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This interview is for educational purposes and covers information provided by Dr. Caglar Yilgor regarding his opinions on Vertebral Body Tethering (VBT) Non-Fusion Scoliosis Surgery. This video is not an endorsement. Viewers should consult their physicians and treating team accordingly. See highlights via timestamps below.
Chapters:
1:06 How do you determine which scoliosis cases are appropriate for VBT?
2:37 VBT patient selection strategy based on remaining growth, Sanders 1-7.
6:48 Optimal parameters for VBT.
9:15 Role of spine flexibility in VBT.
10:52 How much spine flexibility is required for best VBT outcomes?
13:18 Case 1: Sanders 1 VBT.
15:41 Case 2: Sanders 2 VBT.
17:52 Case 3: Sanders 3 VBT.
19:40 Case 4: Sanders 4 VBT.
22:56 For more mature spines, how long does the tether have to stay intact to hold the curve correction?
23:43 Case 5: Sanders 7 VBT.
24:22 Schroth exercises post VBT.
25:40 Pre and Post Op Scoliosis Specific Exercises.
26:34 The importance of having comprehensive scoliosis treatment at one facility for all ages.
29:58 Case 6: 82 degree curve VBT.
32:34 VBT above Sanders 7 maturity level.
34:18 Disc and joint health post VBT.
39:16 Complications following VBT surgery.
41:24 First VBT case outside USA - 8 year follow up.
42:41 Any difference between thoracic and lumbar disc health with VBT?
43:29 Disc autofusion with VBT.
45:07 Case: VBT with disc release leading to autofusion.
46:25 Natural disc autofusion vs disc release autofusion.
47:59 Origin of pain associated with disc autofusion.
49:22 No disc release performed at Dr. Yilgor's spine center.
50:57 Is a pre-surgery degenerated disc still a candidate for VBT with or without disc release?
52:29 The goal of VBT curve corrections is not perfection.
54:12 The effectiveness of VBT is constantly evolving.
56:31 Anterior approach to VBT & long term lung health.
57:19 Lung Health: Anterior surgical approach in VBT vs posterior approach in spinal fusion.
58:10 Why VBT surgery should be minimally invasive thoracoscopic.
59:22 No difference between mini, midi or maxi open incision approach on lung health.
1:00:18 Retroperitoneal incision for thoracolumbar and lumbar VBT.
1:00:49 Published 2 studies on pulmonary function post VBT.
1:00:57 Study 1: Pulmonary function post VBT, anterior & posterior spinal fusion at 2 year follow up.
1:04:47 Any incision + rib retraction has the largest effect on decrease in pulmonary function.
1:06:58 Does reduction in pulmonary function recover eventually?
1:07:38 Location of the VBT surgery may affect pulmonary function.
1:09:41 Study 1 Conclusion: Pulmonary function depends on technique, approach and location.
1:10:23 Study 2: Pulmonary function changes with thoracic, thoracolumbar and double curve VBT.
1:12:24 Study 3 (to be published): Pulmonary function long term follow up 4-5 years.
1:13:09 Pulmonary function continues to improve for thoracic VBT from 1-5 years. Pulmonary function for thoracolumbar and double-curve VBT stay the same.
1:14:05 Why does pulmonary function improve with thoracic VBT?
1:16:16 Effect of VBT on sagittal alignment.
1:18:22 How has your experience with VBT affected how you treat scoliosis patients?
1:18:46 Theories on how scoliosis progresses.
1:19:45 Mechanical Theory & Scoliosis: Spinal Loading & Growth.
1:21:00 VBT and bone growth modulation.
1:21:58 Growth Modulation with conservative treatment: Bracing & Scoliosis Specific Exercises.
1:22:58 Scoliosis occurs in 3 planes.
1:24:19 Can bracing impact growth modulation?
1:25:10 Case Study: Scoliosis bracing in the sagittal plane.
1:27:23 Case Study: Bracing in an 8 year old.
1:28:32 Case Study: Double Bracing a thoracolumbar scoliosis.
1:29:05 Case Study: Lumbar brace with thoracic VBT.
1:29:48 Integrating bracing, exercise and VBT to treat scoliosis.
1:30:47 Bracing thoracic hypokyphosis (flatback).
1:33:01 Treating stiff thoracic hypokyphotic curves.
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