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Thread: Scott's Vertebral Body Tethering Thread

  1. #76
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    Since most members here on this forum are adults, and being a fused adult myself, I wasn't thinking about growth......(It doesn't come naturally anymore, you might say I have a "fused" state of mind) Ha ha

    And how much does a 12 yr old grow? Quite a bit. Now, I can see why these tethers are breaking. I can also see this causing some anxiety....

    How did Scott take all of this? I'm sure he completely understands the process.

    Is there any reason to wear a soft brace during the day time for 2 years? Was this topic brought up with your surgeon?

    Thanks for posting the data.

    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

  2. #77
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    If tethering requires a brace then it is going to defeat the purpose of not needing a brace. Tethering certainly appears so far to be more effective than bracing and I hope the materials science guy figure out the optimal properties needed soon.

    When they work out the details, tethering is going to be the death knell to bracing. Eventually only kids who can't go through surgery will be braced. That is my prediction.

    In re the commentary about waiting to see what happens with tethering, I was reminded of Lonner saying he sat on the sidelines for 5 years watching the tethering because he had concerns. But then he started doing them. Whatever his concerns were they seemed to have been answered. Or maybe too many of his patients were demanding the procedure.

    If my daughters had lumber scoliosis now, I would demand tethering. Not so sure what I would do if they had thoracic like they really had.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

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    Answer: Medicine


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  3. #78
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    Quote Originally Posted by Pooka1 View Post
    If tethering requires a brace then it is going to defeat the purpose of not needing a brace.
    Sharon, true, but soft brace until the correction has remodeled.....after that happens, then the tethers can break. I believe a full bone remodel is 22 months.....Soft tissues remodel also, but I don't know that time frame. Discs remodel in scoliosis patients, that was in one of the studies in the Cotrel white book I posted last week.

    I still think that using cables instead of a solid cord is an idea worth considering. Post #71. Using multiple cables per level is also worth consideration. Thinking about suspension bridges with multiple dynamic cable systems. Suspension bridges are built to sag under stress loads without failure. The main cables support the deck with many smaller cables, that all give together. Ideas happen through concepts. Knowing what works in another application can be of high value. Luque wire systems use multiple wires, not one larger wire. Sewing up soft tissues utilizes multiple strands with multiple attachment points to hold two areas together. The stress is always distributed.

    I am sick with either a cold or the flu. AGAIN! I went and had a flu shot yesterday and my body is exhausted fighting what needs to be fought. I am whooped!

    Since I am the first one that has gotten sick, I have nobody to blame. (smiley face)

    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. #79
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    Quote Originally Posted by titaniumed View Post
    Sharon, true, but soft brace until the correction has remodeled.....after that happens, then the tethers can break. I believe a full bone remodel is 22 months.....Soft tissues remodel also, but I don't know that time frame. Discs remodel in scoliosis patients, that was in one of the studies in the Cotrel white book I posted last week.
    Scott gets his brace off in about 30 days but it's not a normal Scoliosis brace. It's 2 pieces of plastic held together by 6 velcro strips. It isn't meant to mold his body or correct a curve. It is a semi-loose "turtle shell" that protects kids in case they fall and things like that.

    Scott is definitely tired of wearing it, but it's not that bad. He comes home, takes it off and lays down for an hour after school. Then he puts it back on until bed time. Then he takes it off again and sleeps for the night.

    If he absolutely had to wear it for a year or two it would be doable. But... thankfully I don't think we will need to.
    Last edited by Dingo; 10-05-2018 at 02:41 PM.

  5. #80
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    Quote Originally Posted by titaniumed View Post
    How did Scott take all of this? I'm sure he completely understands the process.

    Is there any reason to wear a soft brace during the day time for 2 years? Was this topic brought up with your surgeon?
    Those are the kinds of studies that give his mother and I heart attacks but Scott has never shown any particular worry or concern about his Scoliosis. He doesn't even talk about it and we're glad about that. He can leave the 24/7 worrying up to us. hahaha

    According to that study the tethers are rated at 3000 Newtons which means they can hold about 650 pounds each! That's probably why this girl was doing full blown gymnastics just 12 weeks after VBT surgery! Mackenzie Haar 12 weeks Post VBT surgery (video)

    But in my opinion that's absolutely crazy. Although those tethers are incredibly strong they wear out quickly. Because of that Scott is going to spend a lot of time in front of his computer until he is 18. 8-)

    All rotation exercises are done forever but we are going to start lifting weights next week. We are going to focus on exercises that grow his chest and don't involve any bending or twisting. We want to get 100% of our mileage out of these tethers.

