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Thread: Scott's Vertebral Body Tethering Thread

  1. #31
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    https://www.ors.org/Transactions/57/0827.pdf

    Tethers had less lateral ROM than staples and were stiffer laterally than staples but look at the huge error bars. But tethers were better in ROM and less stiff than staples in other planes of motion. The data were all over the place and if they repeated the study the results might be different in my opinion given the variability in the measurements.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

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  2. #32
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    Quote Originally Posted by Pooka1 View Post
    https://www.ors.org/Transactions/57/0827.pdfTethers had less lateral ROM than staples and were stiffer laterally than staples but look at the huge error bars. But tethers were better in ROM and less stiff than staples in other planes of motion. The data were all over the place and if they repeated the study the results might be different in my opinion given the variability in the measurements.
    Interestingly enough Dr. Newton and Rady Children's hospital participated in that study.

    One thing that's different about tethers compared to staples is that sooner or later the tethers will deteriorate and break. I'm not sure if that means 5 years or 25 years, but they shouldn't last a lifetime.

    As an aside Dr. Newton mentioned to me during our first meeting that he never performed a stapling procedure. He was always focused on tethering.
    Last edited by Dingo; 08-29-2018 at 12:24 PM.

  3. #33
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    As near as I can tell sometime in 2016 Vertebral Body Stapling stopped being performed and the staples stopped being manufactured (link here). If somebody from the medical or research community knows why I'd be fascinated to learn the reasons. There are no long term studies on tethering and I'd like to know how the two procedures might be different. Maybe knowing how tethering is different/better would help me sleep at night, haha.

    These two studies might explain why stapling was ended. There is always risk with any surgery and as better studies were published stapling was found to be not super effective. That's one possible explanation, not sure if there are others.

    Vertebral Body Stapling versus Bracing for Patients with High-Risk Moderate Idiopathic Scoliosis
    Purpose. We report a comparison study of vertebral body stapling (VBS) versus a matched bracing cohort for immature patients with moderate (25 to 44) idiopathic scoliosis (IS).
    Methods. 42 of 49 consecutive patients (86%) with IS were treated with VBS and followed for a minimum of 2 years. They were compared to 121 braced patients meeting identical inclusion criteria. 52 patients (66 curves) were matched according to age at start of treatment (10.6 years versus 11.1 years, resp. [P = 0.07]) and gender.
    Results. For thoracic curves 25–34, VBS had a success rate (defined as curve progression <10) of 81% versus 61% for bracing (P = 0.16). In thoracic curves 35–44, VBS and bracing both had a poor success rate. For lumbar curves, success rates were similar in both groups for curves measuring 25–34.
    Conclusion. In this comparison of two cohorts of patients with high-risk (Risser 0-1) moderate IS (25–44), in smaller thoracic curves (25–34) VBS provided better results as a clinical trend as compared to bracing. VBS was found not to be effective for thoracic curves ≥35. For lumbar curves measuring 25–34, results appear to be similar for both VBS and bracing, at 80% success.

