A few adults have had vertebral body tethering (VBT)

[leahdragonfly]

It was?

--Linda

Linda, you may recall there were some horrendously nasty posts and arguments about VBS (stapling) in 2008. There were one or two posters in particular who are no longer on this forum who were frothing at the mouth against VBS. Really nasty stuff with multiple threads locked or removed. I was pretty new to the forum then and nearly quit because of it. Maybe you blocked out the bad memories.

[Pooka1]

Linda, you may recall there were some horrendously nasty posts and arguments about VBS (stapling) in 2008. There were one or two posters in particular who are no longer on this forum who were frothing at the mouth against VBS. Really nasty stuff with multiple threads locked or removed. I was pretty new to the forum then and nearly quit because of it. Maybe you blocked out the bad memories.

I think I know one participant in that melee. I joined early in 2008 but don't recall the VBS posts too well. That participant and scientific thinking were not acquainted. :-)

I wonder how that participant's daughter did with the Spincor brace. I hope she avoided surgery.

[LindaRacine]

Maybe you blocked out the bad memories.

Ha Ha... I've had to do that a lot! :-)

[LindaRacine]

I have high hopes for tethering adults in case my daughters ever are faced with having to extend their fusions. I hope it pans out.

It seems to me that bending to either side would be exactly as restrictive as a fusion because the tether is on the side. But bending forward and back would be possible though maybe with some limited ROM depending on how tight the tether is.

I don't know but it just seems impossible that tethering could preserve close to all the bending ROM front to back but I of course don't know. If it is super tight I suspect the ROM is essentially the same as for fusion.

Maria would know about VBS but I think the situation there is similar to tethering... similar ROM bending side to side as fusion and possibly more ROM front to back than a fusion. With every vertebra stapled to the next, I am not understanding how that allows more ROM than a fusion in the stapled area.

Maybe both VBS and VBT are better at preserving discs below the treated area for some reason. That would be a good reason to staple and tether if true even if the ROM is ultimately similar to a fusion.

I hope it works as well, but I don't think I'd sign up to be a guinea pig.

With that said, I bet VBT doesn't have much effect on flexibility in either plane.

--Linda

[Pooka1]

I hope it works as well, but I don't think I'd sign up to be a guinea pig.

With that said, I bet VBT doesn't have much effect on flexibility in either plane.

--Linda

Well, consider a tight cord on say the right side of a typical dextro T curve. If it is doing any correction it is going to be damn tight at all times since the curve will be trying to pull it. So bending to the left is going to be impossible. Depending on how stiff it is, bending to the right (unbending the curve) might be impossible also. It would have to buckle in-between vertebra to allow bending to the right. It might... I don't know how stiff the tether is.

Bending front and back again would be limited by how stiff the tether is.. If it is tacked down to each vertebra and very tight, I don't see ow that will allow bending forward and back through the tethered area.

I am wondering if the actual medical reasons for stapling and tethering are to achieve correction with a much smaller operation and to not need bone for fusion. Do surgeons even claim a much larger ROM for either VBS or VBT compared to fusion?

[Pooka1]

Look at this site...

http://www.spineandscoliosis.com/pro...sis-treatment/

Look at the cartoon of the tether about half way down (blue background). Think about how much play you can imagine in that tether in any plane without crushing discs unevenly. It appears to me there is virtually no play in any plane because it looks tight.

They call it flexible fusion but here is them explaining that term... I fixed TWO typos on their page ... the continued moving and bending is achieved with the minimally invasive approach to the surgery, not to preserved ROM with tethering over fusion. The ENTIRE paragraph is about the minimally invasive approach as the advantage of VBT over fusion. Now I think that will be somewhat misleading to most patients and I am not exactly following along because once the muscles heal in an open fusion, there is an increase in the ability to use the back. They appear to just be claiming a shorter recovery time as the reason for VBT. If you look at the cartoon, I can see why they are not claiming more ROM than a fusion.

What are the Advantages of Flexible Anterior Fusion approach -Vertebral Body Tethering (VBT)?

Typically surgery that is less invasive will carry less risk for the patient for several reasons. This is the case using our anterior fusion approach above. The spine can continue to move and bend, so the patient may experience less discomfort and more freedom of movement. We achieve this by using a muscle sparing approach so unlike traditional invasive back surgery, no back muscles are cut, and there is minimal disruption and much faster healing. Additionally blood loss is very low using these less invasive techniques. Recovery therefore averages about 4 weeks, with return to unrestricted activity at 6 weeks in most cases.

[Pooka1]

Newton et al. induced a kyphotic scoliosis in calves (ugh) with a tether and measured ROM. He said the side to side motion was curtailed as I surmised above but the flexion-extension which I assume is forward and backward ROM was pretty good. The discs were significantly wedged but that is due to the tether creating the scoliosis. I think the tether would UN-wedge the discs in correcting a scoliosis.

