Dr. Mike Selby, Anterior Scoliosis Correction (ASC) Non-Fusion Surgery, by Dr. Derek Lee

This interview is for educational purposes and covers information provided by Dr. Mike Selby regarding his opinions on Anterior Scoliosis Correction (ASC) 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
00:00 Introduction
0:20 Training in pediatric and adult spine scoliosis surgery.
2:49 First exposure to Vertebral Body Tethering (VBT).
3:27 Anterior spinal surgery training in Australia is a natural transition to VBT/ASC.
4:30 Anterior Scoliosis Correction (ASC) training with Dr. Betz & Dr. Antonacci.
5:34 Preferred approach to anterior scoliosis surgery for VBT/ASC. Thoracoscopic versus mini-open approach.
7:31 Why does a mini-open anterior approach allow for greater spine de-rotation?
8:13 Long term complications from lung deflation with VBT/ASC.
10:07 Type of instrumentation used for VBT/ASC.
10:43 What was the motivation to learn VBT/ASC? Early lumbar fusion complications.
13:15 Case Study 1: 17 year old female, AIS, ligamentous laxity, lumbar fusion. Follow up at 2 years, complications at 5 years post fusion.
16:43 Complications following lumbar fusion surgical treatment of AIS.
17:48 Case Study 2: 30 year old female, 15 years post lumbar fusion. Thoracic implants removed, severe low back pain.
18:21 Back pain and outcomes of pregnancy after spinal fusion for AIS. Fusion to L3 and especially L4 levels can lead to back pain.
18:54 Lumbar fusion cases have led to considering ASC to preserve motion.
19:04 Case Study 3: Peripheral Neuromodulation for severe chronic low back pain.
20:30 Good Long term outcomes of anterior fusion surgery for thoracolumbar/lumbar AIS. Fusions typically ended at L2 and L3 vertebrae.
21:56 Case Study 4: 16 year old male, thoracolumbar scoliosis. Marfan's Syndrome (hypermobility).
23:13 Solid fusion in Marfan's patients may lead to PJK/DJK complications. Proximal Junctional Kyphosis (PJK), Distal Junctional Kyphosis (DJK).
23:54 Minimally Invasive Technique for Vertebral Body Tethering (VBT).
25:16 Complications with transpsoas approach for lumbar screws.
27:33 What vertebral levels can be accessed via lumbar anterior approach?
28:47 Video of minimally invasive surgical technique.
30:46 What's the lowest lumbar vertebrae that can be tethered?
31:35 Tether tensioning and disc alignment with VBT/ASC.
32:09 Tether technology.
33:27 Perspective on mature spine tethering (ASC). Double tethers.
34:03 Perspective on lumbar disc release for ASC.
35:02 ASC and thoracic disc release.
35:29 Perspective on thoracic vs lumbar disc release.
35:52 Thoracic disc autofusion and osteophyte formation is common in adults.
36:38 Definition of disc release for ASC.
38:25 ASC and nucleus of the disc.
39:03 Perspective on kyphosis with ASC.
40:28 Case Study 5: double lumbar tethers for a primary thoracic curve, AIS.
41:55 Does disc degeneration disqualify a patient from ASC?
42:19 ASC may be an option for an older patient where disc degeneration is at the base of the spine.
42:25 With scoliosis, discs degenerate faster at curve apex and at base of the spine, specifically at L4-5 and L5-S1 discs due to shear forces.
43:56 ASC parameters for immature & mature spines.
44:43 Spine flexibility parameters for tethering. Traction under general anesthetic x-ray.
45:44 Age limit for ASC patients?
46:07 Number of ASC surgeries performed.
47:00 Do VBT & ASC have potentially the best treatment outcomes for scoliotic lumbar spines?
47:18 Thoracic VBT/ASC versus thoracic fusion.
48:31 Would more surgeons use ASC for mature spines if a tether was longer lasting? Does a tether need to last forever?
55:38 VBT/ASC and kyphosis.
54:50 Kyphoscoliosis.
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