This interview is for educational purposes and covers information provided by Dr. Per Trobisch regarding his opinions on Vertebral Body Tethering (VBT) and Anterior Scoliosis Correction (ASC) Non-Fusion Scoliosis Surgery. This video is not an endorsement. Viewers should consult their physicians and treating team accordingly. See highlights via timestamps below.
Chapters
00:00 Introduction
00:20 Career path to spine surgeon.
1:21 First exposure to tethering.
2:53 First VBT surgery.
4:12 Thoracoscopic approach in Europe vs USA.
5:47 Number of tethering surgeries performed.
6:24 Differentiating between VBT, ASC, thoracoscopic approach and mini open.
8:47 Perspective on bone growth modulation and disc modulation for thoracic and lumbar spines respectively.
10:27 Concept of disc maturation. Disc shape and biology changes over time.
11:19 Curve correction before disc biology changes increases the chances of success.
11:53 When does the biology of the disc change?
13:00 Thoughts on tethering more mature spines.
14:38 Dr. Trobisch's curve classification system that guides decision making for or against VBT/ASC.
16:31 Which curve types are good candidates for tethering?
24:30 Perspective on hybrid surgery with selective thoracic fusion and lumbar tethering.
27:43 Approach to lumbar spine tethering. Motion sparing.
27:46 Case Study: Type 1 curve tether with rupture.
31:06 High rupture rate for lumbar curves. All tethers will rupture.
31:31 If tether can hold curve in primary stability until disc maturation, the correction will hold.
32:23 In lumbar spine, disc is much more important compared to the thoracic spine. Bone growth modulation is not as important in the lumbar spine.
32:50 For cases with tether rupture and curve progression, it's likely they needed more time until disc maturation to become stable.
33:24 Two tethers may offer more stability.
34:23 2/3 of scoliosis in lumbar curve is from disc wedging. Lumbar bone growth modulation is not as important.
34:44 Perspective on adult tethering.
35:13 For more mature spines, how long does the tether need to hold?
36:19 For adult spines, how long does the tether need to hold?
37:21 New tether technology.
37:53 Proper patient identification accounts for 80-90% of VBT/ASC success. Tether and tether technology accounts for 10-20% of success of surgery.
38:11 New strong tether won't necessarily be a game changer for VBT/ASC.
38:22 Case Study: Tether complication and revision.
39:11 Not so good cases led to Dr. Trobisch's classification system and more accurate surgical planning.
42:45 Case follow-up questions. Timing of revision and greater correction. Perspective on over and under correction.
43:52 Why don't surgeons aim for more than 50% correction on first standing x-ray?
45:44 Perspective on selective lumbar fusion with tethering.
48:13 Thoughts on future scoliosis non-fusion surgery innovation.
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