and near the lumbar area where load levels and motion are significant. However they've seen less breaks in the thoracic area where load levels and motion are reduced. Dr. Newton said it was theoretically possible that a tether segment in the thoracic area may never snap if it's not under a load. But as of now this is unknown.
                            Last edited by Dingo; 02-28-2019, 09:01 AM.

                            Comment


                            • Wow excellent news. His curve will probably never get bigger and will almost certainly get smaller as he grows.

                              Very interesting abut the mechanics of setting the tether tension.
                              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."

                              Comment


                              • Originally posted by Pooka1 View Post
                                Wow excellent news. His curve will probably never get bigger and will almost certainly get smaller as he grows.

                                Very interesting abut the mechanics of setting the tether tension.
                                Yeah we were very pleased but I'm not going to get cocky. Tethering doesn't always work but so far it's a really good sign.

                                Scott went from 63° to 28°. If he had been fused I'm not certain the correction would have been that much better. I think there are a lot of people that have curves in the 20° range even after fusion.

                                Comment

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