Comprehensive Scoliosis Care
for Children and Adults

Is vertebral body tethering (VBT)/ stapling (VBS) a better way of treating scoliosis? The answer is "YES" in cases for patients with moderate to large curves and adolescent growth left. This innovative, less invasive, and surgical procedure can "modulate bone growth" of the spine during the periods of rapid growth spurts when adolescent spinal curvatures typically progress.

While ScoliSMART clinics do not perform or offer these procedures, we have developed close working relationships with many of the top Orthopedic Spine Surgeons who do offer VBT/S as part of our commitment to getting the right treatment options, to the right patients, at the right time, to achieve the best possible results and prevent spinal fusion surgery.

Bone growth modulation (bracing/VBS/VBT) is not a new concept and is based off the Hueter-Volkmann principle, which states that bone under more pressure will grow slower and denser than bone not under stress, so the bone on the inside part of the curve will grow slower and denser than the bone on the outside of the curve creating a wedge deformity over time. Bone growth modulation techniques are attempting to influence the secondary reaction to the uneven loading caused by the curve, not the genetic and environmental factors that initiate the scoliosis condition itself.

Bracing attempts to hold a curve from progressing but will not correct the curve. VBT and VBS are very different not only in theory, but application. By applying the counter loading directly to the spine, the bone growth modulation can be controlled. Many experts in the field of conservative scoliosis treatment feel Vertebral Body Tethering is far superior to traditional spinal fusion based surgeries.

Who is a good candidate for a VBT procedure?

For VBT patients who are 10 years old or older with a spinal curvature(s) 35-70° with a Risser sign of 0-3. The risser sign is a commonly measured growth plate on the hip that rates the skeletal maturity of the patient on a scale from 0-5. It is commonly found on the radiology report from your child's doctor or you can submit a picture of the most recent x-rays for risser sign determination. While these are the current ideal indications – some selected patients with larger curves and / or selected patients who are older maybe candidates for VBT with doctors at the Institute for spine and scoliosis.

VBT and VBS procedures can often be used in combination to maximize results

The device has been approved by the FDA and case studies published in peer reviewed journals.

bone-model-of-tether-300x226How Does the Vertebral Body Tethering (VBT) Treatment Work?

VBT uses "growth modulation" – restraining one side of the spine to allow growth on the other side – to reverse the abnormal scoliosis growth pattern in the anterior thoracic (upper) spine in a less invasive surgery. Titanium pedicle screws are placed on the convexity (outside) of the vertebrae that are causing the scoliosis; a white polyethylene-terephthalate flexible cord usually used for fusion is attached to each of the bone screws in the vertebral bodies of the spine. When the cord is tightened, it compresses the adjacent screws to help straighten the spine. The affected curve(s) show an immediate improvement right after surgery, and continued improvement over time as the spine grows.

What are the Advantages of Vertebral Body Tethering (VBT)?

Typically surgery that is less invasive will carry less risk for the patient for several reasons. In the case of VBT, the spine can continue to grow, therefore most often allowing for correction of the curve. The spine can continue to move and bend, so the patient may experience more comfort and freedom of movement. Being a one-time surgery for the most part, no bridges are burned; future treatments – if even necessary – are still viable options. These and other factors therefore result in reduced length of hospital stay, making surgery less inconvenient for both patient and family.

Who Should Consider Vertebral Body Stapling (VBS)?

Ideal candidates for VBS: have a diagnosis of idiopathic scoliosis (adolescent or juvenile), or idiopathic "like" (i.e., post- syrinx decompression); are seven years of age or older, with remaining spine growth; have a thoracic curve of up to 35 degrees; have a thoracolumbar curve of up to 45 degrees. Curve patterns that may be treated include single thoracic, single lumbar and double curves. For thoracic, thoracolumbar or lumbar curve(s) of 30 to 60 degrees for patients ten and older, we recommend Vertebral Body Tethering (VBT).

shape-memory-alloy-staple-300x221How Does the Vertebral Body Stapling (VBS) Treatment Work?

VBS uses "growth modulation" – partially restraining one side of the spine to allow growth on the other side – to reverse the abnormal scoliosis growth pattern in the anterior spine in a less invasive surgery. Staples made from a nickel-titanium alloy place a constant force once placed in the bone and returned to body temperature. The affected curve(s) show an immediate improvement right after surgery, and continued improvement over time as the spine grows.

What are the Advantages of Vertebral Body Stapling (VBS)?

Typically surgery that is less invasive will carry less risk for the patient for several reasons. In the case of VBS, the spine can continue to grow, therefore most often allowing for correction of the curve. The spine can continue to move and bend, and along with removing the need for standard daytime bracing, the patient may experience more comfort and freedom of movement. Being a one-time surgery for the most part, no bridges are burned; future treatments – if even necessary – are still viable options. These and other factors therefore result in reduced length of hospital stay, making surgery less inconvenient for both patient and family.

 
double curves
Curve Patterns Treated
(click to see more)

The 25/25 Scoliosis Initiative represents the first significant scale effort in which the Orthopedic and Chiropractic communities are making a collaborative effort towards common scoliosis treatment goals.

Sign The Petition Support early stage scoliosis intervention & scoliosis awareness. The petition will serve as first example of public’s support for reducing the rate of spinal fusion surgeries for scoliosis and the data will be provided to professional organizations such as the Scoliosis Research Society and National Scoliosis Foundation

See more at: www.chiropracticscoliosis.org/25-25-scoliosis-initiative

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