Dr. Darryl Antonacci, Anterior Scoliosis Correction (ASC) Non-Fusion Surgery, by Dr. Derek Lee
Вставка
- Опубліковано 6 сер 2024
- This interview is for educational purposes and covers information provided by Dr. Darryl Antonacci 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:
0:00 Introduction
00:15 Career path to spine surgeon.
1:12 Assembling the 'ABC' team - Dr. Antonacci, Dr. Betz, Dr. Cuddihy.
3:09 Evolution of Anterior Scoliosis Correction (ASC)
3:34 Anterior fusion: 2007-2008.
4:49 Development of VBT: 2012-2013.
6:01 Thoracoscopic approach for VBT is limited to 60 degree curves and 30 degree correction.
6:33 VBT parameters were initially defined by thoracoscopic access.
7:20 ASC mini-open approach gave access to bigger curves and greater correction past 30 degrees (2003-2004).
8:10 530+ cases of ASC to date. 45% percent of cases are over 60 degrees.
8:35 Importance of de-rotation of the curve to produce greater corrections.
9:12 Curve de-rotation with VBT is difficult because ribs are in the way. ASC allows for de-rotation because the ribs are out of the way. Therefore greater corrections are possible.
10:12 VBT limited to 30 degree correction.
11:10 ASC quickly became a corrective procedure.
11:46 Importance of anterior longitudinal ligament release in ASC.
12:33 ASC allows for reduction of hypokyphosis when ALL is released.
13:39 ASC innovation was driven by the expansion of parameters to help more mature curves.
15:17 Oldest ASC patient is 53 years old.
15:35 ASC combines principles of bone remodeling and tissue laxity.
16:28 Target curve correction for both growing and mature teenagers.
17:32 Staged surgeries for 90+ degree curves.
17:59 VBT vs ASC revisions.
20:34 Location of thoracic and lumbar mini-open access points.
21:22 Disc release.
22:46 Released discs re-heal.
23:51 Perspective on controversy surrounding disc release.
25:36 Post ASC, curves stabilize within 1-2 months.
26:12 Mature spine ASC data.
26:40 Comparison of de-rotation with VBT, ASC and fusion.
26:53 Comparison of curve correction with VBT, ASC and fusion.
27:26 Adult ASC curve stability and cord rupture.
28:59 ASC revision rate.
29:47 Data on disc release and disc health long term.
30:37 Why aren't more surgeons performing ASC?
33:25 Perspective on new cords.
34:28 Perspective on use of double cords for de-rotation.
36:31 Limitations of VBT.
36:56 VBT doesn't address thoracic hypokyphosis and resulting cervical kyphosis.
37:45 Candidates for VBT vs ASC.
39:04 Mechanism that frees up spine flexibility?
40:00 ASC milestones.
40:50 Flexibility comparison between metal rod fusion vs ASC.
41:48 Cases: Thoracic ASC.
43:05 Cases: ASC for extreme curves.
43:36 Is there less cord breakage due to less tension with ASC?
44:24 ASC revision rate is about 3% for all cases. Large number of cord breaks do not require revision since spine rebalances and stabilizes.
46:17 Perspective on hybrid fusions and cords.
47:39 Perspective on selective lumbar fusion with cord.
48:11 Case: Lumbar ASC.
49:11 Cases: Extreme curves, revision, over-correction.
50:23 Future of ASC.
drdereklee.com
/ 1198200727630801
This interview is for educational purposes and covers information provided by Dr. Darryl Antonacci 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:
0:00 Introduction
00:15 Career path to spine surgeon.
1:12 Assembling the 'ABC' team - Dr. Antonacci, Dr. Betz, Dr. Cuddihy.
3:09 Evolution of Anterior Scoliosis Correction (ASC)
3:34 Anterior fusion: 2007-2008.
4:49 Development of VBT: 2012-2013.
6:01 Thoracoscopic approach for VBT is limited to 60 degree curves and 30 degree correction.
6:33 VBT parameters were initially defined by thoracoscopic access.
7:20 ASC mini-open approach gave access to bigger curves and greater correction past 30 degrees (2003-2004).
8:10 530+ cases of ASC to date. 45% percent of cases are over 60 degrees.
