Thursday, January 25, 2018
Vertebral Body Tethering (Part 4)
Primum non nocere or “do no harm” is a basic tenet of medicine. This is why for surgical procedures, such as Vertebral Body Tethering or VBT, safety is the pre-eminent concern, even more so than its efficacy or how well it works. If a surgical procedure is safe (infrequent, minor complications, with no significant long-term problems) but only demonstrates mild to moderate efficacy then it may be viewed as a reasonable treatment. However if the procedure cannot be demonstrated to have reasonable safety it is unlikely any level of efficacy will be able to make this a reasonable treatment. This is especially the case for diseases which are not life-threatening, such as scoliosis.
As patients and caregiver potentially contemplate if VBT as a possible treatment (as detailed in an earlier post) it is important that the potential complications or adverse outcomes are detailed and well-understood as to their likelihood, severity and long-term implications. The list of complications which may occur with VBT are:
Anesthetic problem (such as allergic reaction or airway problem)
Injury to the great vessels, heart, lungs
Surgical site infection
Screw pullout or symptomatic migration
Failure of VBT modulate growth
Over-correction of spinal deformity
Pleural scarring secondary to surgical approach and presence of screw heads/tether in chest
Irritation of the diaphragm or psoas due to screws
Back or chest pain
In the next blog post the long-term issues of VBT will be presented.