Scoliosis
Scoliosis is more prevalent in girls
“ So , for a given patient , it ’ s really difficult for us to predict with certainty whether the outcome of VBT will be really ideal or not at this point in time ” deformity ” to make the procedure a success . In his view , the right patients have a considerable deformity ( curves between 40 and 60 degrees ) and are usually 11 or 12 because you need two to three years of growth to make VBT work , and most girls , who have higher prevalence than boys , will grow until 14 . The assessment varies by sex and curve magnitude , with some boys being good candidates even if they ’ re 13 .
“ So , for a given patient , it ’ s really difficult for us to predict with certainty whether the outcome of VBT will be really ideal or not at this point in time ,” he stressed .
The terms of the dilemma Opting for either spinal fusion or VBT is therefore a dicey affair that patients and their families have to disentangle based on their preferences , though doctors will have to play a crucial role in advising them honestly .
“ Advising patients and their parents requires the surgeon to have a realistic discussion of what we know and we don ’ t know ,” said Dr Newton .
Since it ’ s been around longer than VBT , spinal fusion is backed up by much more evidence that helps prognosticate both its good and negative outcomes . “ If you have a spinal fusion , I can give you a very precise number of what your curve correction and rate of revision surgery will be , and what outcome you can expect at 10 and 20 years because we have data on it ,” he explained .
Though spinal fusion can often cure scoliosis for good , in rare instances it fails and needs to be repeated due to a variety of reasons , including infection and implant misplacement . This happens in about two percent of cases two years after the operation , while the failure rate increases to six percent at 10 years .
The same level of certainty is not yet there for VBT because it ’ s still a fairly new and experimental procedure , with doctors struggling to quantify with accuracy how likely patients are to require a second operation . Two years after VBT , only about five percent of patients require either a revision operation to remove the tether and avoid overcorrection or a spinal fusion to fix the problem , according to Dr Newton , who has performed more than 100 VBT surgeries so far . But this jumps to about 50 percent at five years , and we don ’ t have any numbers to predict outcomes after 10 or more years .
“ Some people hear those data and say , ‘ I don ’ t want an unknown outcome with unknown risk of revision surgery , that just sounds crazy to me .’ Other people say , ‘ I don ’ t want to have my spine stiffened if I don ’ t need it stiffened , even if it ’ s going to have only a modest effect on my functions and maybe no effect on my daily life . I just don ’ t think that ’ s normal , and I ’ m willing to try this new technology ,’” he said .
It ’ s worth noting that undergoing a second surgery exposes patients to increased risks . All scoliosis surgeries are invasive operations and VBT involves opening up the chest and possibly damaging vital organs like the lungs and the heart . “ That shouldn ’ t be taken lightly by any patient on the first go and particularly on the second go because there ’ s now scar inside that chest ,” said Dr Newton , highlighting that the life-threatening risks associated with revision VBT surgeries are small but several folds higher than those of the first procedure , though it ’ s hard to translate that into clear-cut numbers .
One challenge patients and families might encounter while picking one procedure over another is the hype surrounding VBT as well as the negative side effects of spinal fusion .
“ All the nonsense and rhetoric around the benefits of VBT that exist on the internet , both in social media and promotional information from surgeons , are disgraceful because they suggest to families and parents that we have clear answers about the outcomes of the procedure and we don ’ t . They just sell it as a panacea that it isn ’ t ,” cautioned Dr Newton .
By contrast , spinal fusion is sometimes mistakenly portrayed as a procedure that will cause a lifetime of pain due to disc disease , together with major mobility
46 OCTOBER 2021 GlobalHealthAsiaPacific . com