I would like to see flexion-extension ROM measured on radiograph with tethering and comparing it to fusion.

http://www.ncbi.nlm.nih.gov/pubmed/11923660

I think when they say "motion sparing" it refers to when they take the tether OFF as in the case of a growing child. Are they planning to remove the tether on all these patients? Every picture I have seen of the tethers appears to me to limit ROM side to side and appears to crush the front of the disc if bending forward.

In the case of an adult I don't think they intend to ever remove the tether. I hope some flexion-extension is preserved even with the tether in case my girls need their fusion extended to their lumbar and are candidates for tethering.

[nybw51mr42]

I'm in NY so I contacted them. Quite curious what they will say and if I qualify, etc. I'm highly skeptical but there is little opportunity cost in at least vetting this a bit further.

Waiting to hear back from them (filled out the online form). I will update the board once I do.

[LindaRacine]

Well, consider a tight cord on say the right side of a typical dextro T curve. If it is doing any correction it is going to be damn tight at all times since the curve will be trying to pull it. So bending to the left is going to be impossible. Depending on how stiff it is, bending to the right (unbending the curve) might be impossible also. It would have to buckle in-between vertebra to allow bending to the right. It might... I don't know how stiff the tether is.

Bending front and back again would be limited by how stiff the tether is.. If it is tacked down to each vertebra and very tight, I don't see ow that will allow bending forward and back through the tethered area.

I am wondering if the actual medical reasons for stapling and tethering are to achieve correction with a much smaller operation and to not need bone for fusion. Do surgeons even claim a much larger ROM for either VBS or VBT compared to fusion?

Sorry, I'm not following. 100% of the bending will come from the discs, which are not affected by the implants, which only go into the vertebral bodies.

[Pooka1]

Sorry, I'm not following. 100% of the bending will come from the discs, which are not affected by the implants, which only go into the vertebral bodies.

The distance between the vertebrae that are tethered is held constant by the tether. The discs are in those distances. If the vertebra are held in the same position with respect to each other then the discs are also.

[3sisters]

As far as anyone knows, this surgery has been performed on one adult. It's nowhere near ready for primetime.

--Linda

Linda, not to discourage those who had recent fusion, but many teens and young adults have been tethered. They do not post here; many are happily found on the link MariaF shared, though.

[3sisters]

The distance between the vertebrae that are tethered is held constant by the tether. The discs are in those distances. If the vertebra are held in the same position with respect to each other then the discs are also.

To my understanding, from my daughter's surgeons (she had VBT), there is a slight resistance if the patient tried to bend towards the side in such a way that would make the tethered portion of the curve increase in size. However, in the thoracic area, there is not really significant bending anyway. Rotating the spine seems unaffected. There are some lumbar tethered patients who engage in high level gymnastics which would not be possible post fusion. If there is some restriction to their bending, it must be minimal.

For your daughters, surely it is good to know that a lumbar tether under thoracic fusion is possible; some patients have had this when for some reason the thoracic curve cannot be tethered (such as a curve that goes higher up the spine.)

[flerc]

Linda, not to discourage those who had recent fusion, but many teens and young adults have been tethered. They do not post here; many are happily found on the link MariaF shared, though.

Sure you are right Emily, it's a great group for people thinking in Vbt, even for people who had fusion. I have a woman friend whose daughter after fusion went to worse in lumbar zone and that group helped her to know that Vbt could be possible for her.
Fortunately there are many good and really big scoliosis groups, also for non surgical options. I think this forum is still the biggest one but only for fusion.. certainly is almost a fusion forum only, people thinking in other options is sure in other sites.

[flerc]

To my understanding, from my daughter's surgeons (she had VBT), there is a slight resistance if the patient tried to bend towards the side in such a way that would make the tethered portion of the curve increase in size. However, in the thoracic area, there is not really significant bending anyway. Rotating the spine seems unaffected. There are some lumbar tethered patients who engage in high level gymnastics which would not be possible post fusion. If there is some restriction to their bending, it must be minimal.

I always thought that the tether should to be something elastic, but I asked it and they said me that it's not. I suppose that if it could be necessary for some cases, surely in a future they will consider that possibility.

[nybw51mr42]

I'm in NY so I contacted them. Quite curious what they will say and if I qualify, etc. I'm highly skeptical but there is little opportunity cost in at least vetting this a bit further.

Waiting to hear back from them (filled out the online form). I will update the board once I do.

It took about 10 days but I finally got a call back. Have an appointment scheduled for next month as of now. I find it odd they are not in-network with any insurance and basically have to pay yourself. Not sure if I will go yet or not, but part of me says even if it is far-fetched on the small chance it is helpful/applicable it would be worth the $400 office visit. If I do go, I'll report back to here.