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.

How Do I Know If I Or My Child Has Scoliosis?

Scoliosis, a condition where the spine curves sideways, can often go unnoticed. Many individuals have mild cases and show no symptoms, not experiencing any pain or discomfort. This can pose challenges, especially in children, as their curves might only become apparent over time.

Signs to Watch For

If you spot any of the following signs, consult your primary care physician:

• Uneven shoulders or waist
• One hip higher than the other
• Prominent ribcage on one side
• Tilting of the body to one side

Causes and Risk Factors

Most scoliosis cases are idiopathic, meaning the exact cause is unknown. However, certain conditions are linked to the development of scoliosis:

• Trauma or infections to the spine
• Congenital conditions present at birth
• Neuromuscular disorders such as muscular dystrophy or cerebral palsy

Risk Factors

While scoliosis affects both genders equally, studies indicate that females are more likely to experience curve progression. Additionally, scoliosis often runs in families. Rapid growth spurts in children can also be a trigger for signs and symptoms to emerge.

Being aware of these details can help you take proactive steps. Early detection and consultation with a healthcare professional are key to managing scoliosis effectively.

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 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

Additionally, VBT is an anterior technique for treating scoliosis but relies on the effects of natural spinal growth because it provides only partial correction. A tether is used to hold the spine around 25-30 degrees. This form of spine straightening surgery is only performed on patients with small curves (65° or below), flexible curves, and incomplete spinal growth.

Unfortunately, it is a very limited procedure applying to only about 10% of scoliosis patients, but even this group has reported revision rates between 15 and 30%. It has also been demonstrated that VBT provides very limited de-rotation of the scoliosis, meaning it is essentially a limited 2D correction. The limitation of the correction leads to high revision rates for the surgery.

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.

ASC(Anterior Scoliosis Correction) provides a flexible approach to correcting scoliosis by avoiding the rigidity of spinal fusion. Unlike traditional methods, ASC offers the benefit of maintaining spinal flexibility, which is crucial for a better quality of life post-surgery. This flexibility allows for a broader range of motion and can be particularly advantageous for those who are actively involved in physical activities.

By targeting specific spinal curves and using a less invasive approach, ASC minimizes recovery time and maximizes the potential for a more natural spinal function post-correction. This makes ASC a revolutionary option for those seeking an alternative to fusion surgeries, which often result in limited mobility.

Key Benefits of ASC:

• Flexibility: Maintains a greater range of motion compared to traditional fusion techniques.
• Broad Applicability: Suitable for skeletally maturing, skeletally mature, and adult patients.
• Innovative Techniques: Uses advanced methods to correct rigid spinal curves effectively.
• Reduced Recovery Time: A less invasive approach results in quicker recovery periods.

In summary, ASC not only broadens the scope of who can receive scoliosis correction but also enhances the patient’s postoperative quality of life by preserving spinal flexibility. This innovative approach represents a significant advancement in the field of scoliosis treatment.

What If I Am Told My Child’s Curves Are Too Big or Too Stiff?

If you are concerned that your child’s scoliosis curves are too big or too stiff, it’s important to know that advancements in surgical techniques have broadened the scope of treatment options. Even patients with less flexible or larger curves can now be considered for procedures like Vertebral Body Tethering (VBT) or Anterior Scoliosis Correction (ASC).

The procedures of VBT or ASC do not need FDA approval. The implant device that the company markets needs that approval. This means that while the surgical techniques themselves are well-established, the tools used in these procedures have undergone rigorous evaluation to ensure safety and efficacy.

By addressing the specific challenges posed by large or stiff curves, these innovative surgical options provide new hope for patients who might have previously been considered unsuitable for non-fusion scoliosis surgery.  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 it is positioned — correcting the spinal deformity immediately.

Advantages of Anterior Scoliosis Correction (ASC)

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, they share many of the same benefits. 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.

Additionally, ASC offers specific benefits particularly relevant for treating children’s scoliosis:

• Lower Rates of Complication: ASC has been shown to have lower complication rates compared to spinal fusion, making it a safer option for children.
• Less Bleeding: The minimally invasive nature of ASC results in less bleeding during the procedure, which is crucial for the overall safety of child patients.
• Less Scarring and Faster Recovery: Children recover faster and with less scarring compared to more invasive surgeries, allowing them to return to their normal activities sooner.
• Preserve Spinal Mobility: ASC preserves spinal mobility better than spinal fusion, which is especially important for growing children.
• Higher Rates of Surgical Success: ASC has demonstrated higher rates of surgical success compared to other growth modulation techniques, ensuring better outcomes for children.
• Prevents Further Progression: Not only does ASC prevent further progression of the scoliosis curve, but it can also correct existing curvature, providing a more comprehensive treatment.

Incorporating these benefits, ASC emerges as a superior choice for both adults and children suffering from scoliosis. The tailored advantages for children make it an especially compelling option for parents seeking the best possible outcome for their child’s spinal health. Because everyone does not qualify for Anterior Scoliosis Correction, a complex surgical procedure, our doctors will answer any 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.

Why Adult Scoliosis Correction Isn’t Suitable for Adults Over 55 with Advanced Spinal Degeneration

Advanced spinal degeneration in individuals over the age of 55 presents unique challenges. Here’s why Adult Spinal Correction (ASC) surgery might not be the best option:

Complexity of Degeneration: As people age, the spine undergoes significant wear and tear. In those over 55, this often leads to complex spinal degeneration, making less invasive surgical options like ASC less effective.

Bone Quality: Older adults generally have decreased bone density. This can pose risks during surgery and complicate recovery. The structural integrity needed for ASC may simply not be there.

High Surgical Risks: The risks associated with surgery increase with age. ASC procedures require precise adjustments that can be complicated by the fragile condition of an older spine.

Comprehensive Management: Advanced cases often benefit more from comprehensive treatment plans. These plans typically include pain management, physical therapy, and possibly more invasive surgery, rather than ASC alone.

Longer Recovery Time: Recovery from any spinal surgery can be longer in older adults. Given the intensive nature of ASC, the recovery period may not be feasible for those with advanced degeneration.

In summary, while ASC offers benefits, it’s crucial to weigh these against the specific conditions and needs of adults over 55 with advanced spinal degeneration.

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.

Why Consider Advanced Spinal Surgery?

Understanding if advanced spinal surgery for scoliosis is right for you involves several key considerations. The surgeons specializing in scoliosis correction are among the most qualified and experienced in the world. They have successfully treated countless cases in both children and adults, employing innovative techniques designed for optimal outcomes.

Innovative Techniques and Success Stories

One notable technique is anterior scoliosis correction (ASC), which has shown promising results. Surgeons utilizing this method have documented significant improvements in patients, which can be seen in before and after-surgery photos. These visual testimonials provide a clear representation of the procedure’s effectiveness.

Personalized Review and Assessment

For those considering this surgery, a personalized review of your case by a leading specialist is available. This ensures that your unique situation is evaluated comprehensively, helping to determine if you are a suitable candidate for ASC. This thorough assessment can provide the reassurance you need to make an informed decision.

Next Steps

To explore if advanced spinal surgery for scoliosis is the right path for you, reach out for an individual evaluation. This step is crucial in understanding the best treatment options tailored to your specific condition.

Contact us today to get started on your journey to a better quality of life.

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 straightens. 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.

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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