Malaysia First Vertebral Body Tethering Surgery For Scoliosis – 马来西亚首宗 Vertebral Body Tethering (VBT) 手术
On November 30, 2024, Alty Orthopaedic Hospital in Kuala Lumpur successfully performed Malaysia’s first-ever non-fusion Vertebral Body Tethering Surgery for Scoliosis. VBT is a minimally invasive surgery. In this article, we will guide you through a detailed understanding of VBT.
2024 年 11 月 30 日，吉隆坡 Alty 骨科医院成功完成马来西亚有史以来的第一宗脊柱侧弯非融合 VBT 微创手术。这篇我们带领大家仔细理解 VBT。
WHAT IS NON-FUSION VBT MINIMALLY INVASIVE SURGERY
Non-fusion VBT (Vertebral Body Tethering) is a new minimally invasive surgical technique for treating Adolescent Idiopathic Scoliosis (AIS). Unlike traditional spinal fusion surgery, it preserves the spinal mobility of children and adolescents post-surgery while correcting the curvature of the spine.
什么是非融合 VBT 微创手术？
脊柱侧弯非融合 VBT（Vertebral Body Tethering，椎体钉索内固定）是一种用于治疗青少年特发性脊柱侧弯（Adolescent Idiopathic Scoliosis, AIS）的新型微创手术方法，与传统的脊柱融合手术不同，它能保留了孩子/青少年术后脊柱的运动能力，同时矫正脊柱的弯曲幅度。
Benefit of Non-fusion VBT Surgery:
- Minimally invasive: The surgery is performed through a small incision, reducing damage to muscles and tissues, thus shortening the recovery time post-surgery.
- Non-fusion technique: Unlike traditional spinal fusion surgery, which requires fixing the spine as a solid structure, VBT uses a tethering system that corrects the scoliosis while preserving spinal flexibility.
- Growth modulation: This technique takes advantage of the fact that a teenager’s spine is still growing. Tension is applied to one side of the spine, utilizing growth modulation principles to achieve natural correction.
非融合VBT手术的特点
- 微创手术：通过小切口进行手术，减少了对肌肉和组织的损伤，达到缩短术后恢复时间。
- 非融合技术：相比传统的脊柱融合手术需将脊柱固定成一个整体，VBT 使用钉索固定系统，在矫正侧弯的同时，保留脊柱的灵活性。
- 生长调控：这项技术利用了青少年脊柱仍在生长的特点，在脊柱的一侧施加张力，通过生长调控原理实现自然矫正。
SURGICAL PRINCIPLE:
- During the surgery, the surgeon will use thoracoscopic technology to attach screws to the convex side of the spinal vertebrae.
- A flexible “cord” (usually made of polymer material) is then tightened between these screws.
- This tension restricts the growth of the convex side while allowing the concave side to continue growing, gradually correcting the scoliosis.
手术原理
- 手术中，医生会通过胸腔镜技术将螺钉固定到脊柱侧弯的凸侧（Convex Side）椎体上。
- 然后在这些螺钉之间拉紧一根柔性“绳索”（通常是高分子材料制成）。
- 这种张力会限制凸侧的生长，同时允许凹侧（Concave Side）继续生长，从而逐渐矫正侧弯。
WHO SHOULD ADOPT THIS TREATMENT
- Adolescent Idiopathic Scoliosis: Especially suitable for patients with remaining growth potential, i.e., adolescents whose bones have not fully matured.
- Curvature angle: Generally recommended for patients with a Cobb angle between 35° and 65°.
- Not suitable for patients with severe scoliosis or those whose growth has already stopped.
适用人群
- 青少年特发性脊柱侧弯：特别适用于尚有生长潜力的患者 i.e. 骨骼尚未完全成熟的青少年。
- 弯曲角度：一般适用于 Cobb 角在 35° 至 65°之间的患者。
- 不适合脊柱侧弯过于严重或已经停止生长的患者。
VBT MINIMALLY INVASIVE SURGERY BENEFIT
- Preservation of spinal flexibility: Compared to traditional fusion surgery, patients can retain spinal mobility after the procedure, allowing for more activities such as bending, twisting, and other movements. (In traditional fusion surgery, the fused segments of the spine lose their independent motion. The degree of limitation depends on the number and range of fused segments. For example, if the fusion covers a large area from the thoracic to lumbar spine, movements like bending and twisting will be significantly restricted post-surgery.)
- Improvement in appearance: In addition to correcting the scoliosis, this surgery can improve body symmetry.
- Fewer postoperative complications: It reduces the long-term complications that may occur after fusion surgery, such as adjacent segment degeneration.
