As an adult that underwent ASC with multiple disc-releases, this was very informative. As a mechanical engineer, I can't help but be fascinated by the advancements that have been made. Excited to see what the future holds for scoliosis patients.
@@keineangstable I got the surgery in August 2019. "Happy" is a difficult term to use in this circumstance but I am confident that my decision to get ASC over fusion was the correct decision. If I had to choose again, I'd choose ASC every time.
In your proffesional opinion are the greater major complication rates in adult fusion patients caused mainly by generally larger curves of the spine or by different factors that change with age? Is there a point that adults patients should decide to have the surgery instead of postponing it?
Great questions. Just my opinion but adult scoliosis patients develop disc degeneration, vertebral wedging and joint degeneration as they age. Disc and joint degeneration are very common in non-scoliosis patients and this can only be more problematic with scoliosis patients who already have greater abnormal spine mechanics with increased loads. It is well documented that adolescents recover much faster than adults after scoliosis surgery with fewer complications. Adult scoliosis spines are not only more degenerated, but typically Cobb angles have increased and more levels need to be fused. Unfortunately, there is no easy answer to your last question because it depends on curve type, maturity level, location of the curve, etc...
@@DerekLee Thank you for your answer Doctor. Your work is admirable. About the last question. Would an ordinary orthopedist be suitable to answer or should someone refer to a surgeon experienced in scoliosis? I suppose the answer to this is obvious. However the former usually suggest the surgery be postponed untill the symptoms become unmanagable or the curve significant while for the latter it could be argued that there is more incentive to suggest surgery.
@@stevenz2998 I would definitely consult with an ortho who specializes in scoliosis surgery. Scoliosis is pretty much a specialty on its own. You want to see an ortho who sees scoliosis everyday.
No Canadian surgeon does ASC which is primarily tethering for mature adults. However, there are maybe half a dozen surgeons who do VBT which is tethering for immature spines.
Very good and informative interview thanks Dr. Lee. I just wonder why these brilliant surgeons have to do fusion at all when they perhhaps could do staged fusionless surgery using ASC techniques for severe. After all, they are happy to do revision surgeries.🙄
This interview is for educational purposes and covers information provided by Dr. Baron Lonner regarding his opinions on Innovative Procedures for Scoliosis in Children and Adults. This video is not an endorsement. Viewers should consult their physicians and treating team accordingly. See highlights via timestamps below. 0:00 Introduction 1:12 Innovative Procedures for Scoliosis in Children & Adults. 1:48 Pediatric and Adult surgical approaches to scoliosis. 2:53 Disc degeneration below a spinal fusion. 3:49 Tries to avoid fusion into the lumbar spine: non-fusion or hybrid alternatives. 4:15 Case Study: 25 years post fusion revision. 5:08 Case Study: 6 years post Vertebral Body Tethering (VBT). 7:17 Disc releases. 9:02 Case Study: 14 year old female with thoracic disc releases for VBT/ASC. 10:09 Anterior surgical approaches to reach the spine. 13:17 Disc release should be used very selectively. 13:50 Disc release: disc autofusion and back pain. 15:39 Complications from spinal fusion. 16:42 Where can pain from a disc release come from? 18:44 Releasing a possibly degenerated disc at scoliosis curve apex. 20:54 How much of the disc and surrounding structures are released? 22:04 Disc release and/or discectomy with posterior surgical approach. 23:21 Case Study: 13 year old female with 4 thoracolumbar disc releases (VBT/ASC). 24:49 How to determine which discs to release? 26:12 Case Study: 15 year old male with tether breakage (VBT/ASC). 27:56 Timeline for a new tether. 28:38 Return to activity post VBT/ASC. 30:24 Perspective on tether ruptures and increased physical activity. 32:39 Case Study: 12.5 year old female with ApiFix. 34:21 Case Study: 13 year old female with hybrid thoracic fusion and lumbar tether. 35:52 Case Study: 14 year old female with hybrid fusion/tether. 37:35 Pulmonary function changes after anterior approaches. 40:11 Deciding an Option for Your Child's Scoliosis Surgery. 42:40 Surgery for the AIS patients after skeletal maturity. 45:42 Case Study: 53 year old female with posterior fusion. 47:42 Case Study: 37 year old female with anterior fusion. 50:45 The lost art of anterior fusion. 52:55 Artificial discs. drdereklee.com
As an adult that underwent ASC with multiple disc-releases, this was very informative. As a mechanical engineer, I can't help but be fascinated by the advancements that have been made. Excited to see what the future holds for scoliosis patients.
Thanks for your feedback. I'm sure your engineering background came I handy when researching this procedure yourself. 🙂
How long has it been since your OP? Are you happy you got ASC instead of fusion?
