Wednesday, January 26, 2022

 

              Appointments: 314-514-3500                                                   Appointments: 314-432-3600

 


Blog Topic:  Latest Publication on Intraoperative Halo-femoral Traction

1-26-2022

 This study was just published in the Journal of Spine Deformity


 

For those interested to read more please use this hyperlink supplied by the publisher:

https://rdcu.be/cFHmd








Sunday, January 16, 2022

 

Blog Topic:  What is a “Spine Fusion”

1-16-2022


In the average, normal spine there are 7 cervical, 12 thoracic, and 5 lumbar vertebra, a sacrum and coccyx. 


From the skull to the sacrum, each vertebra is separated by a mobile disc, which is a highly complex structure which provides stability and motion at the same time.



In spinal deformity, such as scoliosis, the spine twists and bends, first through the discs and then the actual vertebra start to become misshapen, more trapezoidal instead of being more rectangular.

When we do surgery to correct spinal deformity (scoliosis) the first step is to get fixation into the vertebra so we can move those vertebra to a better, more desired position and then hold this new position firmly.  In 2022 the most secure and most commonly utilized spine fixation are metal pedicle screws (usually made of titanium +/- cobalt chrome), which are placed from the back of the spine, into the bone, through the pedicle and into the vertebra.


Alternatively, hooks, wires and bands can also be used but these are not as good a fixation option when compared to screws.

The next step is to connect these screws (or hooks, wires, and bands) together with rods.  These rods can then move the screws (or hooks, wires, and bands) to the desired position and then held rigidly in the new position.  These rods, in my practice, are 98% of the time are cobalt chrome, the stiffest metal currently available and can obtain the optimal 3-d alignment of the spine in my hands.

 

 

These metal screws and rods are VERY strong and durable.  However, we know the day we place them in surgery is when they are their strongest and have the strongest grip/fixation on the spine, and each day that goes by after surgery the metal gradually and almost imperceptibly gets weaker and the screws/hooks/wires/bands can get looser in/on the bone.


So 1 of 3 outcomes happen after we do spine surgery, at EACH VERTEBRAL LEVEL:

1.           1. The screws, hooks, wires, bands get loose from the bone.

2.          2. The rods, screws, hooks, wires and bands break.

3.           3. The spine fuses.


To achieve a spine fusion, we roughen the area to be fused with a drill, and then place bone graft.  The body then breaks down/dissolves the bone graft which is then used by bone cells to create a solid bony connection over the area we want to fuse.

 

The aim of bone graft is to develop a spine fusion before the spine implants get loose from the bone or break.

 

Next blog post will discuss the different type of bone grafts.

Sunday, January 2, 2022

 

Blog Topic:  What is ApiFix?

1-2-2022

In previous posts the Anterior Vertebral Body Tethering (VBT) has been presented.  This implant utilizes the flexibility of the growing thoracic spine, and its growth, to straighten the spine and then modulates its growth through the remainder of spinal growth.  There has been a lot of social media interest and publications about this procedure over the last several years touting its benefits, which are small incisions, rapid recovery, and the ability to correct the spine deformity yet not fuse the spine which preserves some of the spinal motion. The challenges of this procedure have also been well-documented, such as how much tension to apply to the tether/spine, how many levels to tether, and chronologic timing of the procedure (when to do the procedure).



Interestingly, an alternative procedure was approved the same month (8/2019), the ApiFix device.  There has been a lot less attention give to the ApiFix device, compared to the VBT procedure.  So the question is why?



Why has all the focus been on VBT and not ApiFix?

Some reasons:

1.      1. VBT has been used by pediatric spine surgeons in the U.S. since the 2010s, although in an unlabeled manner.  Whereas ApiFix was developed in Israel and used only outside the U.S.  Hence more surgeon in the U.S. are familiar to the VBT procedure than ApiFix

2.     2.  To many the ApiFix looks and acts similar to a traditional growing rod.  Whereas the VBT is inserted through small incisions, placed on the anterior spine and uses a tether as opposed to a lot of metal.

3.      3. Due to the longer surgeon experience with VBT, dramatically more research has been produced on VBT.

4.      4. Currently, any pediatric spine surgeon who undergoes a short training session can perform the VBT procedure.  For the ApiFix device the company is performing a study on all patients in the U.S., so all surgeons who use the device undergo more rigorous training and all patients will be studied.  This means there are far fewer surgeons in the U.S. performing the ApiFix surgery than VBT

5.      5. As a continuation of #4, since all patients are going to be in the FDA study on ApiFix there is strict criteria as to who can undergo the procedure.  The VBT procedure is left up to each surgeon to determine is applicability and effectiveness for each patient.


The effectiveness of VBT and ApiFix for each patient requires an in-depth discussion between patient/family and the surgeon.  At present there is no scientific evidence of the superiority of either system

 

Sunday, December 19, 2021

Blog Topic: Gustavus Health Professions Podcast

 12-19-2021


This fall I had the wonderful opportunity to be interviewed by Heather Banks and Heidi Selzler-Bahr for the Gustavus Health Professions Podcast.  This was impactful for me as Gustavus Adolphus College in St. Peter, Minnesota is my alma mater.  This small, Lutheran, liberal arts college (about 90 minutes from Minneapolis) and provided me the opportunity to grow in all facets of my life.  It helped launch my career in medicine. 


