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Thread: Scott's Vertebral Body Tethering Thread

  1. #91
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    Love it!

    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. #92
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    Clinical Trial: Anterior Vertebral Body Tethering (AVBT) Using Dynesys System Components to Treat Pediatric Scoliosis

    Estimated Enrollment: 25 participants
    Primary Purpose: Device Feasibility
    Official Title: Prospective Pilot Study of Anterior Vertebral Body Tethering Using Dynesys System Components to Treat Pediatric Scoliosis
    Actual Study Start Date: April 25, 2018
    Estimated Primary Completion Date: June 1, 2025
    Estimated Study Completion Date: July 1, 2027

    I believe they are testing this device for tethering. If you scroll to the bottom it looks like they might have a solid cord option in addition to their standard tether.
    DynesysŪ Dynamic Stabilization Product Family

    Scott is still doing great. His brace is off in less than 3 weeks.
    Last edited by Dingo; 10-18-2018 at 03:58 PM.

  3. #93
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    If you select technology, you will see that Dynesys was not intended for anterior tethering.....and is used in a posterior "Wiltse" approach....for single level in adults in the lumbar, used with grafting. Zimmer does not mention scoliosis....

    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. #94
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    Quote Originally Posted by titaniumed View Post
    If you select technology, you will see that Dynesys was not intended for anterior tethering.....and is used in a posterior "Wiltse" approach....for single level in adults in the lumbar, used with grafting. Zimmer does not mention scoliosis....

    Ed
    Yeah I think Dynesys was designed to be used in fusion but I'm not sure how. But I guess they're testing it for tethering.

  5. #95
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    Quote Originally Posted by titaniumed View Post
    They still need to figure out why the solid tethers are breaking. This problem is solvable.

    I wonder if they have thought about using Dyneema? Its a fiber, used in a woven cord.... This gets away from using solid material.

    I am assuming the breaking happens at the screw heads. (perhaps a new floating screw head)

    https://www.youtube.com/watch?v=spdyIKro-nk

    https://www.dsm.com/markets/medical/...pe-fibers.html

    Ed
    They are now double tethering in some cases- this means 2 tethers for the same bit of spine- not the same as a single tether on 2 parts of spine. I think they double tether when the curve is large and there is a lot of growth left.

  6. #96
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    Unless some long term issue arises, I predict tethering is going to replace bracing.
    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. #97
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    Quote Originally Posted by Pooka1 View Post
    Unless some long term issue arises, I predict tethering is going to replace bracing.
    I have heard this and I think so too but bracing is 'conservative' and VBT is invasive and I think that from a medical point of view the physical is always considered before the mental.( it often being difficult psychologically to wear a brace)

    They have to deflate the lung often with VBT because it is an anterior approach. A lot of the negativity about VBT is about this aspect of the procedure.

    Those who do VBT are doing it to avoid having fusion. Although for a patient it could be seen as keeping options open for future for the surgeons it is an 'instead of'. from what I can tell it is only a few whose parameters are on the cusp for whom it is being suggested that it may just temporary and a fusion needed later. And surgeons are going to do a complete 'about face' if they adopt this because a lot of VBT doctors no longer perform fusion surgery on adolescents.

    What I am fascinated about is that VBT seems to be a solution for pain- unlike fusion.

  8. #98
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    Quote Originally Posted by burdle View Post
    What I am fascinated about is that VBT seems to be a solution for pain- unlike fusion.
    Yep, Scott's pre-surgery pain is gone. Before surgery it was getting worse at a steady rate. He feels normal again.

    I remember when Dr. Newton explained the tethering procedure vs. fusion. When he was done I told him that it was a "no-brainer", we should choose tethering. He corrected me immediately. Paraphrasing his response, "Every surgery is risky. If tethering doesn't appear to have a good chance of success we won't do it." So although tethering may be a good procedure it has risks like any surgery. I think they use it as an alternative to fusion, not necessarily as an alternative to bracing in smaller curves.

  9. #99
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    From the study on 17 children who received tethering,

    Anterior Spinal Growth Tethering for Skeletally Immature Patients with Scoliosis: A Retrospective Look Two to Four Years Postoperatively.

    There were 2 minor pulmonary perioperative complications following initial ASGT. One patient had atelectasis and perihilar effusion on postoperative day 1, which required continuous positive airway pressure (CPAP) at night and was
    monitored in the intensive care unit (ICU) overnight. This improved by postoperative day 2. The other patient had atelectasis and pulmonary edema and was returned to the ICU for monitoring, chest therapy, intermittent positive pressure
    breathing, and medical therapy. Both patients recovered and were discharged, on postoperative days 5 and 8.
    The procedure is excellent and Dr. Newton is one of the best in the world. But despite that complications are common. It's not like getting your tonsils out.
    Last edited by Dingo; 10-22-2018 at 10:30 AM.

  10. #100
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    Quote Originally Posted by Dingo View Post
    From the study on 17 children who received tethering,

    Anterior Spinal Growth Tethering for Skeletally Immature Patients with Scoliosis: A Retrospective Look Two to Four Years Postoperatively.



