This interview is for educational purposes and covers information provided by Dr. Suken Shah, MD, regarding his opinions on treatment consensus, VBT, and selective thoracic fusion for adolescent idiopathic scoliosis. This video is not an endorsement. Viewers should consult their physicians and treating team accordingly.
See highlights via timestamps below.
Chapters
0:00 Introduction.
1:32 AIS Treatment Consensus?
1:52 Etiology of Scoliosis.
2:57 Predicting scoliosis curve progression.
4:52 Indications for AIS management.
6:13 BrAIST Study: Bracing works.
8:17 Who to brace and when to brace?
10:59 Bracing options in 2022.
11:15 What about Schroth?
12:04 What happens when a curve progresses?
12:15 Goals of Surgery.
13:09 New AIS Classification to Guide Spine Surgery.
14:28 Assumptions with surgical classification system.
15:00 Selecting Fusion Levels.
17:17 Case Study: AIS treatment options.
17:54 Pre-operative studies.
18:34 Bending X-rays.
18:43 Lenke Classification.
20:15 Surgical fusion plan.
20:52 Ponte Osteotomies
21:47 Differential rod contouring.
22:45 Steps to surgery.
24:11 Concept: Selective Thoracic Fusion.
24:35 Criteria: Selective Thoracic Fusion
25:36 Ideal Selective Thoracic Fusion Radiographs.
26:19 Can we avoid doing a fusion? What is missing?
26:15 The Goal: Avoid Fusion.
27:11 Anterior Surgical Approaches.
27:24 Vertebral Body Tethering (VBT).
30:32 Current indications for VBT.
30:45 Too Much Growth: Overcorrection.
31:11 Success & Failures of VBT: What is the data indicating?
34:48 Today's Techniques for Treatment of Pediatric & Adolescent Spinal Deformity.
36:45 Will a stronger tether widen VBT parameters?
39:03 VBT: Single vs Double Tethers.
41:24 VBT and Disc Health.
43:21 How much spine flexibility is required for VBT?
44:29 The importance of shared decision making between patient, parents and surgeon.
45:39 Disc release and VBT.
46:53 Patient flexibility as a criteria in fusion vs VBT.
47:41 Hybrid VBT with Apical Fusion.
49:15 Dr. Suken Shah's Surgical Pain Management Protocol.
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