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Thread: VBS and Growth of the Spine

  1. #1
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    VBS and Growth of the Spine

    I posted this in a VBS thread already so please forgive me if this is redundant.

    I am curious, what are the implications to the growth of the spine post- VBS? I have read a great deal about this but have not seen this addressed specifically. As the staples function to modulate the curve through the natural growth of the spine, it seems to me that by extention, once a straight curve is reached and the spine continues to grow, the staples will either over compensate or constrain the growth of the spine.

    I am sorry if this is a dumb question.

    Thanks,

    Paul

  2. #2
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    Quote Originally Posted by bpaul
    I posted this in a VBS thread already so please forgive me if this is redundant.

    I am curious, what are the implications to the growth of the spine post- VBS? I have read a great deal about this but have not seen this addressed specifically. As the staples function to modulate the curve through the natural growth of the spine, it seems to me that by extension, once a straight curve is reached and the spine continues to grow, the staples will either over compensate or constrain the growth of the spine.

    I am sorry if this is a dumb question.
    There are no dumb questions as they say.

    I have no experience with VBS but did some reading after my twins were diagnosed.

    I think the surgeons try to account for expected growth in terms of how much correction they aim for at the time of surgery and how much growth is likely to occur post-surgery.

    I suspect if they guess wrong they can remove some or all of the staples when the child is near straight if it looks like there will be an over-correction.

    I wonder if they have ever encountered that though. If anyone here knows, it's MariaF. Maybe she will respond.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
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  3. #3
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    Quote Originally Posted by Pooka1
    I think the surgeons try to account for expected growth in terms of how much correction they aim for at the time of surgery and how much growth is likely to occur post-surgery.

    I suspect if they guess wrong they can remove some or all of the staples when the child is near straight if it looks like there will be an over-correction.

    I wonder if they have ever encountered that though. If anyone here knows, it's MariaF. Maybe she will respond.
    Bpaul - the only dumb questions is one you are afraid to ask :-))

    Sharon - what you wrote above is VERY close to how the surgeons make their decisions.

    Meaning - for example, they may delay VBS for a particular child because of fear of overcorrection. They may feel that a child with lots of growth left, with only a moderate curve (25, 30) AND whose spine is also very flexible is a risk for overcorrection. Since they cannot change the flexibility or the degree of curve, the only variable they have to work with is WHEN to perform the surgery. (These are some of the factors considered to prevent overcorrection - degree, age, flexibility). They may have the child continue bracing and monitor them closely to see when the optimum time for VBS arises. Each case is different and so they do a VERY thorough evaluation of each VBS candidate.

    This is a bit off topic, but VBS is not for everyone. Some patients are told they simply arent' good candidates. This can be if the curve is too large - or generally if they don't feel there is a very good chance for success.

    With regard to instances of overcorrection, there is only one that I am aware of. The girl was one of the early stapling patients and after about 5 years, she did overcorrect and the staples were removed. Had that same child walked in now with the same set of factors (young age, moderate curve, etc), I'm sure they would have done things differently. In fact, her case is probably the reason they changed their guidelines.

    All this being said, for some reason overcorrection rarely happens (I think that case is the only one). When VBS was first "invented" the goal was to HOLD or maintain the curve. In some children, this is what happens - but most get SOME correction, just not nearly enough to be come completely straight (0) and thankfully most never have to worry about overcorrection, especially now that the doctors have learned so much about which cases are likely to overcorrect and they can take measures to prevent it.

    Hope this helps.
    Last edited by mariaf; 07-26-2008 at 10:24 AM.
    mariaf305@yahoo.com
    Mom to David, age 17, braced June 2000 to March 2004
    Vertebral Body Stapling 3/10/04 for 40 degree curve (currently mid 20's)

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  4. #4
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    Welcome, Paul

    Hi Paul,

    I'm glad you got the great replies above. My daughter is 6 y/o also, and is in the situation Maria is describing. Leah's curve is moderate (26 degrees thoracic), very flexible (curve bends down to 5 degrees on a bending x-ray), and so far has not progressed. Due to these specific factors, Dr Betz wants Leah to wait until she is 7 for VBS to reduce/avoid any risk of overcorrection. We are bracing 16 hrs/day in the meanwhile to prevent the bigger fear, a large progression of her curve.

    Have you been to see a pediatric orthopedist scoliosis specialist? This is who you want to follow your daughter's care, not just a general orthopedist. I have heard of some at UCSF, you could also check Children's Hospital Oakland and Lucille Salter Packard/Stanford depending on your location. You can search further for one on the Scoliosis Research Society website (www.srs.org , search for "juvenile"). The doctor should order an MRI to check for any underlying causes of the scoliosis.

    Good luck! There are no dumb questions! I sent you a PM too.
    Gayle, age 50
    Oct 2010 fusion T8-sacrum w/ pelvic fixation
    Feb 2012 lumbar revision for broken rods @ L2-3-4
    Sept 2015 major lumbar A/P revision for broken rods @ L5-S1


    mom of Leah, 15 y/o, Diagnosed '08 with 26* T JIS (age 6)
    2010 VBS Dr Luhmann Shriners St Louis
    2017 curves stable/skeletely mature

    also mom of Torrey, 12 y/o son, 16* T, stable

  5. #5
    Join Date
    Jul 2008
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    Thank you all for the information. We have seen several pediatric orthopedic specialists but we feel we need more information and perspective. We have an appointment with Dr. Betz in two weeks. This is a very difficult time, as my daughter (who is a twin) also suffers from high-frequency hearing loss (which was only recently diagnosed) so between the scoliosis related medical visits and those related to her hearing, she is growing very frustrated with the fact that she is spending so much time the "doctor" while her twin brother is not.

    I noticed that your daughter is using the Boston brace. Have you considered the Spinecor? Is that appropriate for small children?

  6. #6
    Join Date
    Jan 2008
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    Hi Paul,

    I understand how difficult this all must be, especially with two problems at the same time. My daughter did a lot of complaining too about how many "stupid" doctors visits and "boring" x-rays she had to have. We have made a large effort now to sweeten the deal a little by pointing out how she gets to have some special time with mom without her 3 y/o brother. I also try to have plenty for her to do at the appointments and in the car, which helps a lot. You may have a long wait at Shriners so be prepared with lots to do and snacks, too. I was very nervous about our appt there, so I brought along a portable DVD player for the kids so that I could zone out a little sometimes.

    We do not have SpineCor available to us where we live, so I don't know much about it. I know there are some here whose young children with smaller curves are wearing it. Dr Betz told us he did not recommend it at all for our daughter. Also, since I was braced as a child, I am very averse to long-term bracing for Leah, which is why we are interested in VBS. 9-10 years in a brace just doesn't seem feasible for our family.

    Good luck, you will not regret travelling to see Dr Betz.
    Gayle, age 50
    Oct 2010 fusion T8-sacrum w/ pelvic fixation
    Feb 2012 lumbar revision for broken rods @ L2-3-4
    Sept 2015 major lumbar A/P revision for broken rods @ L5-S1


    mom of Leah, 15 y/o, Diagnosed '08 with 26* T JIS (age 6)
    2010 VBS Dr Luhmann Shriners St Louis
    2017 curves stable/skeletely mature

    also mom of Torrey, 12 y/o son, 16* T, stable

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