Spinal fusion hardware versus VBT

The USA's Food and Drug Administration (FDA) recently announced that it had approved its very first spinal tethering device for correcting idiopathic scoliosis in children and adolescents.

The Tether™ vertebral body tethering system is designed to help correct spinal curvatures in young patients whose bones have yet to fully mature.

Made up of titanium anchors, bone screws and set screws, along with a flexible polymer cord, the device aims to prevent further curve progression, theoretically eliminating the need for spinal fusion surgery.

 

What does this mean for young scoliosis patients in the USA?

Manufactured by Zimmer Biomet, the spinal tether device has been presented as something of a breakthrough in paediatric scoliosis management. It is an innovative treatment option that aims to improve quality of life for young patients with idiopathic scoliosis.

Dr Baron Lonner, Professor of Orthopaedic Surgery at New York City's Mount Sinai Hospital, applauded the FDA's decision, noting that vertebral body tethering (VBT) could become a "mainstream option for scoliosis treatment" in due course.

The Tether™ VBT system is designed to help young scoliosis patients with a Cobb angle of 30-65 degrees.

 

Idiopathic scoliosis in children

Idiopathic scoliosis is the most common form of scoliosis. The causes of idiopathic scoliosis are unknown (this is what the word 'idiopathic' means). It is typically diagnosed in children and adolescents between the ages of 10 and 18.

The most commonly-prescribed medical treatment for idiopathic scoliosis is bracing. If the brace does not successfully halt the progression of the patient's spinal curve, surgery may be recommended.

Though often effective, the spinal fusion procedure can lead to problems of its own, with patients sometimes facing such issues as restricted motion and arthritis down the line.

The FDA's decision to approve this new tethering device could give young scoliosis sufferers a new hope in tackling their spinal issues.

 

Is vertebral body tethering effective?

In June 2018, NHS England published a report titled Evidence Review: Vertebral Body Tethering for Treatment of Idiopathic Scoliosis.

This review examined the effectiveness of VBT and the complication rates associated with this treatment method.

Here are two key findings from NHS England's report...

  • 5 out of 25 patients required repeat surgery: "At skeletal maturity, Ames, Samdami et al reported 5 patients from the cohort of 25 requiring repeat surgery to loosen the tether in order to treat or prevent overcorrection (Ames, Samdani, & Betz, 2016)."

  • In total, 44% of patients experienced some complications. In addition to the 5 patients who required repeat surgery (see above), another 5 experienced "transient thigh pain or numbness", and there was 1 patient with "unresolved intercostal neuralgia".
  • There's not yet enough evidence of VBT's effectiveness: "It is not possible at present, given the lack of experimental studies, to confirm that this treatment is relatively effective, safe and acceptable when compared to standard care."

 

Scoliosis treatment at the Scoliosis SOS Clinic

While the FDA's decision may be welcome news to young scoliosis sufferers in the USA, vertebral body tethering still has a long way to go as an alternative to spinal fusion surgery, and it remains to be seen just how effective the Tether™ will be in the long term. Note also that this treatment method still requires the patient to undergo an operation.

If you're seeking a less invasive option for yourself or a loved one with scoliosis, you may be interested in the treatment courses that we deliver here at the Scoliosis SOS Clinic in London, England. Our ScolioGold programme combines a variety of non-surgical methods to create a unique approach that is unlike anything offered elsewhere.

Better still, the ScolioGold method is constantly evolving in line with advances in the field of non-surgical treatment, ensuring that our therapeutic programme continues to deliver the best possible results.

Contact Scoliosis SOS to book a ScolioGold consultation >>

FURTHER READING:

Woman jogging in the sunset

Celebrating the benefits of an active lifestyle, National Fitness Day takes place annually to help promote the benefits of physical fitness.

National Fitness Day 2019 falls on Wednesday 25 September. People across the UK will be encouraged to get active and commit to get fit in pursuit of healthier lives.

Organised by UK Active, this event aims to highlight the importance of keeping fit and staying active, regardless of your age and ability.