    The procedure is excellent and Dr. Newton is one of the best in the world. But despite that complications are common. It's not like getting your tonsils out.
    There is a lot of concern about where and how deep to place the screws I understand as very close to Aorta.

  11. #101
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    I am so pleased to hear that Scott is pain-free. This aspect of the treatment should be highlighted because maybe it would stop orthos in general still putting it out that Scoliosis doesn't cause pain, which for a lot of patients not eligible for surgery causes a lot of psychological distress

  12. #102
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    My one daughter with the fast moving curve had pain which went away after she was fused. She was hyper-corrected and does not technically have scoliosis any more (<10*). The other one did not have pain before or after fusion.
    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. #103
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    Quote Originally Posted by Pooka1 View Post
    My one daughter with the fast moving curve had pain which went away after she was fused. She was hyper-corrected and does not technically have scoliosis any more (<10*). The other one did not have pain before or after fusion.
    Surgeons and consults should not still be saying that scoliosis doesn't cause pain. It is a meaningless sentence without context but it is still said and damages awareness and effective treatment for some. Some people do not have pain which is GREAT- however the effect of having a scoliosis is often pain

  14. #104
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    According to this study 40% of kids with Scoliosis have chronic back pain. That was true for Scott. Somewhere after 40° is when the pain started.

    EVIDENCE OF IMPAIRED PAIN MODULATION IN ADOLESCENTS WITH IDIOPATHIC SCOLIOSIS AND CHRONIC BACK PAIN.
    Spine J. 2018 Oct 18

    BACKGROUND CONTEXT:
    Although 40% of adolescent idiopathic scoliosis (AIS) patients present with chronic back pain, the pathophysiology and underlying pain mechanisms remain poorly understood. We hypothesized that development of chronic pain syndrome in AIS is associated with alterations in pain modulatory mechanisms.

    PURPOSE:
    To identify the presence of sensitization in nociceptive pathways and to assess the efficacy of the diffuse noxious inhibitory control in patients with AIS presenting with chronic back pain.

    STUDY DESIGN:
    Cross-sectional study.

    PATIENT SAMPLE:
    Ninety-four patients diagnosed with AIS and chronic back pain.

    OUTCOME MEASURES:
    Quantitative sensory testing (QST) assessed pain modulation and self-reported questionnaires were used to assess pain burden and health-related quality of life.

    METHODS:
    Patients underwent a detailed pain assessment using a standard and validated quantitative sensory testing (QST) protocol. The measurements included mechanical detection thresholds (MDT), pain pressure threshold (PPT), heat pain threshold (HPT), heat tolerance threshold (HTT), and a conditioned pain modulation (CPM) paradigm. Altogether, these tests measured changes in regulation of the neurophysiology underlying the nociceptive processes based on the patient's pain perception. Funding was provided by The Louise and Alan Edwards Foundation and The Shriners Hospitals for Children.

    RESULTS:
    Efficient pain inhibitory response was observed in 51.1% of patients, while 21.3% and 27.7% had sub-optimal and inefficient CPM, respectively. Temporal summation of pain was observed in 11.7% of patients. Significant correlations were observed between deformity severity and pain pressure thresholds (P = 0.023) and CPM (P=0.017), neuropathic pain scores and pain pressure thresholds (P=0.015) and temporal summation of pain (P=0.047), and heat temperature threshold and pain intensity (P=0.048).

    CONCLUSIONS:
    Chronic back pain has an impact in the quality of life of adolescents with idiopathic scoliosis. We demonstrated a high prevalence of impaired pain modulation in this group. The association between deformity severity and somatosensory dysfunction may suggest that spinal deformity can be a trigger for abnormal neuroplastic changes in this population contributing to chronic pain syndrome.

  15. #105
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    Quote Originally Posted by Dingo View Post
    I remember when Dr. Newton explained the tethering procedure vs. fusion. When he was done I told him that it was a "no-brainer", we should choose tethering. He corrected me immediately. Paraphrasing his response, "Every surgery is risky. If tethering doesn't appear to have a good chance of success we won't do it." So although tethering may be a good procedure it has risks like any surgery. I think they use it as an alternative to fusion, not necessarily as an alternative to bracing in smaller curves.
    A lot has to do with the patient and the parents....If someone is afraid of surgery, then bracing is an option. The minute something goes wrong, there is a ton of bricks each surgeon has to deal with, and they hate it when things go wrong. Bracing will always be around because its the easier alternative. There is nothing a surgeon can do if someone doesn't want surgery.

    I am afraid that the tethering technology and the studies will take a few decades just like what happened with the pedicle screw and the CD system (Jan 1983) They will solve problems, but its not going to be tomorrow. I would like to see this happen soon since I waited so long.....They didn't have any long term results back then, it was all experimental.

    Surgeons really need to go visit with hardware companies. (You know, medical Disneyland.....Ha ha) I would imagine that many different prototypes have been made that have been sitting on the back burner. A surgeon can go in and be a catalyst on a device.....

    I still have my tonsils....so cant comment on that. But I have had complications from a tooth extraction. 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
    Last edited by titaniumed; 10-23-2018 at 10:41 PM.
    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

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