Surgical intervention is the greatest fear of parents and patients with spinal deformity and should always be a last resort after all conservative approaches have been exhausted. Recently, a robust interest in fusionless scoliosis surgery has encouraged progress in developing various new surgical approaches, innovations, and devices.
What is Anterior Scoliosis Correction (ASC)
To make non-fusion scoliosis surgery available to a larger group of patients, new and innovative surgical techniques have been developed that allow for patients with little or no growth remaining and/or rigid spinal curves an opportunity to be candidates. This can include skeletally maturing, skeletally mature, and even adults with scoliosis. The procedures of VBT or ASC do not need FDA approval themselves. It is the implant device that the company markets that need approval. Anterior Scoliosis Correction surgery cost generally range from $100,000 to $160,000 USD
Surgery Should always be the last option

The Origins of Anterior Scoliosis Correction

Vertebral Body Stapling (VBS)

The ASC procedure began with the development of spinal growth modulation surgical procedures in the early 2000s. These initial efforts were vertebral body stapling (VBS) procedures being utilized with early-stage growth cases with progressive spinal deformity to modulate asymmetrical spinal growth. The vertebral body staples provided compression on the outer part of the curve. Many patients did have positive outcomes during periods of remaining growth, and the procedure was discontinued for a variety of reasons:

  • Limited window patients could benefit from the procedure
  • Difficulty stabilizing spinal curves during remaining growth
  • Over-correction complications

Although, the vertebral body staples are expected to become available again in coming years for patients with small curves desiring an internal brace, as opposed to wearing an external brace for an extended period.

Vertebral Body Tethering (VBT) Surgery for Scoliosis

Gradually, the concept of using a single cord/tether to “tie” all of the curve segments together and achieve a similar clinical goal as vertebral body stapling was explored and began in 2011. This was used primarily in the thoracic spine to provide a more definite and predictable post-surgical outcome during the remaining growth. This “combo” approach using VBS and VBT also allowed surgeons to begin treating patients with double curves (“S” shaped scoliosis curves) with non-fusion scoliosis surgery procedures, resulting in excellent results. Soon, the advantages of using a cord/tether instead of staples had become clear, and the VBS procedures were discontinued entirely.

While the more powerful and versatile vertebral body tether over vertebral body staples was still very limited to young patients who had very flexible spines and significant growth remaining, the Federal Food & Drug Association (FDA) approved “The Tether – Vertebral Body Tethering System” by Zimmer-Biomet in mid-2019. It is the first approval order for a humanitarian-use device in spinal pediatrics within the last 15 years.

What is the Difference Between ASC & VBT?

The primary difference between Anterior Scoliosis Correction procedures and Vertebral Body Tethering procedures is the surgical approach taken by the surgeon. The hardware and tether material are virtually identical. ASC is generally for correcting the curvature in patients who have reach skeletal maturity.

Approval Process for ASC or VBT

The approval process for Anterior Scoliosis Correction (ASC) or Vertebral Body Tethering (VBT) involves stringent evaluations. As innovative surgical techniques, both ASC and VBT require thorough assessments before implementation. The Federal Drug Association (FDA) approval, also known as the Food and Drug Administration, is crucial for ensuring patient safety and treatment efficiency. These procedures, considered a viable option for a larger group of patients, undergo rigorous scrutiny to guarantee positive outcomes. The rigorous approval process for drug administration reflects the commitment to the advancement and safety of anterior scoliosis correction methods.

Pros and Cons of ASC Compared to Traditional Scoliosis Treatments

Anterior Scoliosis Correction (ASC) offers a less invasive alternative to traditional scoliosis surgeries, promoting quicker recovery and preserving spinal mobility. However, while ASC avoids spinal fusion, there may be limitations in correcting severe cases or large spinal curves, such as adolescent idiopathic scoliosis. Traditional methods like posterior instrumentation allow for more extensive correction but come with the risk of greater postoperative discomfort and longer recovery periods. Understanding the nuances of each approach, including the evolution of anterior spinal instrumentation, is key in determining the most suitable treatment for individual cases.

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Advantages of Anterior Scoliosis Correction (ASC)

Not only does Anterior Scoliosis Correction (ASC) present a minimally invasive approach to addressing spinal deformities, it also offers the advantage of preserving spinal motion compared to traditional fusion surgery. By utilizing innovative techniques like vertebral body tethering, ASC can effectively correct the curvature in younger patients without impeding their spine’s natural flexibility. This method is particularly beneficial for cases where spinal fusion may not be suitable due to the patient’s age or the severity of the curvature, reducing the risk for developing back pain and arthritis later in life.

