A question!

[flerc]

http://europepmc.org/articles/PMC308...Sf7fxWA0MwTD.0

Since they are talking about preoperative and postoperative I suppose External Fixator for AIS is a non fusion surgery, although I'm not sure about what kind of surgery may be.
The before/after photos are really incredible. Someone know about it? I cannot find anything else.

[flerc]

I found something more..

http://www.thespinejournalonline.com...934-9/abstract

but I'm not sure to be understanding..

The time between initial treatment and final correction was 50 days. Ten thoracic curves, one thoracolumbar curve and one lumbar curve were treated, with an average of 93 degrees.

Is this an alternative to fusion in big curves or has nothing to do ?

[rohrer01]

Here is what the meat of the article said:

Methods

The surgical procedure consisted of two stages, anterior and posterior approach, dissectomies, vertebrectomy at the apex, spinal column shortening and the placement of an external stabilization device. Progressive correction of the curve was done by a daily increase in distraction (3 mm/day). When the correction was finished, a different internal fixation device was used to maintain the correction. The time between initial treatment and final correction was 50 days. Ten thoracic curves, one thoracolumbar curve and one lumbar curve were treated, with an average of 93 degrees. All patients had kyphosis with an average of 89 degrees. Vertebral rotation was not found in two patients.

Results

Average correction of scoliosis was 52.9% and of kyphosis, 29%. Vertebral rotation in eight cases was corrected. There were no neurological irreversible lesions in any patient. There was one infection. Using an evaluation result scale, there were 2 excellent, 6 good and 4 fair outcomes. The average loss of correction was 5 degrees.

Conclusion

The results suggest that the use of an external stabilization device with controlled compression on the convexity and distraction on the concavity of the curve can achieve a correction of up to 50% in scoliosis, 30% in kyphosis and 1 degree in the rotation of the spine.

It sounds like a lot of surgery with the patients ending up being internally fixated. Fused or not, this would still limit mobility. Discs and the apical vertebra were removed. The external fixator sounds like something like they do with severely broken bones where the device is attached to the bone but the mechanism extends outside of the skin. It sounded to me like it was less invasive until I read the part about actually removing the vertebra! All of this, over two months, and there is no better correction and possibly less than the more traditional fusion. I would think that the external fixator would also make one more susceptible to infection. I don't think that this would be my method of choice if I ever had surgery. Granted it was talking about the very large curves.

I believe that Karen Ocker had >100* curves and got 50% correction with the fusion approach.

Look back at Elias. They did some sort of internal release, applied traction over about the same period of time, then fused him. He got way better than 50% correction.

[Pooka1]

It sounds like they were looking for a safer way to straighten the curve prior to fusion than the present methods afford. There is a chance of neuro injury in straightening the large curves. The "internal fixation" is fusion.

If this was a way of avoiding fusion it would have been on the front page of the NY Times above the fold and the surgeons would have the Nobel. That didn't happen.

If something doesn't make sense then it probably isn't true. As in all of life.

[rohrer01]

http://europepmc.org/articles/PMC308...Sf7fxWA0MwTD.0

Since they are talking about preoperative and postoperative I suppose External Fixator for AIS is a non fusion surgery, although I'm not sure about what kind of surgery may be.
The before/after photos are really incredible. Someone know about it? I cannot find anything else.

I didn't see this first post for some reason. One example they used of nonfusion surgery was VBS. The other was the external fixator, pictured just as I'd imagined as described in my previous post. Yes, the before and after look promising. However, this girls posture was either guarded or still bad. There looked to be something unnatural about the "after" photo in the way she is standing.

I'm going to assume that the person has to be hospitalized during this whole time while wearing the external fixator. It would be nearly if not totally impossible to dress with that device attached to the spine. It doesn't seem cost effective to keep someone hospitalized for that long. It would also seem that the longer the fixator was worn and adjusted, the better the correction would be. So at what point do "they" (doctors and insurance companies) say that the correction is good enough? As a parent and a patient, I would want total correction if it could be obtained. I'm quite sure that this would take a lot longer than 50 days. Realistically, who wants to spend that amount of time in the hospital? I'm guessing that this is the reason that we don't hear so much about it???

[rohrer01]

It sounds like they were looking for a safer way to straighten the curve prior to fusion than the present methods afford. There is a chance of neuro injury in straightening the large curves. The "internal fixation" is fusion.

If this was a way of avoiding fusion it would have been on the front page of the NY Times above the fold and the surgeons would have the Nobel. That didn't happen.

If something doesn't make sense then it probably isn't true. As in all of life.

The first article was entitled "Fusionless surgery" or something like that. I would think that treating a very large curve the way that Elias was treated, with release and traction, would be safer than the risk of infection from an external fixator. The risk of spinal cord damage by straightening out very large curves is very real. The other boy from Canada ended up paralyzed from his procedure. So sad I can't even express it.

I was pretty sure that the "internal fixation" was fusion. But since it didn't say "fusion" I didn't want to infer. The outcome would be the same with lack of mobility, though. I don't know how they could internally fixate without fusion without a mechanical breakage. I'm still wondering if those staples will eventually break in VBS. With bone remodeling, hopefully it won't matter as long as the vertebrae have unwedged during the growth period. Only time will tell. It's still relatively new.

[Pooka1]

I found the full article at one point and the external fixator was used specifically as a hopefully safer way to straighten the curve prior to definitive fusion.

If the external fixator could straighten the spine for life and not require fusion then 50 days in the hospital is worth it in my opinion. I would do it in a New York minute if I were the patient. That would constitute a huge breakthrough, the largest in this field in my opinion. Yet we hear nothing about any breakthrough. I doubt any insurance would pay for 50 days in the hospital.

[rohrer01]

I doubt any insurance would pay for 50 days in the hospital.

That's my whole point.

I think Elias spent more than 50 days in the hospital. I would do it, too, if it would straighten me without a fusion. It just doesn't seem realistic. But, Flerc was asking because he did not know.

[Pooka1]

http://europepmc.org/articles/PMC308...Sf7fxWA0MwTD.0

Okay this article does appear to be claiming that external fixation can be used as a non-fusion surgical treatment. I wonder if this is meant for as long as say a brace is worn or if this is also only 50 days. If it is only 50 days and works then this is a non-fusion solution to AIS. Yet we hear nothing.

The other article, the one I read, was using external fixation instead of, say, traction, in order to more safely straighten the curve prior to fusion.

[flerc]

Here's a large explanation about external fixator, but not used in scoliosis http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2504087/ I though before begining to read it that the effect was similar to something as an antigravitational brace, but seems to follows other remodeling principles different to Wolff's law..
I'm almost sure that surgery was done in Russia. May we be sure we knows what they are doing there?

[rohrer01]

Bumping your thread above all of the spam.