8:35 Importance of de-rotation of the curve to produce greater corrections.
9:12 Curve de-rotation with VBT is difficult because ribs are in the way. ASC allows for de-rotation because the ribs are out of the way. Therefore greater corrections are possible.
10:12 VBT limited to 30 degree correction.
11:10 ASC quickly became a corrective procedure.
11:46 Importance of anterior longitudinal ligament release in ASC.
12:33 ASC allows for reduction of hypokyphosis when ALL is released.
13:39 ASC innovation was driven by the expansion of parameters to help more mature curves.
15:17 Oldest ASC patient is 53 years old.
15:35 ASC combines principles of bone remodeling and tissue laxity.
16:28 Target curve correction for both growing and mature teenagers.
17:32 Staged surgeries for 90+ degree curves.
17:59 VBT vs ASC revisions.
20:34 Location of thoracic and lumbar mini-open access points.
21:22 Disc release.
22:46 Released discs re-heal.
23:51 Perspective on controversy surrounding disc release.
25:36 Post ASC, curves stabilize within 1-2 months.
26:12 Mature spine ASC data.
26:40 Comparison of de-rotation with VBT, ASC and fusion.
26:53 Comparison of curve correction with VBT, ASC and fusion.
27:26 Adult ASC curve stability and cord rupture.
28:59 ASC revision rate.
29:47 Data on disc release and disc health long term.
30:37 Why aren't more surgeons performing ASC?
33:25 Perspective on new cords.
34:28 Perspective on use of double cords for de-rotation.
36:31 Limitations of VBT.
36:56 VBT doesn't address thoracic hypokyphosis and resulting cervical kyphosis.
37:45 Candidates for VBT vs ASC.
39:04 Mechanism that frees up spine flexibility?
40:00 ASC milestones.
40:50 Flexibility comparison between metal rod fusion vs ASC.
41:48 Cases: Thoracic ASC.
43:05 Cases: ASC for extreme curves.
43:36 Is there less cord breakage due to less tension with ASC?
44:24 ASC revision rate is about 3% for all cases. Large number of cord breaks do not require revision since spine rebalances and stabilizes.
46:17 Perspective on hybrid fusions and cords.
47:39 Perspective on selective lumbar fusion with cord.
48:11 Case: Lumbar ASC.
49:11 Cases: Extreme curves, revision, over-correction.
50:23 Future of ASC.
drdereklee.com
Facebook VBT/ASC/Tethering Support Groups:
Canada: facebook.com/groups/60224...
USA: facebook.com/groups/Scoli...
UK: facebook.com/groups/12878...
I just found this interview. This is wonderful to understand the process more. I am setting up my consultation with Dr. A here soon as I am in contact with his staff. Thank God there is an answer for the pain I’ve endured for decades. Just amazing work!
My daughter had ASC with Dr Antonacci in Sept 2020. The correction was even better than they predicted. She recovered quickly.
Drs ABC and the St Peters hospital and staff were outstanding. Do not committ to VBT or Fusion before you speak to ABC. Dr A is at the top of his game. Very thankful of these fine people.
Hi Kevin, thank you for your review would it be possible that I could have a discussion with you? My daughter also has a scoliosis and it would be very helpful to have a discussion. Hope this review finds you much appreciate it. Allan
I just want to say well done. You do so well not to get flustered and upset or defensive when discussing these topics. You always ask level-headed questions and seek to gain more knowledge without judgement or presupposed positions from other the discussions you have had. I truly admire how you handle and interact with these interviews and applaud you for sharing your work.
I have been learning a lot and appreciate it very much! Keep it up!
Thanks for your kind words!
From the beginning, it was my intention to have the surgeons speak for themselves and for parents/patients to decide for themselves which path to pursue.
That’s amazing and such a great interview you asked all the right question!!
Thank you! My daughter has surgery scheduled with Dr Antonacci in Dec. This was very informative!
I'm glad the interview was useful. :)
@suzannekelly, goodmorning, can you tell me please how it is going with the surgery?
@@elleelle5939 I.like to.know too
Hi Suzanne, hope it’s all well with you and your daughter..would you mind updating us on your daughter’s surgery?