    The reason we're going to focus on chest exercises is because at Scott's age exercise can increase the final adult size of his rib cage which may in turn may help control his curve to a greater degree. Bigger is better!
    Last edited by Dingo; 10-05-2018 at 04:06 PM.

  6. #81
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    Quote Originally Posted by titaniumed View Post
    I still think that using cables instead of a solid cord is an idea worth considering. Post #71. Using multiple cables per level is also worth consideration. Thinking about suspension bridges with multiple dynamic cable systems. Suspension bridges are built to sag under stress loads without failure. The main cables support the deck with many smaller cables, that all give together. Ideas happen through concepts. Knowing what works in another application can be of high value. Luque wire systems use multiple wires, not one larger wire. Sewing up soft tissues utilizes multiple strands with multiple attachment points to hold two areas together. The stress is always distributed.
    Dr. Newton (and probably other surgeons) have been working on tethering since at least 2002. Most of this took place outside the public eye. I wouldn't be surprised if they've got a half dozen improvements like what you mentioned in the pipeline right now.

    A new partial fusion device is being tested in children as we speak.

    Preservation of Spine Motion in the Surgical Treatment of Adolescent Idiopathic Scoliosis Using an Innovative Apical Fusion Technique: A 2-Year Follow-Up Pilot Study.

  7. #82
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    Quote Originally Posted by Dingo View Post
    Scott gets his brace off in about 30 days but it's not a normal Scoliosis brace. It's 2 pieces of plastic held together by 6 velcro strips. It isn't meant to mold his body or correct a curve. It is a semi-loose "turtle shell" that protects kids in case they fall and things like that.

    Scott is definitely tired of wearing it, but it's not that bad. He comes home, takes it off and lays down for an hour after school. Then he puts it back on until bed time. Then he takes it off again and sleeps for the night.

    If he absolutely had to wear it for a year or two it would be doable. But... thankfully I don't think we will need to.
    I had a clam shell or turtle shell brace for my surgical recoveries. This was cast before my surgeries, and then after my surgeries, I grew 4 inches and had a huge ileus. Needless to say, it did not fit well at all. I guess it offered some protection....my efforts were mainly about not falling, and no BLT's, or lifting which is not a great idea when trying to fuse.

    The soft brace I am referring to would be called a corset brace. This was the most comfortable to wear, I used it for skiing years ago. It offers some level of protection, and would restrict or slow down any quick types of impulsive moves that might be damaging. Kids do these quick types of movements often. You would have to throw it by your surgeon and see what he thinks. (See attached photo below) They are around $45 ea. If the tethers are breaking at roughly 2 years, it would be nice to know why they are breaking. It would seem logical to try to preserve the tethers. Going in and doing a floor routine 3 months after had to have everyone cringing.

    Ed
    Attached Images Attached Images
    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

  8. #83
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    Quote Originally Posted by Dingo View Post
    Scott has never shown any particular worry or concern about his Scoliosis. He doesn't even talk about it and we're glad about that.
    Oh...but he is thinking about it. Seriously thinking about it.

    Kids might not be the most communicative types..... especially around parents. There is a LOT going on, and we wonder about what is going to happen. That's our main worry.

    I went through an anger phase which completely locked me up....it was when I realized that I had to accept what was happening that the anger phase quelled. These feelings went back and forth for a bit when I was a teen. It was quite a battle. Scoliosis and High School DO NOT go well together.....Peer pressure, Locker room antics, bullying, not being able to throw a discus a mile, that sort of thing. Boys are quite physical and some boys can be animals.

    I mentioned the corset brace as a measure of protection. BUT, the minute you have a corset on in the boys locker room, the attacks will begin, that's guaranteed. You can see how complicated this all gets. This is just an example. Some comments we hear will not get repeated, parent or not. Comments like spineless jellyfish.....funny that the person that mentioned this to me in 1975 now has a daughter with scoliosis.

    The psych ramifications of teen scoliosis are really hard on us. On a positive note, this all passes in time... it all gets worked out. We might have a harder outside shell after all of this, but we are all very soft inside.

    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

  9. #84
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    Just dipping in again...

    Most doctors - ie Antonacci, Betz , Cuddihy , Alanay and the ones in Europe do not use Bracing as a general rule after VBT. So maybe if bracing is required it is for short term protection. It can't be for holding a curve as in pre-fusion because VBT is precisely for allowing remodelling using growth,

    having said that some of the surgeons doing ASC on a mature ( fully grown spine ) are sometimes using a brace for a short while after op.


