Improvements to VBT (tethering)

[mariaf]

I learned from another parent (confirmed to me by Dr. Betz) that kids who might not have been VBT candidates before might now be able to opt for tethering rather than fusion. Some larger curves, particularly more rigid curves, can now - in some cases - be tethered by including a discectomy along with the tethering. From my non-scientific view point this involves removing a portion of the cushion (40-50%) between some of the vertebrae (in this child's case, 3 vertebrae) in order to make it more flexible and respond to the tether. Apparently, there have been a few such surgeries performed already with very promising initial results.

I also learned recently that tethering curves of more skeletally mature patients is not too far away. There is already one doctor (Braun? not sure where he is located) who has started to do this.

Nice to see these doctors are never satisfied and want to keep making more and more improvements to scoliosis care!

[Pooka1]

Maria, all that sounds so promising. Maybe eventually they will just remove a few discs and tether people instead of doing a fusion. Maybe that will suffice for life. That would be so good.

I remember Braun's name from years ago where he was doing early tethering work on animals. I always hope the animal welfare people police these things enough and that they are not in pain.

[jrnyc]

Maria, what great news....
i hope the progress continues...until children of all ages
can have the procedure...
and maybe eventually, it will help other age groups...
alternatives are usually good things...this sounds
great.

woofs to you and Jackie...
from jess....and Sparky

[leahdragonfly]

Hi Maria,

That sounds very promising. Do you know what they do to the area that had discectomies? Probably can't just leave them without a disc??? or it would seem likely to cause pain. Or maybe it's just a partial discectomy to reshape the area?

Anyway, I think that is great news, especially for the pre-teens/teens with large curves who are looking for an alternative to fusion. I think I would strongly consider it for my child if the need arose.

Any word on VBS (stapling) for the 25-35 degree curves? I still think this is such an elegant solution for the moderate curve in the younger child who still has lots of growth. Sure beats years and years of 23/7 bracing in my mind.

Thanks for the update,

Gayle

[mariaf]

That sounds very promising. Do you know what they do to the area that had discectomies? Probably can't just leave them without a disc??? or it would seem likely to cause pain. Or maybe it's just a partial discectomy to reshape the area?

Hi Gayle,

You would probably understand more about this than me, but the mom who explained it described it as a cushion where 40-50% of the stuffing is removed. She said she did not fully understand it either but was thrilled to have this option :-)

Happy Holidays to All!

[3sisters]

The times are catching up, and mature adolescents and even adults are receiving tethers from at least three surgical teams so far. Regarding the disc release, some surgeons perform them if the curve is particularly stiff in order to gain more correction. It is a new wave of advanced treatments for even larger or stiffer curves. Usually it involves only part of the disc being manipulated/ removed with an anterior release to gain desired correction; especially helpful with stiff curves or very large ones- now tethering up to 80 degrees by some surgeons.

The school of thought that some of these surgeons are following now that allows them to tether older patients relies a lot on the natural bone remodeling that occurs throughout a lifetime. Much like dental orthodontics. The tethers are strong and expected to last a long time, ideally a lot of remodeling occurs before the tether breaks. IF it even does, the maximum amount of regression would be whatever correction was gained at that one level; perhaps 5 degrees or so. The tether is affixed to each vertebrae, so a break at one level would not affect tension on the others.

From what I've seen and heard, young adolescents are still ideal- less rib cage deformity is likely to have occurred, and there is more guarantee of vertebral re-wedging through growth. Plus, further correction will be gained with growth that adults are not expected to see post op. But, this is being performed on mature spines, at least. Naturally, there are also more available surgeons for the younger set- about two dozen in the States as well as some in Canada, England, India, Spain, and (maybe New Zealand.)

Some important considerations for success are spinal flexibility, location of curve (generally not tethering above T5,) degrees of kyphosis, and bone density.

Good news in the VBT world, for sure.

[flerc]

3sisters, Vbt cannot be done in high thoracic curves?