If you are interested to hear this podcast, copy and past the below webpage address into your browser:

https://anchor.fm/heather-banks/episodes/Orthopaedic-Pediatric-Surgeon-Dr--Luhmann--86-e1aht86

Sunday, November 28, 2021

 

Blog Topic: New publication comparing MAGEC Growing Rods, Posterior Spinal Fusion and Vertebral Body Tether in 8-11 year old scoliosis patients.

 

 

Spine (Phila Pa 1976)2021 Oct 1.

 doi: 10.1097/BRS.0000000000004245. Online ahead of print.

Magnetically Controlled Growing Rods (MCGR) Versus Single Posterior Spinal Fusion (PSF) Versus Vertebral Body Tether (VBT) in Older Early Onset Scoliosis (EOS) Patients: How Do Early Outcomes Compare?

Catherine Mackey 1Regina HansteinYungtai LoMajella VaughanTricia St HilaireScott J LuhmannMichael G VitaleMichael P GlotzbeckerAmer SamdaniStefan ParentJaime A GomezPediatric Spine Study Group

Affiliations expand

·        PMID: 34610613

·        DOI: 10.1097/BRS.0000000000004245

Abstract

Study design: Retrospective review of prospective data from multicenter registry.

Objective: Compare outcomes of posterior spinal fusion (PSF) versus magnetically controlled growing rods (MCGR) versus vertebral body tethers (VBT) in 8- to 11-year-old idiopathic early onset scoliosis (EOS) patients.

Summary of background data: In EOS, it is unclear at what age the benefit of growth-sparing strategies outweighs increased risks of surgical complications, compared with PSF.

Methods: One hundred thirty idiopathic EOS patients, 81% female, aged 8-11 at index surgery (mean 10.5 yrs), underwent PSF, MCGR, or VBT. Scoliosis curve, kyphosis, thoracic and spinal height, complications, and Quality of Life (QoL) were assessed preoperatively and at most recent follow-up (prior to final fusion for VBT/MCGR).

Results: Of 130 patients, 28.5% received VBT, 39.2% MCGR, and 32.3% PSF. The VBT cohort included more females (P < 0.0005), was older (P < 0.0005), more skeletally mature (P < 0.0005), and had smaller major curves (P < 0.0005). At follow-up, scoliosis curve corrected 41.1 ± 22.4% in VBT, 52.2 ± 19.9% in PSF, and 27.4 ± 23.9% in MCGR (P < 0.0005), however, not all VBT/MCGR patients finished treatment. Fifteen complications occurred in 10 VBTs, 6 requiring unplanned surgeries; 45 complications occurred in 31 MCGRs, 11 requiring unplanned surgeries, and 9 complications occurred in 6 PSFs, 3 requiring unplanned revisions. Cox proportional hazards regression adjusted for age, gender, and preoperative scoliosis curve revealed that MCGR (hazard ratio [HR] = 21.0, 95% C.I. 4.8-92.5; P < 0.001) and VBT (HR = 7.1, 95% C.I. 1.4-36.4; P = 0.019) patients were at increased hazard of requiring revision, but only MCGR patients (HR = 5.6, 95% C.I. 1.1-28.4; P = 0.038) were at an increased hazard for unplanned revisions compared with PSF. Thoracic and spinal height increased in all groups. QoL improved in VBT and PSF patients, but not in MCGR patients.

Conclusion: In older idiopathic EOS patients, MCGR, PSF, and VBT controlled curves effectively and increased spinal height. However, VBT and PSF have a lower hazard for an unplanned revision and improved QoL.Level of Evidence: 3.

Sunday, November 21, 2021

 

Blog Topic:

Talking Points between Surgeon and Patient/Family about Thoracic Vertebral Body Tethering vs. Thoracic Posterior Spinal Fusion

 

Vertebral Body Tethering (VBT) is a procedure which has garnered a lot of attention from surgeons, patients and families.  Below is a list of talking points which should be known about VBT so there can be informative, educated, transparent discussions about VBT, when compared to the other commonly-performed procedure Posterior Spinal Fusions.  Discussions on these points is necessary before VBT surgery between the surgeon and patients/families to be fully-informed.

Tether

Posterior Spinal Fusion

Preoperative

FDA approved

Yes

Yes

FDA approved diagnoses

Idiopathic only

All diagnoses

Length of Time Procedure has been Performed in U.S.

About 16 years

>100 years; >45 years with metal implants

Skeletal Maturity Risser

0 to 2

Any

Skeletal Maturity Sander Grade

2 to 4

Any

Curve Size

45 to 60 degrees

>50 degrees

Curve Flexibility

Sidebender <30 degrees

Not applicable

Compensatory Curve Size

<45 degrees

Any size

Surgical

Incisions, Total Number

3 to 5

1

Incisions, Total Length

10 cm

25 cm

General Surgeon Assisting?

Yes

No

Need to deflate one lung?

Yes

No

Major Curve Correction, Immediate

Mild to Moderate

Moderate to High

3D correction

Mild to Moderate

Moderate to High

Length of Hospital Stay

3 days

3 days

Risk of Complications

Low

Low

After Discharge

Return to Sports

6 weeks to 3 months

6 months

Loss of Flexibility

Little

Moderate, depends on fusion length

Risk of Reoperation

>20%

<3%

Curve correction over time

Low to High

None

Risk of Implants Breaking

100%

<1%

Predictability of Outcome

Uncertain

High

Long-term Outcome

Uncertain

Good

 

Thanks to Dr. Mike Vitale, Columbia University in New York, for discussing this topic and providing the concept idea at the ICEOS meeting in Salt Lake City.