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.
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:
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)
as allergic reaction or airway problem)
Injury to the great
vessels, heart, lungs
vessels, heart, lungs
Uncontrolled bleeding
Neurologic deficit
Postoperative
pneumothorax
pneumothorax
Surgical site infection
Screw pullout or symptomatic
migration
migration
Tether breakage
Failure of VBT modulate
growth
growth
Over-correction of spinal
deformity
deformity
Pleural scarring
secondary to surgical approach and presence of screw heads/tether in chest
secondary to surgical approach and presence of screw heads/tether in chest
Irritation of the diaphragm
or psoas due to screws
or psoas due to screws
Back or chest pain
In the next blog post the long-term issues of VBT will
be presented.
be presented.