    Vertebral Body Stapling for Moderate Juvenile and Early Adolescent Idiopathic Scoliosis: Cautions and Patient Selection Criteria.
    STUDY DESIGN: Single-surgeon retrospective case series.
    OBJECTIVE: To validate and further describe clinical and radiographic outcomes of patients undergoing vertebral body stapling (VBS), with the goal of learning if VBS is a safe and effective alternative to bracing for treating moderate idiopathic scoliosis (IS) in the growing pediatric patient.
    SUMMARY OF BACKGROUND DATA: VBS is a growth-modulation technique to control moderate idiopathic scoliosis (IS) while avoiding fusion. Existing studies state successful curve control rates equivalent to bracing, but the majority of reports have come from a single institution.
    METHODS: All IS patients who underwent VBS by 1 surgeon were included. Indications were brace intolerance and a structural coronal curve of 25 to 40. Proportional nitinol staples were used in all cases. Pre- and postoperative radiographs, pulmonary function testing, and physical exam measurements were serially recorded.
    RESULTS: VBS was performed on 35 patients (28 females, 7 males) with mean age 10.5 years (range 7.0-14.6 years). Total of 31 patients (33 stapled curves) completed follow-up. Preoperative Risser grade was 0 in 31 patients, 1 in 1 patient, and 2 in 3 patients. Stapled curves were controlled with <10 of progression in 61% of cases. Curves <35 had a control rate of 75%, and patients <10 years had a 62% curve control rate. Eleven patients (31%) required subsequent fusions; two curves (6%) over-corrected. Preoperative supine flexibility > 30% was predictive of ultimate curve control. No neurologic complications were encountered; 5 patients (14%) developed small pneumothoraces.
    CONCLUSION: This series contains the most patients and longest followup reported for VBS. Successful curve control was achieved less frequently than in previous reports, particularly in patients <10 years.
    LEVEL OF EVIDENCE: 4.
    Last edited by Dingo; 08-29-2018 at 01:32 PM.

  4. #34
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    Quote Originally Posted by Dingo View Post
    How old were you when you had the fusion from your X-Ray? Those look like vampire screws! How long was the recovery?


    That image is amazing! Do you know how much the surgery improved your rotation?

    Dr. Newton measured Scott's rotation at 20. He didn't tell us the new measurement after the surgery but my guess is roughly half that amount.
    10+/- is still a lot but massively better than it was. Any improvement after this is icing on the cake.
    I was 49 when my scoliosis surgery was done. The x-rays in my signature are from Jan 2008

    The CT was a year later April 2009 looking for stones.

    My recovery from my scoliosis surgeries?....90% after 12 months, 100% after 2 years. the 2nd year was the rebuilding of the soft tissues, not an easy thing for athlete's. If you don't use muscles, you lose them. Getting them back is not an easy thing and it takes time. Adults over 50 need at least a year for recovery, full open scoliosis surgeries are invasive procedures.

    I have no idea on my rotational correction. I don't know what level the CT is sliced at, and don't know what my rotation was to begin with. The rotation obviously is different on each level. Here is a study on the subject matter....
    https://www.ncbi.nlm.nih.gov/pubmed/15800431

    I wanted to show what rotation or thoracic torsion looks like and the CT is the best way to see. Not too many of these MRI's are floating around....Also, it addresses another severity of scoliosis, the other dimension that you don't see on x-rays.....Notice how my screw heads are buried deep below the surface of my skin, yet some patients can have them protrude from the surface. The torsion is a subject that isn't discussed often, here is a little something on gravity induced torque in scoliosis.
    https://journals.lww.com/spinejourna...tation.23.aspx

    UHMW is an incredibly strong material. Its 10-15 times stronger than steel. Put it this way, those tethers are not rubber bands. Millions of people have UHMW implanted in them for various reasons. I would love to look at the hardware, was it shown to you? They produce different shapes and braided cords. I don't know who is making the hardware? Zimmer perhaps, here is a site that will explain some things about this material.
    https://www.dsm.com/markets/medical/...que-fiber.html

    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

  5. #35
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    Quote Originally Posted by Dingo View Post
    Dr. Newton told us the level where the Syrinx was located but I can't remember exactly. It was in his lower neck. Although I'll never know for sure I believe the Syrinx is a red flag that perhaps something was wrong from the beginning. Scott's early-onset scoliosis may have been the result of a birth defect. Hopefully some smart scientists will figure this out over the next few decades. 8-)

    Scott never had pain until he hit age 14. After that he began to have pain in the middle of his back and as the year went on it got worse. Walking and standing for long periods became difficult. The day before surgery when we were discussing Fusion vs. Tethering he told me that something needed to be done because the pain was getting worse. Hearing that was heart wrenching.

    Since surgery that pain is gone. He still has general soreness from the surgery and he gets tired easily. After school he lays down and plays on his phone which is relaxing and feels good.
    It is interesting that the prevailing thought from the medics STILL seems to be that scoliosis doesn't cause pain yet every VBT case I have read or followed has had the pain diagnosis confirmed and moreover that the VBT procedure would and did favourably address it. Why are the guys in the fusion world still allowing the statement that scoliosis doesn't cause pain?

