Sunday, December 19, 2021

Blog Topic: Gustavus Health Professions Podcast


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:

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


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.


Posterior Spinal Fusion


FDA approved



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


Skeletal Maturity Sander Grade

2 to 4


Curve Size

45 to 60 degrees

>50 degrees

Curve Flexibility

Sidebender <30 degrees

Not applicable

Compensatory Curve Size

<45 degrees

Any size


Incisions, Total Number

3 to 5


Incisions, Total Length

10 cm

25 cm

General Surgeon Assisting?



Need to deflate one lung?



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



After Discharge

Return to Sports

6 weeks to 3 months

6 months

Loss of Flexibility


Moderate, depends on fusion length

Risk of Reoperation



Curve correction over time

Low to High


Risk of Implants Breaking



Predictability of Outcome



Long-term Outcome




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.

Friday, November 12, 2021


Blog Topic: Pain Control and Muscle Spasm Management after Idiopathic Scoliosis Surgery




1.      Preoperatively

At  At the last outpatient clinic visit before surgery, all patients will also have a visit with the Pediatric Anesthesia service on the same day.  This group of physicians and Advanced Practice Providers (AAPs) will provide the general anesthesia (means the patient will be asleep) for the entire surgical procedure AND manage the postoperative pain and muscle spasms (by the Pain Service). 

2.      After surgery, the Pain Service will start its care immediately after surgery and will continue care until hospital discharge.


3.      Pain management. after surgery will be a combination of opioids and non-opioid medications.  By using non-opioid medications the amount of opioid medications can be minimized. The negative aspects of opioids are well-known, specifically addiction. In the short-term, after surgery, these medications also decrease breathing rate, lower blood pressure, induce nausea and vomiting and create constipation.  These are all great reasons to minimize opioids, as much as possible.  The below medications in our protocol work together to minimize pain and the side effects of opioids.

a.      Opioids:

                                                    i.     Intravenous morphine or morphine-equivalent medication, by a device call a PCA which stands for “Patient-Controlled Analgesia”: day 0-1

                                                   ii.     Oral oxycodone: days 1 to discharge

b.      Use of non-opioids

                                                    i.     Intravenous ketorolac: days 0-2

                                                   ii.     Oral acetaminophen: days 0 to discharge

4.      Muscle spasm management. Spine surgery requires operating around or through muscle, which creates swelling and secondarily muscle spasm.  To minimize muscle spasm the below medication are used, and they work together with the above-mentioned pain medications to make the patients as comfortable as possible.

a.      Methocarbamol: days 0-2

b.      Diazepam: days 0-2

c.      Flexeril: days 2+

5.      Discharge (at-home treatment).  The below medications are the typical medications spine patients have for pain and muscle spasm management.

a.      Oral oxycodone (as needed)

b.      Flexeril (as needed)

c.      Acetaminophen (as needed)

6.      Pain Service is available to patient/family as needed to optimize patient comfort.

7.      Gradually pain and muscle spasm will resolve, with most patients using only oral acetaminophen about 2 weeks after surgery.