Wednesday, January 26, 2022


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


Blog Topic:  Latest Publication on Intraoperative Halo-femoral Traction


 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:

Sunday, January 16, 2022


Blog Topic:  What is a “Spine Fusion”


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?


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