 

Staying fit with scoliosis

People with scoliosis sometimes find it difficult to take part in sports and other forms of strenuous exercise.

But scoliosis doesn’t have to dictate how you live your life, and it needn't stop you from participating in activities you enjoy.

It's a somewhat common misconception that sporting activity can make scoliosis worse. This myth has been debunked by medical professionals.

In fact, some sports can actually help to boost your flexibility and strengthen your core - particularly swimming, cycling and even football.

 

Usain Bolt has scoliosis!

For proof that people with scoliosis can achieve sporting glory, look no further than Olympic sprinter Usain Bolt.

Despite being born with scoliosis, the Jamaican youngster with the spinal curve never let it hamper his dreams, defying the odds to become one of the most celebrated Olympians in history.

Bolt overcame his spinal curvature and became known as the fastest man on Earth, shattering records in the 100m, 200m and 4 x 100m relay (and winning countless medals along the way).

 

Success stories from Scoliosis SOS

But Usain Bolt isn't the only scoliosis sufferer who's made his sporting dreams a reality. In fact, many of the patients we've treated here at the Scoliosis SOS Clinic have managed to triumph over adversity and remain active despite their spinal issues.

Through their dedication and hard work, these people have been able to overcome the pain of scoliosis with the help of our non-surgical treatment courses, allowing them to continue to participate in the activities they love.

View some of our sporty success stories >

If you're struggling with scoliosis and you'd like to book a consultation with the Scoliosis SOS Clinic, please contact us today.

One of the oldest, most tried-and-tested methods of scoliosis treatment is bracing. This is where the scoliosis patient wears a brace around their torso to prevent the curve in their spine from getting worse as they grow.

There have been huge leaps forward in both the design and functionality of scoliosis braces since this approach was first tried, and modern scoliosis patients may wear all sorts of different braces depending on the nature of their condition.

The main difference between different types of scoliosis brace lies in the level of pressure that is applied to the wearer's spine and ribs. Some braces must be worn on a full-time basis, whereas others need only be worn while sleeping.

Let's take a closer look at the various scoliosis braces currently in use.

 

Boston brace

Boston Brace

The most commonly-prescribed brace for scoliosis patients today is the Boston brace. This model was first developed in the early 1970s by Dr John Hall and Mr William Miller of The Boston Children's Hospital (hence the name). It is a type of thoracolumbosacral orthosis (TLSO), commonly referred to as 'low-profile' or 'underarm' braces.

Other models of the Boston brace exist, such as a CTLSO, which is a TLSO with a neck extension. These are used for high-degree curves located on the thoracic spine, but are generally used far less often.

The Boston brace is small in size, with plastic components that are custom-made to fit the wearer's body exactly. At the front, the Boston brace starts just below the breast and extends all the way to the beginning of the pelvic area. At the back, it begins below the shoulder blades and continues all the way down to the tail bone of the spine - covering most of the torso.

The Boston brace works by applying pressure to the spine's curve pattern in order to prevent further curvature. This forces the lumbar areas to 'flex', pushing in the abdomen and flattening the posterior lumbar curve.

 

Wilmington brace

Wilmington Brace

The Wilmington brace is another common TLSO. However, unlike the Boston brace, the Wilmington brace is entirely custom-made for each wearer, based on a cast taken while they patient is lying down and facing upwards. Once the cast is produced, corrective forces specific to the wearer's spinal curve are added to complete the brace.

The Wilmington brace is applied to the body in a similar fashion to a tight jacket and is known as a full-contact TLSO as a result of its lack of open spots and gaps.

 

Milwaukee brace

Milwaukee Brace

The Milwaukee brace is the original cervico-thoracic-lumbar-sacral orthosis (CTLSO), prescribed to individuals who have been diagnosed with a high thoracic curve. This type of scoliosis brace has a distinctive design that is designed to manipulate the wearer's full upper body. The Milwaukee brace extends from the pelvis all the way up to the neck and is made with a contoured plastic pelvic girdle and neck ring. These are connected with a metal bar in both the front and back of the brace.

