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Displaying items by tag: VBS
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Unfortunately, the lowest common denominator that all non-surgical scoliosis treatments have in common is the hope of preventing the "need" for scoliosis surgery......standing at approximately 38,000 per year in the US right now. I say that it is "unfortunate", because this seems like it should be a rather low bar to hurdle, but to date no one has been able to effectively demonstrate the ability to do this on a large scale. The advent of genetic testing (Scoliscore) will provide the necessary genetic predisposition data to determine if a given non-surgical treatment has actually altered the natural course of the condition, so hope is on the horizon, but to simply boil down all treatment effort to avoiding surgery is abandoning a much loftier and noble goal of finding a cure. I would rather fail attempting to achieve high expectations, than succeed achieving low standards. The current review of scoliosis brace data clearly demostrates that brace treatment does NOT reduce the rate of scoliosis surgery (Weinstein, 2007 and Oglivie, 2009); and rehab based programs like Schroth, CLEAR Institute, FITS, SEAS, Yoga, Pilates, ect haven't produced any large scale data to determine effectiveness in reducing surgical rates at this time, so we're in a bit of a tough spot here. It has always been stated that one of the greatest challenges the scoliosis practioner has had was determining which cases would progress and how far, but in reality bracing's known and proven inability to alter the natural course of the condition made that a moot point anyway, and essentially there is nothing standing between the adolescent idiopathic scoliosis (AIS) patient and surgical intervention except genetic predisposition and luck. This is simply unacceptable. The gap between prognostic testing for AIS and the ability to alter the natural course that prognostic testing can help predict is wide and widening further by the day. We have entered a realm in which we can tell a patient they are essentially a ticking time bomb for severe scoliosis, but there is no way to de-fuse it, so sit back, watch it get worse and we'll perform a highly invasive surgical procedure that very often results in long-term chronic pain and disability once the curve gets bad enough. Again, this is simply unacceptable. So what can be done to lower the rate of spinal fusion rates for scoliosis in the future? 1. Earlier detection of small curves. This allows for genetic testing to determine genetic predisposition and the opportunity for early stage scoliosis intervention for the patients whom are at elevated risk for severe curve progression. 2. Early Stage Scoliosis Intervention. A neuro-muscular re-education based rehab program that targets the involuntary postural control centers of the brain stem that will "re-train" the brain to hold the spine in a straighter position automatically....when the spinal curvature is still relatively small and flexible for maximum benefit to the patient. 3. Vertebral Body Stapling (VBS). This is a relatively new, minimally invasive non-fusion surgical procedure which provides a "guided bone growth" type mechanism. It is mostly indicated for juvenile scoliosis cases, but could be used in certain "high genetic risk predisposition" AIS cases if the curve is discovered at an early enough age and the patient fails to respond to the early stage scoliosis intervention program. 4. Improved spinal rehab techniques for patients with larger spinal curvatures. As effective any any screening program could be and as well as any early stage scoliosis intervention program is, there will always be some patients whom "fall through the cracks" and need an effective rehab based program that is specifically designed and targets the unique biomechanical needs of patients with large spinal curves. To date, it appears that only CLEAR and Schroth are making in roads into this area. 5. Increased patient education in the risk/benefit and long-term consequences to chosing surgical intervention for scoliosis. Scoliosis surgery is not medically necessary...even in very severe cases....and is almost entirely based on improving the cosmetic deformity of the condition. However, trading deformity for dysfunction comes with a very steep price......chronic pain, hardware failure, rapid degeneration around the non-fused areas, ect. In short, many scoliosis patients would be far better off doing nothing than choosing spinal fusion surgery. They should be more aware and better educated on the fact that they indeed do have a "choice". This is certainly not an exhaustive list, nor is it beyond debate, so please feel free to dispute, comment, or add to this discussion as you see fit. Please click here to receive a FREE SCOLIOSIS TREATMENT INFORMATION KIT ASAP.
Endoscopic vertebral body stapling is an innovative technique intended to treat adolescent idiopathic scoliosis, but the optimal instrumentation design is not yet established. The objective was to simulate the immediate correction obtained from two stapling configurations. A parametric finite element model of a typical right thoracic scoliotic spine (Cobb 21 degrees ) was developed using geometrical and mechanical data from the literature. Staple insertion and closing were modeled. The intra-operative lateral decubitus and standing positions were taken into account. Two implant configurations, varying the number of staples per vertebra, were simulated. The major correction (9 degrees ) came by simulating the intra-operative posture. The immediate Cobb angle correction due to the staples alone was less then 1 degrees for both configurations. However, the staples helped maintain the correction obtained by the intra-operative posture when the post-operative standing position was simulated. Next steps are to validate the model using surgical cases, implement growth modulation modeling, improve lateral decubitus modeling, and analyze different vertebral stapling strategies for different scoliotic curves.
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*** Note, VBS is generally is NOT indicated for adolescent idiopathic scoliosis due to lack of suffient spinal growth potential past the age of 12 years old.
STUDY DESIGN: Retrospective review.
OBJECTIVE: To report the results of vertebral body stapling (VBS) with minimum 2-year follow-up in patients with idiopathic scoliosis.
SUMMARY OF BACKGROUND DATA: While bracing for idiopathic scoliosis is moderately successful, its efficacy has been called into question, and it carries associated psychosocial ramifications. VBS has been shown to be a safe, feasible alternative to bracing for idiopathic scoliosis.
METHODS: We retrospectively reviewed 28 of 29 patients (96%) with idiopathic scoliosis treated with VBS followed for a minimum of 2 years. Inclusion criteria: Risser sign of 0 or 1 and coronal curve measuring between 20 degrees and 45 degrees .
RESULTS: There were 26 thoracic and 15 lumbar curves. Average follow-up was 3.2 years. The procedure was considered a success if curves corrected to within 10 degrees of preoperative measurement or decreased >10 degrees . Thoracic curves measuring <35 degrees had a success rate of 77.7%. Curves which reached < or =20 degrees on first erect radiograph had a success rate of 85.7%. Flexible curves >50% correction on bend film had a success rate of 71.4%. Of the 26 curves, 4 (15%) showed correction >10 degrees. Kyphosis improved in 7 patients with preoperative hypokyphosis (<10 degrees of kyphosis T5-T12). Of the patients, 83.5% had remaining normal thoracic kyphosis of 10 degrees to 40 degrees. Lumbar curves demonstrated a success rate of 86.7%. Four of the 15 lumbar curves (27%) showed correction >10 degrees. Major complications include rupture of a unrecognized congenital diaphragmatic hernia and curve overcorrection in 1 patient. Two minor complications included superior mesenteric artery syndrome and atelectasis due to a mucous plug. There were no instances of staple dislodgement or neurovascular injury.
CONCLUSION: Analysis of patients with idiopathic scoliosis (IS) with high-risk progression treated with vertebral body stapling (VBS) and minimum 2-year follow-up shows a success rate of 87% in all lumbar curves and in 79% of thoracic curves <35 degrees. Thoracic curves >35 degrees were not successful and require alternative treatments.
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