Anterior Scoliosis Correction

Anterior Scoliosis Correction (ASC): 

To begin with, all of our doctors and surgeons believe that surgical intervention should always remain a last resort after all conservative approaches have been exhausted. Recently, a robust interest in scoliosis surgery without using fusion has many doctors interested in its treatment success. This new procedure refers to Anterior Scoliosis Correction (ASC).

ASC refers to a surgical procedure that corrects scoliosis. Scoliosis can cause pain, difficulty with mobility, and other problems. The ASC procedure involves making an incision in the front of the patient’s chest and using screws and rods to realign the spine and correct the curvature. Our surgeons only recommend this procedure for patients with severe scoliosis who have not been able to find relief with other treatments, such as physical therapy or bracing. The complex and invasive procedure requires extensive training by specialized surgeons with vast experience in this type of surgery. We have that experience at the Southwest Scoliosis and Spine Institute.

The History of Using a Tether to Correct Scoliosis

The Anterior Scoliosis Correction (ASC) procedure began with the development of spinal growth surgical concepts in the early 2000s. These initial efforts were vertebral body stapling (VBS) procedures that were used for children to stop spinal curves from getting worse. The results were encouraging as many patients had positive outcomes during periods of remaining growth, but the treatment was stopped because of the following reasons:

• A limited time period for patients to benefit from the procedure
• The procedure did not stabilize spinal curves during the remaining growth periods of a child
• There were over-correction complications

Vertebral Body Tethering (VBT) Surgery for Scoliosis

Slowly, the concept of using a single cord/tether to “tie” all of the curve segments together to correct scoliosis was explored and the concept started again in 2011. This treatment focused primarily on the thoracic spine to provide a more definite and predictable post-surgical outcome during the remaining growth of the child. This concept also allowed surgeons to begin treating patients with double curves (“S” shaped scoliosis curves) with non-fusion scoliosis surgery procedures. Surgeons began seeing excellent results and the Vertebral Body Tethering Treatment began getting rave results.

Doctors and surgeons also use Vertebral Body Tethering (VBT) as a surgical procedure to correct scoliosis. However, unlike ASC, which involves removing and replacing vertebral bodies, VBT involves attaching a flexible tether (a type of device) to the spine. The tether constitutes a flexible material and surgeons use it to slowly and gently straighten the spine over time.

The Federal Food & Drug Association (FDA) approved “The Tether – Vertebral Body Tethering System” by Zimmer-Biomet in 2019. This became the first FDA-approved humanitarian device in spinal pediatrics in over a decade.

ASC & VBT Difference

The surgical approach provides the primary difference between Anterior Scoliosis Correction procedures (ASC) and Vertebral Body Tethering (VBT) procedures. The hardware and tether material look virtually identical. Surgeons use ASC for correcting scoliosis in late adolescents and adults, while VBT prioritizes children who continue to grow.

The Anterior Scoliosis Correction (ASC) procedure approaches the spine from the front side of the body. During the procedure, the surgeon may remove some of the vertebral bodies (the bones of the spine) and replace them with artificial ones made of bone graft or metal, or they may use screws or rods to hold the spine in its correct position.

In general, ASC and VBT are both used to treat scoliosis in children and adolescents, but they are used in different situations. Surgeons use ASC for more severe cases of scoliosis, while surgeons use VBT for mild to moderate cases. Both procedures effectively correct scoliosis, but they provide different risks and benefits, and the best treatment option for a particular patient will depend on their specific needs and circumstances.

Anterior Scoliosis Correction (ASC)

To make non-fusion scoliosis surgery available to a larger group of patients, new and innovative surgical techniques allow patients with little or no growth remaining and/or rigid spinal curves an opportunity for the ASC procedure. This can include skeletally maturing, skeletally mature, and adults with scoliosis. The procedures of VBT or ASC do not need FDA approval. The implant device that the company markets needs that approval.

Considering ASC

As doctors and surgeons, we believe that Surgical procedures of any kind should take place after all nonsurgical scoliosis treatments prove unsuccessful.  Furthermore, fusion-less scoliosis surgery for adults should take place as an alternative to scoliosis fusion surgery. Other surgeons in the medical community consider our surgeons to be among the very, very best and refer patients to us.