@@keineangstable I got the surgery in August 2019. "Happy" is a difficult term to use in this circumstance but I am confident that my decision to get ASC over fusion was the correct decision. If I had to choose again, I'd choose ASC every time.
@@Terribad13hi! Who did your surgery?
@@taylorreinhardt9807 Dr. Antonacci.
Dr Derek im very grateful for your fantastic work in sharing knowledge about scoliosis treatments
Thanks! I hope you find the content helpful.
In spinal fusion surgery, does the unfused part whether lower or above causes any issues later in long run
There can be adjacent level degeneration. Best to talk to a surgeon for the most accurate answers.
In your proffesional opinion are the greater major complication rates in adult fusion patients caused mainly by generally larger curves of the spine or by different factors that change with age? Is there a point that adults patients should decide to have the surgery instead of postponing it?
Great questions. Just my opinion but adult scoliosis patients develop disc degeneration, vertebral wedging and joint degeneration as they age. Disc and joint degeneration are very common in non-scoliosis patients and this can only be more problematic with scoliosis patients who already have greater abnormal spine mechanics with increased loads.
It is well documented that adolescents recover much faster than adults after scoliosis surgery with fewer complications. Adult scoliosis spines are not only more degenerated, but typically Cobb angles have increased and more levels need to be fused.
Unfortunately, there is no easy answer to your last question because it depends on curve type, maturity level, location of the curve, etc...
@@DerekLee Thank you for your answer Doctor. Your work is admirable.
About the last question. Would an ordinary orthopedist be suitable to answer or should someone refer to a surgeon experienced in scoliosis?
I suppose the answer to this is obvious. However the former usually suggest the surgery be postponed untill the symptoms become unmanagable or the curve significant while for the latter it could be argued that there is more incentive to suggest surgery.
@@stevenz2998 I would definitely consult with an ortho who specializes in scoliosis surgery. Scoliosis is pretty much a specialty on its own. You want to see an ortho who sees scoliosis everyday.
Dr. Lee, are you aware of anyone in Canada performing this type of non evasive scoliosis surgery. I live in Calgary, Alberta. thanks
No Canadian surgeon does ASC which is primarily tethering for mature adults. However, there are maybe half a dozen surgeons who do VBT which is tethering for immature spines.
Very good and informative interview thanks Dr. Lee. I just wonder why these brilliant surgeons have to do fusion at all when they perhhaps could do staged fusionless surgery using ASC techniques for severe.
After all, they are happy to do revision surgeries.🙄
Often there's too much degeneration in the spine to perform ASC with fusion being the only option.
This interview is for educational purposes and covers information provided by Dr. Baron Lonner regarding his opinions on Innovative Procedures for Scoliosis in Children and Adults. This video is not an endorsement. Viewers should consult their physicians and treating team accordingly. See highlights via timestamps below.
0:00 Introduction
1:12 Innovative Procedures for Scoliosis in Children & Adults.
1:48 Pediatric and Adult surgical approaches to scoliosis.
2:53 Disc degeneration below a spinal fusion.
3:49 Tries to avoid fusion into the lumbar spine: non-fusion or hybrid alternatives.
4:15 Case Study: 25 years post fusion revision.
5:08 Case Study: 6 years post Vertebral Body Tethering (VBT).
7:17 Disc releases.
9:02 Case Study: 14 year old female with thoracic disc releases for VBT/ASC.
10:09 Anterior surgical approaches to reach the spine.
13:17 Disc release should be used very selectively.
13:50 Disc release: disc autofusion and back pain.
15:39 Complications from spinal fusion.
16:42 Where can pain from a disc release come from?
18:44 Releasing a possibly degenerated disc at scoliosis curve apex.
20:54 How much of the disc and surrounding structures are released?
22:04 Disc release and/or discectomy with posterior surgical approach.
23:21 Case Study: 13 year old female with 4 thoracolumbar disc releases (VBT/ASC).
24:49 How to determine which discs to release?
26:12 Case Study: 15 year old male with tether breakage (VBT/ASC).
27:56 Timeline for a new tether.
28:38 Return to activity post VBT/ASC.
30:24 Perspective on tether ruptures and increased physical activity.
32:39 Case Study: 12.5 year old female with ApiFix.
34:21 Case Study: 13 year old female with hybrid thoracic fusion and lumbar tether.
35:52 Case Study: 14 year old female with hybrid fusion/tether.
37:35 Pulmonary function changes after anterior approaches.
40:11 Deciding an Option for Your Child's Scoliosis Surgery.
42:40 Surgery for the AIS patients after skeletal maturity.
45:42 Case Study: 53 year old female with posterior fusion.
47:42 Case Study: 37 year old female with anterior fusion.
50:45 The lost art of anterior fusion.
52:55 Artificial discs.
drdereklee.com