THORACOSCOPIC ANTERIOR TETHERING
TREATING SCOLIOSIS WITHOUT APPLYING FUSION
Anterior Vertebral Body Tethering for Idiopathic Scoliosis
Dr. Alanay Performs First Thorascoscopic Non-Fusion Operation Outside the United States
Today, the standard surgical treatment of the scoliosis is spinal fusion—a procedure that stabilizes the spine with screws and rods. Based on the location of the curve, fusion can be performed either through an anterior or posterior approach. However, the most common technique is the posterior approach through a procedure called posterior instrumented fusion.
This treatment is highly effective for a disease that may cause serious health problems and cosmetics issues. However, the vertebra stabilization prevents mobility.
While focusing on identifying the etiology of idiopathic scoliosis, scoliosis surgeons also try to find ways to treat scoliosis without applying fusion. Such a technique is finally available.
The first thoracoscopic non-fusion surgical operation was performed in the United States four years ago. Two-year follow-up results of this operation, called thoracoscopic anterior vertebral body tethering, reported a 95 percent success rate. This technique was first applied by Dr. Alanay with the accompaniment of the U.S. pioneer of this technique, Amer Samdani. The special equipment has since been brought to Turkiye and this technique has been applied to other patients by Dr. Alanay and his team.
About anterior tethering technique
In this technique, toracoscopic anterior screws are placed in the convex side of the curvature. Then, a polyester band is bound to these screws and partial curve correction is achieved by tethering. This band decelerates the curve progression on the convexity. Meanwhile, the concavity continues growing naturally. The curve correction is thus achieved by the patient’s own growth.
Three incisions of 1 cm and three incisions of 3 cms are made, preventing a long scar appearance after the surgery. These incisions might be hidden under a bra or bikini. Also, using a band versus rods allows mobility for the patient after surgery.
Who are good candidates for anterior thoracoscoic tethering?
This technique can be performed on the patients having the following conditions;
- Having enough remaining growth potential. The proper age is 10-14. The optimal time period for girls is when they are still pre-menarche or within one year after menarche. It is not suitable for the children younger than 10.
- The magnitude of the curve at the thoracic area should be between 30-60 degrees. The curve should be corrected on the bending radiographs. Scoliotic curve in the lower-back (lumbar area) should not be present, or if present, the magnitude of this curve should be below 25-30 degrees.
- Patients should not be hyperkyphotic.
Hospitalization period after fusionless scoliosis surgery
After the surgery, the patient will have a thorax tube. The patient will be discharged after the removal of this drain in approximately three to four days post-operation. Bracing is rarely recommended. Students can return their school after two weeks. This technique is less painful than the posterior instrumented fusion technique. No blood transfusion is necessary.
Follow up period of anterior vertebral tethering
EOS radiographic control is required six weeks and six months post surgery. Then an EOS radiographic control is done every six months until the end of the growth.
The preliminary results of thoracoscopic tethering
The 2-year follow-up results of first 60 patients treated with thoracoscopic anterior vertebral body tethering technique were satisfactory. None of these patients were re-operated because of curve progression. No major complication observed related to the surgery. Only two patients were re-operated due to overcorrection. In these revision operations, the inferior part of the tether was cut and the overcorrection and reverse curve progression was stopped.
The advantages of endoscopic anterior vertebral body tethering technique over traditional scoliosis fusion technique
- Since it is an endoscopic (closed) technique, the surgical scar is in a smaller area and may be concealed under bikinis, bras, etc.
- Less bleeding
- Faster recovery rate and return time to school
- No limit of mobility post surgery
- No sports activities are banned after surgery