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

Approval for ASC or VBT

Adolescents

The FDA guideline for VBT in adolescent patients requires that the patient has less than a 30-degree curve at the curve’s apex.  This requirement provides a pre-requisite for going forward with an ASC. This new procedure contributes significantly to maximizing outcomes for skeletally mature patients with scoliosis who undergo the Anterior Scoliosis Correction (ASC) procedure.

Adults

Doctors have made significant progress in the treatment of scoliosis during the last century. Bracing, on the other hand, has probably been around for a little longer. Recent advancements, including spinal fusion and tethering, have shown great effectiveness. Furthermore, we now have even more intriguing alternatives for reversing scoliosis, such as ASC. That said, this type of treatment does not replace the presently available treatment methods. Instead, ASC provides adult patients with extra options when the circumstances allow for such a procedure. When we need medical help, we want choices, and that’s exactly what we get from contemporary medicine.

ASC entails the use of screws and a tether, which appears as a rope-like device. The screws get placed on the convex side of the aberrant curvature by the surgeon performing the procedure. The surgeon next weaves the cable between the vertebrae on both sides. Your doctor will pull the tether taut after its positioned — correcting the spinal deformity immediately.

Advantages of Anterior Scoliosis Correction (ASC)

Although doctors regard ASC as a viable option for spinal fusion, what makes it so? Any surgical technique has its own set of pros and cons, and spinal fusion and ASC do as well. However, because both treatments use minimally invasive procedures and they have many of the same benefits. However, the risks associated with spinal fusion become avoidable with ASC. The following outline the best reasons to use an ASC for an adult with scoliosis:

• Complication rates remain lower than with spinal fusion.
• Compared to typical methods, less bleeding takes place.
• Compared to more intrusive operations, this procedure causes less scarring and a shorter recovery period.
• Better than spinal fusion for preserving spinal mobility.
• Surgical success rates remain higher than other procedures.
• Prevents (and even corrects) future curve growth.
• Better Cosmetic Results.
• More precise correction.
• Improved spinal stability.
• Faster recovery.
• Lower risk of infection.

Because everyone does not qualify for Anterior Scoliosis Correction, a complex surgical procedure, our doctors will answer any and all questions and explain the pros and cons of each procedure. The potential advantages and disadvantages of ASC should be carefully weighed by the patient and their surgeon before deciding on the best course of treatment.

Acceptable Requirements for an Anterior Scoliosis Correction (ASC):

Of course, doctors need lots of health information to decide on the best course of treatment.  Regarding the nature of the patient’s scoliosis, our doctors will require several prerequisites. To begin, an adult’s scoliosis should have a curvature of 35 to 60 degrees. Second, as opposed to congenital or injury-induced scoliosis, the patient must possess idiopathic scoliosis. If the patient meets all of the requisite criteria, the doctor, in the best interests of the patient, may prefer a spinal fusion; even though the ASC procedure appears to have a huge potential as a treatment, and the evidence speaks for itself.

How Does Anterior Scoliosis Correction Work for Treating Scoliosis?

To fix a faulty scoliosis pattern of development in the anterior upper spine, we use this less intrusive procedure.  A rod-cord (white polyethylene-terephthalate flexible cord) gets fastened to each of the bone screws in the vertebral bodies of the spine; titanium pedicle screws get inserted on the convexity (outside) of the vertebrae that cause scoliosis. When the implants get tightened, the spine straightened. The damaged curve(s) improves immediately after surgery.

When should someone make an Appointment?

Neuromuscular disorders such as muscular dystrophy or cerebral palsy can also cause Scoliosis, and therefore, children and adults with those diseases should be continually monitored. Having stated that, ASC can greatly help individuals with idiopathic scoliosis (no known cause) as well.

If you or your child has scoliosis and want to further discuss the options to avoid or stop the pain, we invite you to give us a call and make an appointment to speak to one of our Scoliosis Doctors. Our Medical Practice at Southwest Scoliosis and Spine Institute with offices in Dallas, Plano, and Frisco, Texas has top-rated specialists with the experience and knowledge necessary to offer patients the best possible treatment for Scoliosis. Additionally, we welcome new patients and invite you to make an appointment.

____________________

Institute for Spine and Scoliosis: Anterior Scoliosis Correction
Boston Children’s Hospital: Anterior Scoliosis Correction
Cincinnati Children’s Hospital: Anterior Scoliosis Correction
Pediatric Spine Foundation: Anterior Scoliosis Correction