These metal bars play a vital role in scoliosis correction, as they help the torso to extend while the neck ring keeps the wearer's head in a central position over their pelvis. Pressure pads are strategically placed to the metal bars with straps, aligning to the shape of the wearer's spinal curve.

First developed in 1945 by Dr Albert Schmidt and Dr Walter Blount of the Medical College of Wisconsin and Milwaukee Children's Hospital, the Milwaukee brace is seen by many as the first modern scoliosis brace. Since its introduction, it has undergone a number of tweaks and improvements; however, the current design has been in use since 1975.

 

Charleston brace

Charleston Bending Brace

The Charleston bending brace is the most commonly-prescribed night-time scoliosis brace. Just like the Wilmington brace, it is custom-fitted based on a cast taken of the patient's torso. Once the case has set, corrective forces are added to the brace based on X-rays of the patient's spine.

This Charleston bending brace is designed to be worn laying down, not while up and moving around. This allows the brace to apply greater forces and isn't restricted by considerations for the head to remain balanced over the pelvis.

As well as applying lateral forces to push the spinal curve closer to the back's midline, the Charleston bending brace also applies pressure to bend and hold the spine in an overcorrected position. This extreme position can be held much more easily at night, while laying down and sleeping, than during the day when the wearer is going about their daily activities.

 

Providence brace

Providence Brace

The Providence brace applies the same hypercorrective force on the spine as the Charleston bending brace, which is only possible whilst laying down and sleeping at night. However, the main difference with this type of scoliosis brace is that, instead of the spine's curve bending in the opposite direction, one shoulder is slightly elevated to apply lateral and rotational forces on the curve.

The Providence brace aims to push the curve toward the midline or even beyond in some cases.

 

Gensingen brace

Gensingen Brace

The Gensingen brace was designed with a view to encouraging corrective movement instead of restricting movement like the braces we've already seen. It positions the wearer's back in the opposite position to their spinal curve.

Read our blog about the Gensingen brace to learn more about this option.

 

Bracing tends to deliver better outcomes for scoliosis patients when combined with a specialised physiotherapy course. To find out more, read 'Why Is It Important to Do Specialised Physiotherapy Alongside Wearing a Back Brace for Scoliosis?'

Our Treatment Programme   Book an Initial Consultation

Further reading:

Job interview

Whether you're applying for a job, sitting in an interview or getting ready for your first day, if you have a medical condition like scoliosis, you may be wondering whether you ought to let your employer know about it.

Read on to find out more about what you are - and aren't - obliged to share with the people you work for. Please note that the information in this article pertains to UK law only - the law may be different where you live.

 

The legalities

The Equality Act 2010 was passed to help protect jobseekers from discrimination. It forbids employers from asking questions about your health or sickness record before they offer you a job.

As a result of this legislation, you are not required to disclose any health information at either the application or interview stage. If your potential employer does ask any questions about your health and you are then turned down for the role, you may have grounds for unlawful discrimination.

On the other hand, disclosing information after you've received a job offer may be beneficial, as employers have to make reasonable adjustments for people who disclose health issues that are protected under the aforementioned Equality Act.

 

The application process

When you're applying for jobs, you do not need to mention any illnesses or disabilities on your CV, even if they were the reason you left a previous role. If your medical conditions have created gaps in your employment history, there are ways that you can fill these in with activities such as periods of study, working on your own projects, or temp work.

However, if medical conditions have contributed to extensive or repeated gaps in your resumé, you may wish to omit employment dates from your CV altogether and replace them with the length of time you worked within each role.

 

The interview

During your interview, you can decide how much you wish to say about your medical condition(s). If you do have any noticeable gaps in your work history, prepare an explanation that doesn't disclose any health issues. You can use 'personal reasons' as justification for leaving a role, but make sure these are framed in a positive way that matches what you're now applying for.

Focus on why you want the role and how your skills and abilities will enable you to make a meaningful contribution.

