Non-fusion surgeries for scoliosis have emerged as a better way for patients and parents seeking an alternative to traditional scoliosis fusion surgery. These procedures, such as Vertebral Body Tethering (VBT) and ApiFix, have gained popularity due to their motion-sparing benefits. While these techniques have been used off-label in the United States of America and received CE mark approval in Europe, recent FDA HDE approvals for both devices have provided a more structured pathway for their implementation.
The rapid evolution of non-fusion surgical options has led to a scenario where many parents and patients are faced with uncertainty regarding the most suitable procedure for early-stage growth patients with progressive scoliosis. Understanding the nuances between various fusionless surgical techniques is crucial for making informed decisions about treatment options. It is essential for medical professionals to guide patients and their families through this decision-making process by providing comprehensive information on the benefits and potential risks associated with each procedure.
Furthermore, ongoing research and advancements in non-fusion surgeries for scoliosis underscore the importance of staying informed about the latest developments in this field. Patients and parents should actively engage with healthcare providers to discuss individualized treatment plans that align with specific needs and desired outcomes. Ultimately, the availability of non-fusion surgical options offers a promising avenue for addressing scoliosis while preserving spinal mobility and function.
VBT vs ApiFix – A Detailed Comparison
Vertebral body tethering and the MID-C system by ApiFix are both surgical procedures used to treat scoliosis, but they differ in their approach and mechanism of action. Vertebral body tethering involves attaching a flexible cord to the spine to correct the curvature gradually over time. On the other hand, the MID-C system utilizes a minimally invasive technique that involves implanting a device to guide the spine into proper alignment.
While vertebral body tethering requires periodic adjustments as the spine grows, the MID-C system offers a more dynamic correction through its innovative technology. Patients undergoing vertebral body tethering may experience restriction in spinal movement, whereas those treated with the MID-C system may have greater flexibility post-surgery.
Both procedures aim to achieve spinal alignment without fusion, preserving flexibility and mobility. However, it is essential for patients to consult with their healthcare providers to determine the most suitable treatment option based on their specific condition and needs.
Vertebral Body Tethering (VBT)
Vertebral Body Tethering (VBT) is a cutting-edge non-fusion surgical technique designed to preserve motion. During this procedure, small incisions are made in the chest cavity to insert anterior surgical screws into the vertebral bodies along the outside of the spinal curvature. A tether or cord is then threaded through these screws and tightened, resulting in the straightening of the spine and promoting further spinal growth. While VBT primarily aims to reduce spinal rotation during remaining growth stages, it has a moderate impact on existing rib cage rotation.
One of the key advantages of VBT is its ability to maintain flexibility and movement in the spine compared to traditional fusion surgeries. By allowing for continued growth and mobility, VBT offers a less invasive treatment option for conditions such as scoliosis. Patients undergoing VBT may experience improved post-operative recovery times and reduced risks associated with long-term spinal fusions. Additionally, VBT is typically performed in a small group setting, allowing for personalized care and attention from the medical team.
It is essential for individuals considering VBT to consult with orthopedic specialists and surgeons experienced in this specialized procedure. Patient selection criteria, pre-operative evaluations, and post-operative care play crucial roles in ensuring optimal outcomes and long-term benefits from Vertebral Body Tethering.
What’s VBT theory?
VBT, or Vertebral Body Tethering, is a surgical technique used to correct spinal deformities in children and adolescents. It involves attaching screws to the vertebrae and connecting them with a cord, allowing for gradual correction of the spine’s curvature as the individual grows.
Click on the Scoli-Fact to see the rest of the Scoliosis Facts!
MID-C (Minimally Invasive Deformity Correction) by ApiFix
ApiFix is a revolutionary posterior fixed device equipped with an internal ratchet system designed to stretch the inner part of the spinal curve, effectively reducing the curvature. It is important to note that ApiFix does not de-rotate the spinal curvature but focuses on opening up the curve. Although the device has limitations in terms of intersegmental range of motion, it incorporates an innovative poly-axial joint system. This unique feature enables patients to maintain significantly more spinal mobility compared to traditional short fusion procedures.
The advanced technology utilized in ApiFix allows for targeted treatment of spinal curvature while preserving spinal motion. By offering a balance between correcting the curvature and retaining flexibility, ApiFix provides a tailored solution for individuals seeking to address their spinal issues without compromising overall mobility. This innovative approach marks a significant advancement in spinal care, offering patients a more personalized and effective treatment option for managing spinal curvatures.
VBT & ApiFix Comparison
VBT
- FDA-approved device
- Recommended for patients with early-stage growth (Risser 0–2)
- Significant curve flexibility required
- 75% curve correction (on average)
- Recommended for thoracic curve patterns only
- Curve sizes 35–60 degrees
- Multiple surgical implants and hardware
- Limits range of motion by approximately 20%
Improves lateral bending (Cobb angle) and spinal rotation
ApiFix
- FDA-approved device
- Recommended for very early-stage growth patients (Risser 0–1)
- Extreme curve flexibility required
- 35% curve correction (on average)
Recommended for thoracic or thoracolumbar curve patterns
- Curve sizes 40–65 degrees
- Only 2–4 posterior screw attachments
- Limits range of motion by approximately 40%
- Improves lateral bending (Cobb angle) only
Alternatives for Scoliosis Surgery: Scoliosis Boot Camp
Conclusion
ApiFix and Vertebral Body Tethering are innovative treatment options gaining popularity for patients with progressive scoliosis who still have significant growth potential. These procedures offer a less invasive alternative to traditional spinal fusion surgeries, aiming to guide ongoing growth and mitigate spinal deformities. The key advantage of these modern surgical techniques is their ability to preserve motion in the spine, reducing stress on unfused segments that would typically degenerate post-fusion. Additionally, the reduced blood loss and smaller incisions associated with ApiFix and Vertebral Body Tethering lower the risks of infection, hospital stays, and recovery periods.
Vertebral Body Tethering (VBT) is suitable for patients with double curve patterns, while ApiFix is recommended for individuals with single curve patterns, particularly those at Risser stages 0–2 with excellent curve flexibility (curving less than 30 degrees on lateral bending x-rays). By offering tailored solutions based on the patient’s condition and growth potential, these advanced treatments provide new hope for scoliosis patients seeking effective and minimally invasive interventions.
Multiple patients have been able to increase curve flexibility with the ScoliSMART BootCamp program, which can be a vital resource for parents and patients seeking VBT or ApiFix procedures but do not currently qualify due to the curve apex flexibility requirements. Research is currently underway to determine the program’s effectiveness as a viable VBT or ApiFix preparation program option.
“Fusion-free” devices for scoliosis surgery definitely seem to be the future innovation for moderate to severe scoliosis cases not responding to conservative treatments and that are likely to experience growth-spurt related progression. Less invasive, more motion-sparing, and faster recovery times are welcome features over traditional scoliosis fusion procedures. Long-term follow up studies still need to be conducted to determine the rate of complications and effectiveness over the course of a normal lifespan.
