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
Uncontrolled bleeding
Neurologic deficit
Postoperative pneumothorax
Surgical site infection
Screw pullout or symptomatic migration
Tether breakage
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.

No comments:

Post a Comment