 

FURTHER READING: Can You Work with Scoliosis?

 

If you feel that your scoliosis is preventing you from following your preferred career path, the Scoliosis SOS Clinic may be able to help. Get in touch to arrange a consultation.

Our Treatment Courses   Book an Initial Consultation

We at the Scoliosis SOS Clinic are all about helping our patients to manage their scoliosis independently. When you attend one of our treatment courses, our therapists will teach you a range of corrective and strengthening exercises to combat your spinal curvature; you will then need to continue performing these exercises at home in order to keep your scoliosis under control.

Many of the exercises we recommend require particular pieces of equipment. These are, for the most part, relatively common, and may even be things that you already own. Read on to find out what you'll need to keep up your scoliosis exercises once you've left the clinic.

Please note: all exercise equipment can be purchased from the Scoliosis SOS Clinic directly. Please don't stop or avoid doing your scoliosis exercises if you can't find the equipment you need in shops.

 

Poles for scoliosis exercises

Poles and Chin-Up Bars

One of the main ways we are able to control our patients' elongation during treatment is by using poles and wall bars. They help to straighten the spine while giving the patient something to hold on to for guidance and stability. We recommend that our patients use a chin-up bar in place of wall bars and, because many chin-up bars are portable and relatively inexpensive, this can be a great investment for patients who are going on holiday.

 

Plastic tubes and wooden blocks

Wooden Blocks and Plastic Tubes

You will become very familiar with these plastic pipes and wooden blocks by the end of your ScolioGold course. Our physiotherapists use the blocks to correctly position you during exercises, and they use the pipes to help you stretch and elongate when prone.

Having these pieces of equipment at home will help you achieve the same results, although you may need to ask a friend or partner for some assistance.

 

Strap and belt exercises

Strap and Belt

These are definitely among the more unusual pieces of equipment that we use in our scoliosis exercise routines. The strap and belt are secured to the wall bars, and they help our physiotherapists to stabilise the patient's pelvis during different exercises.

This is a great piece of equipment for you to purchase if pelvis alignment is one of your key treatment goals.

 

Beanbags, wedges and resistance bands

Wedges, Beanbags and Resistance Bands

Besides being nice and comfortable, these beanbags and wedges help to de-align and rotate your spine. They will also come in very handy while you complete other exercises that require different parts of your body to be supported while you exercise.

We also recommend that you purchase a variety of resistance bands. These will help you to build up the strength of your muscles during FITS, PNF and stabilisation techniques.

 

Exercise mats and stability ball

Exercise Mats and Stability Balls

Suitable for most forms of floor-based exercise, an exercise mat can cushion you against hard and cold floor surfaces. If you plan to exercise on wood flooring (or even outside on the patio), investing in an exercise mat is a great idea!

The stability ball is a piece of equipment that we incorporate into many of our scoliosis exercises. It's an incredibly versatile apparatus that can help you to build strength and improve your balance. If you don't already have one at home, we recommend purchasing one - they're great fun and very useful!

 

Plastic stool and trigger point balls

Plastic Stools and Trigger Point Balls

Lightweight plastic stools are perfect for positioning yourself during exercises. We're sure you already have something like this at home, but if not, now might be the time to purchase some.

The colourful, spikey balls you see above are trigger point balls. They provide proprioceptive feedback and muscle stimulation.

 

Foam roller and stability disk in use

Foam Rollers and Stability Disks

Foam rollers (like the blue one pictured above) are specifically for hyperkyphosis patients. They help patients to work the deep tissue around the spine, and can also be used to relieve muscular aches and pains.

Stability disks are used by patients who have completed more advanced exercises during their treatment. By balancing on the stability disk while holding corrective poses, patients are able to improve their balance and strength.

Remember that you can purchase all of this scoliosis exercise equipment directly from the Scoliosis SOS Clinic, so don't worry if you're struggling to find something that you've enjoyed using during your treatment.

Contact Scoliosis SOS >>