Additional Read – Not Too Late: How Adults with Scoliosis Can Get Ahead of the Curve

How Anterior Scoliosis Correction (ASC) Works for Treating Scoliosis

Anterior Scoliosis Correction (ASC) involves a less invasive approach than traditional spinal fusion. By utilizing titanium screws to halt the progression of spinal curves, ASC corrects spinal deformities through an anterior surgical approach. This method allows for spinal correction without the need for posterior instrumentation. Through innovative techniques, ASC offers viable treatment for severe scoliosis cases, especially in adolescent patients who have not found relief through other treatments such as physical therapy or bracing. The procedure prioritizes achieving positive outcomes while minimizing the invasiveness of the surgery.

When should ASC be considered?

Surgical procedures of any kind should always be considered a last resort after all nonsurgical treatment for adults has been exhausted or proven unsuccessful. Fusionless Idiopathic scoliosis surgery for adults should only be considered an alternative to scoliosis fusion surgery.

Pros of ASC vs. VBT include:

  • Significantly larger range of curve size (40 degrees to 100+ degrees)
  • More aggressive de-rotational 3D correction
  • Any curve flexibility
  • No additional growth remaining requirement

Anterior Scoliosis Correction Before and After X-Ray

Can the Scoliosis Boot Camp Program Help Improve the Odds of You or Your Child Becoming a Candidate for Anterior Scoliosis Correction?

It may be hard to believe, but the topic of curve flexibility and rigidity is still relatively poorly understood and under-researched.

It is known that curve stiffness is correlated with patient age and curve size but is not necessarily proportional in any given case with any given patient — leaving a huge amount of variability.

Identical Twins Scoliosis Success Story

While the FDA guidelines for VBT in adolescent patients require to curve flexibility of less than 30 degrees at the curve’s apex, this requirement is unnecessary for ASC. Still, it is generally accepted as a general rule of thumb — and contributes significantly to maximizing outcomes for skeletally mature and adult patients who undergo the Anterior Scoliosis Correction procedure. However, for optimal results, it is recommended that patients be between the ages of 8 and 15, as this is the ideal range for skeletal maturity. Going too far below this age range may lead to unwanted complications, whereas going too far above it may affect the efficacy of the treatment in general.

The condition is widely known and accepted as a 3-dimensional spinal deformity primarily “driven” by spinal rotation, resulting in a “cool down” effect. This is similar to the “curve” produced by a rubber band when twisted from the top and bottom (see picture).

Spinal Rotation to the Left Forces the Vertebral Body Bending to the Right

The “torsion” created by the “coil down effect” seen as a spinal curvature on x-ray (stemming from the spinal rotation) may be the primary reason for increasing curve rigidity in larger curves.

One peer-reviewed and published case study, in particular, showed a combination of Manipulation Under Anesthesia (MUA) and the ScoliSMART exercises protocols had an encouragingly positive and long-lasting effect on function, range of motion, and curve flexibility.

In addition, anecdotal evidence suggests the ScoliSMART approach for directly targeting, improving, and reducing spinal rotation as a “pre-VBT or ASC preparation program” may be ideal for increasing curve flexibility for patients considering VBT or ASC who do not qualify due to curve rigidity.

Ongoing data collection and evaluation is currently being conducted with the intent of publishing additional clinical data on how specialized scoliosis exercise programs can improve curve flexibility and reduce apex rigidity – enabling more patients to qualify for non-fusion surgical procedures like ApiFix, Vertebral Body Tethering, and Anterior Scoliosis Correction.

We Help Kids Avoid Scoliosis Surgery

ApiFix as a Minimally Invasive Scoliosis Surgery

ApiFix offers a minimally invasive option for scoliosis correction. This innovative solution targets spinal deformities without the need for a spinal fusion. Using a single cord mechanism, ApiFix allows for gradual correction of Idiopathic scoliosis curves. With robust interest and positive outcomes, ApiFix presents a viable alternative, particularly for adolescent patients with idiopathic scoliosis. By providing a less invasive approach compared to traditional methods, ApiFix demonstrates promising results in treating the spinal deformity.

Patient Success Stories with ASC

Patient Success Stories with ASC: Patients who have undergone anterior scoliosis correction surgery often report significant improvements in their spinal curvature and overall quality of life. Many individuals have expressed gratitude for the lesser pain, improved posture, and increased mobility following the procedure. These success stories, including hundreds of successfully corrected cases of scoliosis in both children and adults, serve as inspiration for others considering ASC as a treatment option.