VBT 微创术优点
- 保留脊柱灵活性：相比传统融合手术，患者术后可以保留脊椎灵活度，从而进行更多的运动，如弯腰、左右扭转等。（传统融合术后，被固定的脊柱节段将失去独立运动能力。具体限制程度取决于融合节段的数量和范围。例如，如果患者接受的是从胸椎到腰椎的大范围融合，术后弯腰、扭转等动作将受到显著影响。）
- 外观改善：在矫正侧弯的同时，可以改善体型对称性。
- 较少的术后并发症：减少了融合术后可能发生的长期并发症，如邻近节段退变。
RISK MANAGEMENT
- Postoperative recurrence: The surgery may not fully correct the scoliosis, or the curvature may recur after correction. Regular follow-up helps detect issues early and allows for appropriate intervention.
- Hardware issues: The tethering system may loosen or break, requiring a corrective surgery.
- Strict indications: Not all scoliosis patients are suitable for this surgery; it should be evaluated by a doctor based on the individual’s specific condition.
风险管理
- 术后复发：手术可能无法完全矫正侧弯，或矫正后侧弯可能再次出现。定期随访有助于及早发现问题，并采取适当的干预措施。
- 硬件问题：钉索可能会松动或断裂，需要进行修复手术。
- 严格适应症：并非所有侧弯患者都适合这种手术，需由医生根据具体情况评估。
Postoperative recovery:
- The recovery time is relatively short, and most patients can resume daily activities ranges within a few weeks to a few months.
- Regular follow-up visits are necessary to assess the correction results and the condition of the hardware.
术后恢复
- 恢复时间较短，通常几周到几个月内可以恢复日常活动。
- 需要定期复查以评估矫正效果和硬件的状态。
Summary:
Non-fusion VBT surgery offers an innovative treatment option for adolescent scoliosis patients, preserving their mobility. However, it is not suitable for all patients. A detailed evaluation under the guidance of a spinal specialist is recommended to select the most appropriate treatment plan. Make an appointment to access your condition.
总结
非融合 VBT 手术为青少年脊柱侧弯患者提供了一种保留运动能力的创新治疗选择，但并非适合所有患者。建议在脊柱侧弯专科医生的指导下进行详细评估，选择最适合自己的治疗方案。点击预约。
APPENDICES 附录
Potential cause of tethering system loosening:
- Bone insufficiency:
The tethering system needs to be securely fixed to the vertebrae. If the patient has low bone density (such as osteoporosis or underdeveloped bones), the screws may not be firmly fixed, leading to loosening. - Dynamic changes due to growth:
VBT surgery relies on the growth of the adolescent spine for correction, but as growth and body shape change, the fixation points may gradually lose stability. - Suboptimal fixation during surgery:
If the screws are not properly implanted or their position is unstable during the surgery, it may increase the risk of loosening. - External impact or excessive activity:
Intense physical activity or external trauma can cause loosening of the tethering system, especially during the early postoperative rehabilitation period.
钉索可能松动的原因
- 骨质不足：
- 钉索系统需要固定在椎体上，如果患者骨质密度低（如骨质疏松或骨发育不全），螺钉可能无法牢固固定，导致松动。
- 生长导致的动态变化：
- VBT 手术依赖于青少年脊柱的生长进行矫正，但随着生长和体型的变化，固定点可能会逐渐失去稳定性。
- 术中固定不理想：
- 如果术中螺钉未正确植入或位置不稳定，可能增加松动的风险。
- 外部冲击或过度活动：
- 剧烈运动或外部创伤可能导致钉索系统松动，特别是在术后康复早期。
POSSIBLE CAUSE OF BREAKAGE
- Wear and Tear:
The tethering system is typically made from high-strength materials (such as titanium alloy or polymer), but prolonged exposure to dynamic tension can lead to material fatigue, which may cause it to break. - Failure of growth modulation:
If the corrective force applied to the scoliosis exceeds the design limits of the tethering system, it may result in a fracture. - Mechanical wear:
As the spine moves, the tethering system may experience friction with surrounding tissues or other hardware. Over time, this wear and tear can lead to breakage.
钉索可能断裂的原因
- 材料疲劳：
- 钉索通常由高强度材料（如钛合金或高分子聚合物）制成，但长期承受动态拉力可能会导致材料疲劳，进而断裂。
- 生长调控失败：
- 如果侧弯的矫正力超过了钉索的设计承受范围，可能导致其断裂。
- 机械磨损：
- 随着脊柱的活动，钉索系统可能与周围组织或其他硬件发生摩擦，长期磨损可能导致断裂。
CASE STUDY 案列：
If you need a consultation, please visit the appointment page to schedule a meeting with Dr. Lee Chee Kean.
如需咨询，请前往预约页面与李志坚医生安排面谈。