Dr Stuart Weinstein, MD, The Natural History of Scoliosis and the BrAIST study, by Dr. Derek Lee
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- Опубліковано 15 жов 2022
- This interview is for educational purposes and covers information provided by Dr. Stuart Weinstein, MD, regarding his opinions on the natural history of scoliosis plus insights into his BrAISTS scoliosis bracing study 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:
0:51 Evolution of the Iowa Scoliosis Natural History Studies.
2:17 Tacking of an untreated scoliosis group started in 1976.
3:29 The secret to sustaining a 50+ year natural history study.
3:53 Why knowing the natural history of a disease is important.
4:17 Early views on the natural history of scoliosis were disastrous and incorrect.
5:55 How many patients are still participating in the long term natural history study?
6:11 Most of the scoliosis participants had normal lives.
6:58 Were the results of the study surprising?
7:52 Medical myths are often difficult to reverse.
8:50 Natural History of scoliosis curve progression.
10:54 Curves that are under 30 degrees at skeletal maturity will probably not get worse.
11:12 50+ degree curves at skeletal maturity, especially in the thoracic region, have a high probability of getting worse.
11:58 For curves between 30 and 50 degrees at skeletal maturity, monitor for change.
12:38 Natural history of scoliosis in immature patients.
13:49 Significant growth remaining and immaturity are higher risk factors for curve progression.
15:13 When is the right time to have surgery for mature scoliosis spines?
16:38 It is a misconception that someone has to have surgery.
18:15 Surgical indications for adult scoliosis.
19:47 Most patients in the natural history study wanted to have treatment choices when young.
20:14 Many patients were not happy with their appearance.
21:53 Perspective on fusion surgery vs natural history of scoliosis.
23:12 Today's scoliosis surgery offers better corrections & shorter segment fusion in a safe surgical environment.
25:57 Indications for surgery for AIS: 50+ degree curve in skeletally immature patient.
28:25 Parameters for scoliosis bracing.
30:08 BrAIST Study provided level 1 evidence that bracing works for scoliosis.
31:01 Bracing indications are for curves over 20 and under 40 degrees in skeletally immature children.
32:38 BrAIST study was for full time bracing at 14-16 hours/day.
33:38 Physiotherapy Scoliosis Specific Exercises - Schroth.
34:57 Bracing curves above 40 degrees.
36:22 Is there a preferred brace type?
39:04 Future of scoliosis bracing.
40:13 Thoracic curves have a higher probability of progression.
42:38 Other scoliosis natural history and post bracing studies.
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This interview is for educational purposes and covers information provided by Dr. Stephanie Da Paz regarding her opinions on Lateral Disc Release and Hybrid VBT with Apical Fusion Scoliosis Surgery. This video is not an endorsement. Viewers should consult their physicians and treating team accordingly. See highlights via timestamps below.
Chapters
0:00 Introduction.
0:43 Evolution of Hybrid VBT with Apical Fusion.
1:23 Hybrid VBT with Apical Fusion technique.
2:49 Case Study: Hybrid VBT with Apical Fusion.
4:34 Determining spine flexibility on bending x-rays.
5:06 Discectomy with Apical Fusion.
5:41 Preparation of the disc space for fusion.
7:19 How long does it take for the apical segment to fuse?
7:52 Why not bone on bone apical fusion?
8:53 First Hybrid VBT with Apical Fusion at 1 year.
9:15 Is there less tether tension with apical fusion?
9:55 Hybrid VBT with Apical Fusion for lumbar curves only.
10:13 Stability of the apical fusion device.
12:27 Maturity Parameters for Hybrid VBT with Apical Fusion.
13:03 More details on evolution of Hybrid VBT with Apical Fusion.
15:28 Intraoperative video of Lateral Disc Release with VBT.
18:42 Tether tensioning post lateral disc release.
20:04 Why 2 types of screws with double tethers?
21:30 Anterior screws of 2nd tether is tensioned 50%.
22:16 Is tensioning the tether altered by the apical fusion?
22:55 Disc release controversy.
23:56 Why are lumbar disc release more problematic than thoracic disc releases?
24:21 New tether technology?
25:35 Hybrid VBT with apical fusion is not for everyone.
26:24 Non-fusion scoliosis surgery is dependent on spine flexibility. VBT cannot give you spine flexibility if the spine is already stiff.
27:58 Can disc release improve spine flexibility?