[burdle]

I learned from another parent (confirmed to me by Dr. Betz) that kids who might not have been VBT candidates before might now be able to opt for tethering rather than fusion. Some larger curves, particularly more rigid curves, can now - in some cases - be tethered by including a discectomy along with the tethering. From my non-scientific view point this involves removing a portion of the cushion (40-50%) between some of the vertebrae (in this child's case, 3 vertebrae) in order to make it more flexible and respond to the tether. Apparently, there have been a few such surgeries performed already with very promising initial results.

I also learned recently that tethering curves of more skeletally mature patients is not too far away. There is already one doctor (Braun? not sure where he is located) who has started to do this.

Nice to see these doctors are never satisfied and want to keep making more and more improvements to scoliosis care!

Do you have a contact for Dr Betz. I am concerned that he is allowing Scolismart to promote a close relationship with him and to strongly suggest on their web page that the Scolismart neurotransmitter re-training/chiro treatment is a pre-cursor to VBT etc.

[Pooka1]

Do you have a contact for Dr Betz. I am concerned that he is allowing Scolismart to promote a close relationship with him and to strongly suggest on their web page that the Scolismart neurotransmitter re-training/chiro treatment is a pre-cursor to VBT etc.

I almost threw up in my mouth reading this.

These chiros have no shame. They will push pseudoscience all day and then steal credibility from real doctors and researchers. Disgusting human beings.

[3sisters]

I am not defending all chiros, but would like to clarify two positive roles that Scolismart docs have played.

1. When patients have come to them with curves they feel they cannot help, they actually tell them about VBT instead of stringing them along. I think that is commendable.

2. For some adolescents who do have stiff curves, they seem to have had success loosening up the curve pre-op. This is not unlike how many scoliosis specific exercises were initially used; to help create better flexibility pre-fusion. I do not take offense at them helping gain better mobility.

I don't think that Dr. Betz send patients to Scolismart, but the other way around. Scolismart doctors help patients learn about their surgical care options. I personally know of one patient who was initially denied VBT due to her kyphosis. Schroth exercises helped reduce it enough to move from fusion to tethering candidate.

I do not believe a chiro can rearrange and cure someone's spine with his hands, but I also don't feel that they aren't all bad; some of these chiros are helping in their way, if you know what you are looking at.

[burdle]

I am not defending all chiros, but would like to clarify two positive roles that Scolismart docs have played.

1. When patients have come to them with curves they feel they cannot help, they actually tell them about VBT instead of stringing them along. I think that is commendable.

2. For some adolescents who do have stiff curves, they seem to have had success loosening up the curve pre-op. This is not unlike how many scoliosis specific exercises were initially used; to help create better flexibility pre-fusion. I do not take offense at them helping gain better mobility.

I don't think that Dr. Betz send patients to Scolismart, but the other way around. Scolismart doctors help patients learn about their surgical care options. I personally know of one patient who was initially denied VBT due to her kyphosis. Schroth exercises helped reduce it enough to move from fusion to tethering candidate.

I do not believe a chiro can rearrange and cure someone's spine with his hands, but I also don't feel that they aren't all bad; some of these chiros are helping in their way, if you know what you are looking at.

Scolismart charge a fortune for a bootcamp that you don't need if you want to loosen up your spine. There is NO evidence that it is any more effective than ordinary PT or exercise. Also their standpoint is that you must avoid fusion surgery at all costs- which allows them to pretend there is an alternative i.e. their bootcamp. They openly rubbish the motives of surgeons (this is what I would like to draw Dr. Betz's attention to) VBT is a new surgical solution and so Scolismart have had to cosy up to it to avoid going out of business but they are no more a valid treatment path to VBT than eating a banana is! If VBT really needed greater flexibility in a spine that could ONLY be achieved by Scolismart then they would refer to them beforehand but they don't which tends to point that while Scolismart may not be doing harm with their exercise program it is no actually doing any good either!

However where it DOES do harm is by encouraging people who may need fusion surgery to avoid at all costs and by the time they realise it maybe too late...


Scolismart does not do Schroth exercise- they have developed exercise based on a so-called neuro-transmitter re-education program!!!

[Pooka1]

Burdle, able to cure people of nausea! I immediately felt better after reading that post.

I applaud your understanding of this issue and hope others read your posts. I wish I could write as well.