  6. #36
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    i don't actually know if most surgeons are still saying scoliosis doesn't cause pain.

    In general, to the extent that only very few cases reach surgical territory and maybe only very large curves tend to be painful (based on my daughters), it might be the case that 99+% percent of scoliosis cases do not cause pain. Maybe they are hanging their hat on that.
    Last edited by Pooka1; 08-30-2018 at 11:32 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."

  7. #37
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    The other thing I wanted to amplify from earlier comments was that fused kids may not realize they have a decreased ROM. They feel normal and don't notice they have lost ROM.

    My daughter claimed she did not have restricted motion after her T4-L1 fusion. I asked her to bend and flex in all three planes. The only noticeable difference from what I could do is she had only about 50% of the lateral ROM that I did. But I guess because she has no reason to bend laterally, she never realized this. That is why my kids claim they feel normal after fusion. Not sure this is the case with lumbar involvement but it seems to be the case with these two T4-L1 fusions.

    The poster boy for amazing ROM after fusion is Ed. Those sitting rotations are amazing and nobody would guess he was fused.
    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."

  8. #38
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    Quote Originally Posted by burdle View Post
    It is interesting that the prevailing thought from the medics STILL seems to be that scoliosis doesn't cause pain yet every VBT case I have read or followed has had the pain diagnosis confirmed and moreover that the VBT procedure would and did favourably address it. Why are the guys in the fusion world still allowing the statement that scoliosis doesn't cause pain?
    Yep. Scott's pain began somewhere after 30 and probably before 40. I wonder if that's a common threshold.
    It wasn't that it hurt all the time. But physical work, long walks or standing became uncomfortable and then if he didn't stop it became painful.
    Last edited by Dingo; 08-30-2018 at 10:12 AM.

  9. #39
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    That rotation study is gold! It's an interesting way to look at it.

    Step 1) S curve.
    Step 2) Gravity rotates the spine.
    Step 3) Rib hump.

    Now I understand how correcting the S curve with tethering may help the rotation. As the S curve diminishes so do the gravitational forces that produce the rotation. Super interesting!

    By the way I don't see any bending and twisting pics after full fusion at this link. Am I doing something wrong?
    http://www.scoliosis.org/forum/showt...on.&highlight=
    Last edited by Dingo; 08-30-2018 at 10:26 AM.

  10. #40
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    Quote Originally Posted by Pooka1 View Post
    i don't actually know if most surgeons are still saying scoliosis doesn't cause pain.

    In general, to the extent that only very few cases reach surgical territory and maybe only very large curves tend to be painful (based on my daughters), it might be the case that 99+% percent of scoliosis cases do not cause pain. Maybe they are hanging their hat on that.
    A registrar said it doesn't to my face at RNOH in UK - needless to say I wasn't impressed.

    Also a link was posted recently that still suggested this- will try to find it.

  11. #41
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    Quote Originally Posted by Dingo View Post
    Now I understand how correcting the S curve with tethering may help the rotation. As the S curve diminishes so do the gravitational forces that produce the rotation. Super interesting!

    By the way I don't see any bending and twisting pics after full fusion at this link. Am I doing something wrong?
    http://www.scoliosis.org/forum/showt...on.&highlight=
    7.5 Newton meters is 5.5 Ft-lb's torque or "rotational force" on each vert in the standing position. They don't mention curve size or weight. The interesting thing is that the rotation differs and at the apex, its at its worst. Ribs also conform, some worse than others. I had a thoracic hump similar to Scott's in the photo, not as bad as some rib humps that produce a sort of large ridge, some patients undergo thorocoplasty to have this reduced. The tethering will help stop this deformation which can continue into adulthood. Even though some curves can hold, most of our curves progress at slow rates. Large curves look painful...well, I can vouch for that.