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I’m a 64 year old with scoliosis (I didn’t know until my 50’s that I had the condition)
Tried spinal injections, PT and all the tests. Neurosurgeon has been my last stop.
Pinched nerve, numbness in my feet, sciatica.
At this point, a local neurosurgeon says that I have two options for surgery. Fusion of L4 to L5 or fusion from T12 to L4.
I’ve not scheduled surgery because I’m not ready.
I’m thinking of going back to conservative care..
I’m at 27 degrees.
Thank you for this wonderful video.
Feel free to join my private Facebook group. I have expert surgeons and physical therapist who can answer questions. 🙂. facebook.com/groups/1198200727630801/?ref=share
Thank you both for taking the time for this interview and allowing the information to be shared to the general public. I have learned so much in the one month that my son has been diagnosed and that would not have been possible without true experts reporting their scientific evidence-based findings. Parents are often stuck with the emotional weight of making the “right decision”, which is difficult especially since I have seen 4 different experts for my son’s new diagnosis and all 4 provided different approaches:
1) wait and see
2) night time bracing
3) night time plus soft day brace
4) bracing 20 hours
Without information like this interview being available I would have a very difficult time deciding.
Thanks again.
Thanks for the kind words! That was my whole motivation for doing these interviews. Happy you are finding them informative.
Also, feel free to join my Facebook group.
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Very interesting as always! First time I understand a bit more about the higher progression risk for Thoracic curves, at least in theory. I'm not sure it is what I see in my practice though... At least with the many women over 50 I see my impression is that many of them come from around 30/35 degrees and find themselves back at a 50 degree curve because of disc degeneration and a rapid progression. What's your impression Derek? What is very interesting as well is the gentle way dr Weinstein is guiding patients towards their decision. In my experience very often the pressure to have surgery is higher. So I like this shared decision making! Thanks again Derek!!
Hi Truus! I also thought it counter intuitive that thoracic curves would progress the most compared to lumbar curves. But, the research I've looked at does seem to indicate that thoracic discs and vertebrae are more rotationally unstable, and the facet alignment does seem to make thoracic rotation easier compared to the lumbar facets.
Regarding your clinical observations, are you talking about lumbar curves degenerating quickly vs thoracic curves?
He has a wonderful approach to guiding patients. His patients are lucky to have him.
In my opinion, for parents to effectively advocate for their kids or for adults to advocate for themselves, they have to do 2 things.
Educate themselves to find a treatment consensus they are comfortable with. And then, find a surgeon/practitioner to create a team where shared decision making is for the benefit of the patient.
@@DerekLee Hi Derek, I think the progression I see in the Lumbar curves is indeed following a more rapid disc degeneration. In the younger population the Thoracic and Thoracolumbar cuves progress more than the Lumbar ones so that perfectly makes sense. Especially the ones with a lot of rotation seem to be more progressive and even more if the kids are very flexible...
I'm turning 60 had Herrington rod surgery when I was 12.2 children and breast later, I am now having issues 😢and I don't know what to do
Hi Dr. Lee! I immensely appreciate your channel and your work. In this video you mentioned that curves under 30 degrees generally don't get worse after skeletal maturity is reached. But what about 30 degrees curves? I have an S shape scoliosis and my thoracic curve is 30 degree while my lumbar curve is 27 degrees and I am a 21 years old male. I've been physically active my whole life, I've been in competitive swimming till I was 18 and now I go to the gym to keep my muscles strong and give support to the spine. I very rarely have back pain.
Am I in a limbo regarding the future of my spine? (in terms of worsening of the curves)
Thank you a lot
Feel free to post your question in my private Facebook group where spine surgeons are members.
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Your curve is similar to my 21 yr old son, we to have questions and concerns of his curve worsening too. It's great you stay active.
Hello, I have a 33 degree thoracolumbar curve at risser 5 skeletal maturity, I'm really worried whether or not I should have surgery now or just later cause it's a gamble between having to do surgery with less complications now or having to do it when I'm older where there's more likelihood of complications arising...
Most surgeons won't consider surgery until your curve is 50+ degrees.
What do you do when a doctor doesn’t think your curvature has anything to do with your pain.? I went to a chiropractor prior to ever having these issues now.. please - thoughts?
Find another doctor. Opinions vary with different doctors.
The degree doesn’t always tell the story of the pain the person is in- no one thinks a moderate curves cause issues? Please help
Of course mild and moderate curves can cause pain. Why wouldn't it?
Also, feel free to join my Facebook group where scoliosis surgeons, physios and orthotists are expert members.
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