    VBT will replace bracing in so far as VBT is done before fully grown unlike fusion. Bracing may still be of some use if the child is very young and the curve is large ( in the 40*) because they don't use VBT too early in case of overcorrection which is a risk. So if you are still a very low Sanders score ( lots of growth left) they will wait and may suggest bracing then
    Last edited by burdle; 10-07-2018 at 12:10 PM.

  10. #85
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    Quote Originally Posted by titaniumed View Post
    Oh...but he is thinking about it. Seriously thinking about it.

    Kids might not be the most communicative types..... especially around parents. There is a LOT going on, and we wonder about what is going to happen. That's our main worry.

    I went through an anger phase which completely locked me up....it was when I realized that I had to accept what was happening that the anger phase quelled. These feelings went back and forth for a bit when I was a teen. It was quite a battle. Scoliosis and High School DO NOT go well together.....Peer pressure, Locker room antics, bullying, not being able to throw a discus a mile, that sort of thing. Boys are quite physical and some boys can be animals.

    I mentioned the corset brace as a measure of protection. BUT, the minute you have a corset on in the boys locker room, the attacks will begin, that's guaranteed. You can see how complicated this all gets. This is just an example. Some comments we hear will not get repeated, parent or not. Comments like spineless jellyfish.....funny that the person that mentioned this to me in 1975 now has a daughter with scoliosis.

    The psych ramifications of teen scoliosis are really hard on us. On a positive note, this all passes in time... it all gets worked out. We might have a harder outside shell after all of this, but we are all very soft inside.

    Ed
    I'm sure you are right on that, Scott keeps it to himself. Maybe that's an instinct.
    He has been excused from PE so he doesn't have to worry about any locker room jabbing. His last day in the "turtle shell" brace is November the 6th. Technically speaking after that point he is released for all normal activities. But his days of Airsoft wars are over. haha
    Last edited by Dingo; 10-07-2018 at 12:01 PM.

  11. #86
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    We did Scott's first chest workout tonight.

    4 sets of 3 push ups
    4 sets of 5, 5 pound dumbbell press
    4 sets of 5, 5 pound pullover

    Super super easy stuff at a very low weight just to get him used to form again. He said he didn't feel any pain or discomfort.

    It's been 8 weeks since surgery and he's just about 100%.

    We'll do light workouts through October and in November we'll get back to normal workouts.

  12. #87
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    No discomfort at all. I am not surprised....

    What is the exercise protocol? Is there some sort of written procedure of do's and dont's.


    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

  13. #88
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    Quote Originally Posted by titaniumed View Post
    No discomfort at all. I am not surprised....

    What is the exercise protocol? Is there some sort of written procedure of do's and dont's.


    Ed
    Dr. Newton wasn't really specific. He asked us the kinds of physical activities we might do and I told him lift weights. His general vibe was be gentle, careful, etc. etc.
    Basically common sense stuff.

    I did mention that we wouldn't do any more twisting exercises. He said at the very least we should wait 90 days before any twisting. I'm thinking more like 5 years. 8-)

  14. #89
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    Quote Originally Posted by Dingo View Post
    His general vibe was be gentle, careful, etc. etc.
    I guess that leaves the 1000# Russian dead lift out. Can you imagine what is going on with their lumbar discs? Let alone blood pressure? Man-o-man!

    When I did my shoulder PT, the therapist was afraid of my spine....It was just too much to gamble with. So, we started with motion exercises without weights, then progressed slowly in 1# increments.

    I used the arm bike....starting with no resistance, forward and backward. Good for toughening up paraspinal's in fusion patients and does not change spine position much.

    Which exercises would apply minimal stress to the tethers?

    It would be neat to exercise under flourscopy to see what is happening inside.....

    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

  15. #90
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    Quote Originally Posted by titaniumed View Post
    Which exercises would apply minimal stress to the tethers?

    It would be neat to exercise under flourscopy to see what is happening inside.....

    Ed
    Scott put a rubber band between two pencils and then held each pencil in a fist. He positioned his fists one on top of the other like vertebrae.

    1) Twisting created the most tension by far.
    2) Side bending towards the rubber band reduced tension.
    3) Side bending away from the rubber band increased tension a lot.
    4) Rolling the fists forward or backward to simulate a forward/backward bending motion didn't change the tension very much if at all.

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