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

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.

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