    Laying down gives us a big break, now you can see why. Scoliosis curve is one thing, rotation adds to the reduction of nerve pathways which cause incredible amounts of pain. Its a double whammy. There is no rotation in kyphosis, and no rotational correction in minimally invasive scoliosis surgery per Dr Anand.

    The photos are gone due to software updates on the NSF server. At some point, I will need to take another series of photos and probably start another thread. All the Benny Hill videos were lost. How depressing. The most important thing about all of this has to do with laughter, because when we are laughing, the pain ceases.....

    I am having trouble remembering pain when I was younger as many years have passed. Recovery from pain events happens faster when younger vs older. The thing is that I do remember using infra rub at age 22, and had inversion boots at age 23, so I guess I was experiencing pain. I did block a lot of it out mentally through the years.....Its something we get used to.

    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

  12. #42
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    Scott was diagnosed with a small Syrinx inside one vertebrae just below his neck prior to tethering surgery. A second MRI with contrast was ordered to make sure it wasn't dangerous. They determined that it wasn't.

    And here comes the research...

    This study found that out of 504 infants and juveniles that were diagnosed with scoliosis 94 or 18.7% had intraspinal anomalolies.
    The prevalence of intraspinal anomalies in infantile and juvenile patients with “presumed idiopathic” scoliosis: a MRI-based analysis of 504 patients

    Total number of neural abnormalities detected on preoperative MRI evaluation: 94
    Isolated Arnold-Chiari malformation: 43 (45.7 %)
    Arnold-Chiari malformation combined with syringomyelia: 18 (19.1 %)
    Isolated syringomyelia: 13 (13.8 %)
    Tethered cord combined with diastematomyelia: 6 (6.4 %)
    Diastematomyelia: 6 (6.4 %)
    Tethered cord: 4 (4.3 %)
    Intrinsic spinal cord tumor: 3 (3.2 %)
    Syringomyelia combined with tethered cord and tumor: 1 (1.1 %)

    If the syrinx caused Scott's Scoliosis I think he would have been considered to be in the Isolated Syringomyelia category. Although he had a syrinx, it was inside only one vertebrae and wasn't officially diagnosed as Syringomyelia (a more extreme case of the same basic thing I believe).

    It's also possible that the syrinx may have been a consequence and not the cause of Scott's scoliosis. They didn't know.

    Missed Diagnosis of Syrinx
    Syrinxes usually result from lesions that partially obstruct cerebrospinal fluid flow . At least half of syrinxes occur in patients with congenital abnormalities of the craniocervical junction (e.g., herniation of cerebellar tissue into the spinal canal, called Chiari malformation), brain (e.g., encephalocele), or spinal cord (e.g., myelomeningocele)
    Last edited by Dingo; 08-31-2018 at 04:18 PM.

  13. #43
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    Quote Originally Posted by titaniumed View Post
    The photos are gone due to software updates on the NSF server. At some point, I will need to take another series of photos and probably start another thread. All the Benny Hill videos were lost. How depressing. The most important thing about all of this has to do with laughter, because when we are laughing, the pain ceases.....
    You can post them on www.imgur.com and link to them from anywhere. You can include descriptions and a lot of people around the world will probably see them. Your X-ray is amazing!

  14. #44
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    Quote Originally Posted by burdle View Post
    A registrar said it doesn't to my face at RNOH in UK - needless to say I wasn't impressed. Also a link was posted recently that still suggested this- will try to find it.
    burdle, you seem to know more about tethering than anyone on the forum. Do you work in healthcare?
    Also you are in the UK? Do they do tethering in the UK yet?

  15. #45
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    Quote Originally Posted by Dingo View Post
    burdle, you seem to know more about tethering than anyone on the forum. Do you work in healthcare?
    Also you are in the UK? Do they do tethering in the UK yet?
    I think she is on the closed FB group. Now that your son has been tethered I think that group would love to have you join.

    I direct people there. You and burdle are the only ones here with any knowledge at this point.
    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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