vertebral body tethering (vbt) in 2014
DESCRIPTION
Vertebral Body Tethering (VBT) In 2014. A fusionless treatment option for scoliosis in the growing spine. UPDATED March 2014. Spinal Tethering. Old use: FDA approved as a “dynamic stabilizer” in the posterior lumbar (lower) spine - PowerPoint PPT PresentationTRANSCRIPT
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Vertebral Body Tethering (VBT)In 2014
A fusionless treatment option for scoliosis in the growing spine
UPDATEDMarch 2014
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Spinal Tethering
Old use: FDA approved as a “dynamic stabilizer” in the posterior lumbar (lower) spine
New use: Physician directed scoliosis treatment as a dynamic stabilizer in the growing anterior thoracic (upper) spine
“Growth modulation”- partially restraining one side of the spine to allow growth on the other side to reverse the abnormal scoliosis growth pattern
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Here is a bone model of the tether (white cord) attached to bone screws in the vertebral bodies of the spine
(anterior)front of the spine
(posterior)back of the spine
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Components
• Titanium pedicle screws placed on the convexity (outside) of the vertebrae causing scoliosis
• Polyethylene-terephthalate (PET)* flexible tether connects to each screw and when tightened, compresses the adjacent screws to help straighten the spine– Cable safety extensively studied– Animal and computer simulation models show scoliotic
correction– Early adolescent cases show scoliotic correction
*Dynesys system by Zimmer spine
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“Ideal” candidate
• Idiopathic scoliosis (adolescent or juvenile) or Idiopathic “like” (i.e. post syrinx decompression)• >10yrs old with remaining spine growth
( done TOO young increases risk of overcorrecting the curve)
• Thoracic, thoracolumbar or lumbar curves 30° to 60°
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Tethering advantages
• FUSIONLESS• Allows the spine to grow• Allows the spine to move and bend• Most are one time surgery ( may need an
adjustment of tether if overcorrection seen)• “burns no bridges”, can do a later fusion if
needed
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During surgery
Case #1 Feb 2011 12 yo female
Tethering
Staples
Before surgery5 days after surgery
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Case #1
35°
35°
3 years laterBefore surgery
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Case #3 Aug 2011 14 yo male
2 years later
38°
1st erect
25° 6°
Before surgery
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Case #6 Oct 2011 13 yo female
Before surgery
44°
36°
6°
6°
2 years later
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Case #11 Feb 2012 12 yo female
Before surgery 18 months later
50°3°
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Case #65 Nov 2013 12 yo female
Before surgery 6 weeks later
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Unknowns
• New use of an existing technology• No long term follow-up• Potential for overcorrection (curve opposite way)• Refined criteria for “ideal” candidate• Quicker return to all activities (currently 6 weeks)
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For More Information
If you have questions about tethering (VBT), please feel free to contactJanet Cerrone, PA-C [email protected]@spineandscoliosis.com