Dr. Caglar Yilgor MD, Integrating VBT, Bracing and Scoliosis Specific Exercises, by Dr. Derek Lee

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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