I was really looking forward to your discussion with him. Thank you for this!
Hopefully the interview gave you some relevant information. Happy to share!
thankyou. its so informative
That's my goal. 🙂
I want to have this surgery, but it's saddening that there are no doctors performing it in my country, South Korea. When might South Korea see the emergence of alternative options to spinal fusion surgery?
Hello Dr. Lee What is the likelihood that an insurance will cover the ASC procedure? How long is the average time frame after contacting Dr’s ABC before the due date for surgery? Im very interested in the surgery as a 27 year old male my condition has deteriorated sadly within the last couple of months to where im in severe pain every day and my quality of life has significantly dropped.
Once again Dr. Lee thank you very much for the wonderful interview giving us sufferers of Scoliosis some hope. Dr. Antonacci and the rest of the team at ABC are visionaries who are changing the world of scoliosis surgery. Thank you thank you thank you!
That's a difficult question to answer. Insurance coverage in the US is a challenge to navigate. I suggest you follow directly with ABC. I'm sure they get asked that question everyday.
Im planning on going ahead with the surgery and before out of pocket is $150,000 and after insurance it is $70,000. That is not including all of the hospital and anesthesiologist finances. To book the surgery it is not super booked since its so expensive, but in the summer there is a longer wait time. Hope everything goes well, as i have chronic pain too.
I have been looking for this type of surgery for my son for a long time and he is now 25, brace/exercises did not help. I cannot find this type of surgery here in Canada and wonder how much it would cost, this would be a blessing as he is constantly asking where he can go for this.
Very few surgeons worldwide use this approach and none in Canada. I believe cost is around $200K USD in this case.
If you'd like to chat with Dr. Antonacci, you are welcome to join my Facebook group where he and other surgeons can comment. :)
facebook.com/groups/1198200727630801/
can this surgery correct hyperkyphosis due to wedged vertebrae?
Unfortunately not. This surgery is also contraindicated for kyphotic curves greater than 50 degrees.
i am from egypt and i want to have this surgery for my doughter, how can i connect him
Through his website: spineandscoliosis.com/
Hi Dr. Lee. In rewatching this video I was curious to watch the presentation that Dr. Antonacci mentioned from the Eurospine conference "Non-fusion Anterior Scoliosis Correction for mature AIS patients". I was able to find it but not to watch it given a paywall. As a physician, were you able to watch the video yourself? If so, how does the longer term data look for adults?
Here you go. :)
esmed.org/MRA/mra/article/view/2632
@@DerekLee Amazing! Thank you. Those are excellent results. ASC really looks to be the future for scoliosis correction.
@@keineangstable still too early to tell. I suspect that a new stronger will be the next step in the evolution of VBT/ASC.
@@DerekLee Do you believe a stronger tether would mitigate the need for disc release? That's the biggest question for me about ASC at the moment.
@@elizabethhogan5272 for ASC of stiff curves, a stronger tether wouldn't make a difference because disc release is to increase spine flexibility. Spine flexibility is what determines the magnitude of the correction.
You can ask Dr.A's opinion in my Facebook group.
Does the lung need to be deflated for lumbar only ASC?
It depends on how high up the lumbar curve travels. The higher the level, the more likely a lung deflation.
@@DerekLee ok thank you. Mine is the entire lumbar
What criteria do you use to recommend surgery?
Typically when Cobb angles are 50+ degrees.
can this surgery help with congentital scoliosis
If there are structural issues with the vertebrae then unfortunately no.
Ma per quelli interessati come me
non c’è la possibilità di traduzione?!
Grazie
Proverò a pubblicare i sottotitoli in italiano ma devi farmi sapere se la traduzione è buona.
E pecato Che non hai imparato inglese a scuola..e lingua impotante in tutto mondo...prova a studiare..non sei tardi...sono ghanese ma ho imparato italiano..so che non e facile..se vuoi, posso auitati gratis.
Can asc be done in adults
Yes but depends on the amount of degeneration present in the spine.
Does this work on adult males?
ASC is performed on both males and females.
what is a "staged surgery"? its more than one surgery?
For VERY severe curves, I believe a first surgery aims for maybe 50% correction. Then a 2nd surgery to max correction.