Institute for Spine and Scoliosis

07/24/2025

𝗔𝗽𝗽𝗿𝗼𝘅𝗶𝗺𝗮𝘁𝗲𝗹𝘆 𝗵𝗼𝘄 𝗹𝗼𝗻𝗴 𝗶𝘀 𝘁𝗵𝗲 𝗵𝗲𝗮𝗹𝗶𝗻𝗴 𝗽𝗿𝗼𝗰𝗲𝘀𝘀?

Depends on your age group. But if you're under 21, pretty much everyone who has ASC surgery, we start to release them to activity at six weeks. For the first six weeks, we just want them walking around.

So in the hospital for five days, they're not feeling so great for the next two weeks. So around three weeks, four weeks is where they start to turn the corner. They start to feel a little bit better.

They're starting to walk several blocks and doing a lot more. And then if you're 15 years old, by six weeks, our data is that at around two months, 70% of our patients are going back to sports. And now that's in the younger age group.

If you're 40 years old, that's not happening. It may be another couple of weeks. But at six weeks, we release you to the, we get an x-ray, check if everything's okay.

And if it is, then we start you on a Pilates program to start toning your core. And if you're a competitive athlete, usually it takes another month and a half or two months to get back to full sport. Sometimes the competitive athletes, I really do mean the track athletes or the hurdlers or the sprinters, they'll tell you they feel a little shorter wind for the first three months.

And then around three to four months, their wind's coming back. But they start training and doing Pilates at the six to eight week period. They're really toning up their core over the next several weeks.

And that's pretty much a general process. If you're 40 years old, you can tack on an extra month or two. And, you know, but if you're 15, 16, 20, you're gonna rebound fairly quickly on average.

07/22/2025

𝗔𝗻𝘆 𝘁𝗶𝗽𝘀 𝗼𝗻 𝗿𝗲𝗰𝗼𝘃𝗲𝗿𝘆 𝗮𝗻𝗱 𝗽𝗿𝗼𝗰𝗲𝘀𝘀?

“Yes, the more fit you are before surgery, the better off you'll be after surgery. Whether you're 14 or 15, you know, if you have these athletes that are playing hockey or soccer, this or that, they have really tight hamstrings, they have their scoliosis. And if they're loose with their hamstrings before surgery, then at six weeks or when we start the Pilates and the toning and the recovery, they're looser then and they can rebound quicker.

So with the scoliosis curves, they are rotated, but that means the pelvis goes with the curves, the hamstrings get tighter on one side more than the other and keeps feeding that curve. And so they come into surgery tight. We loosen things up, we make the corrections, but they're still going to fight that tightness.

So hamstring muscles are really important, psoas muscles are really important for being stretched out. And then also because this is a dynamic correction, you can have a posture like me sitting like this or you can have a posture like this a year and a half after surgery. What's the difference? Pilates and tone and thoracic muscle strength.

So swimming in a pool with breaststroke and your thoracic extensor stronger is really important. So loose hamstrings, loose psoas muscles, strong thoracic muscles to hold posture and you're optimizing your outcome.”

07/21/2025

𝗖𝗮𝗻 𝗿𝗲𝗹𝗲𝗮𝘀𝗲𝗱 𝗱𝗶𝘀𝗰𝘀 𝗯𝗲 𝗿𝗲𝗹𝗲𝗮𝘀𝗲𝗱 𝗯𝘆 𝗮𝗿𝘁𝗶𝗳𝗶𝗰𝗶𝗮𝗹 𝗼𝗻𝗲𝘀?

“And the answer to that is yes. So that's right. So that's a great concept, which is a future concept in the sense that if you have a metal rod surgery for a fusion from 5 to 12 or a thoracic or down to L2, 3, 4, thoracolumbar, lumbar, or double curve, you've just obliterated the disc completely.

And this is where the logic breaks down of people who try to resist the concept of the release. The alternative here is you either can have a metal rod fusion that's destroyed the disc on purpose and never be able to do anything with it, or do the ASC, where our data is now really showing that several years after the surgery the discs are doing fine, and they don't have pain on average. It doesn't mean this is going to be for everybody.

And so the reason this question is really important is because what happens if a disc does go bad? Right, you have an 18-wheel truck and one of the tires does blow out and become painful, right? So if you fuse like in this the girl I just showed from top to bottom you have 18 releases, but one disc three years later starts to become painful. Well, first you have to diagnose that. And the issue here is most of the time when people develop some pain, it's not related to the disc.

I have yet to truly see a disc-related pain source. There's a couple patients, even of mine, that I did the ASC and three or four years later, they started getting pain. They came to see me and it was not from their disc.

They had some facet pain like this girl. They had a break and you could actually diagnose the pain along the breaks. But they also went to see someone else and then they ended up with full Monte fusion from top to bottom, which was ridiculous because here the question would be, can you just replace the one disc that's painful? The answer is yes.

That's the future. You can replace just the one disc. It's still functional to the point where you can remove it and put in a functional disc replacement.

So that's a great question because that is where we are. That is where we're going to in the future is just to more target as opposed to shotgun effect of other issues that come back, come up.”

07/18/2025

Q&A With Dr. A…

“𝗪𝗵𝗮𝘁 𝗶𝘀 𝘁𝗵𝗲 𝗹𝗼𝗻𝗴-𝘁𝗲𝗿𝗺 𝗶𝗺𝗽𝗮𝗰𝘁 𝗼𝗳 𝗱𝗶𝘀𝗰 𝗿𝗲𝗹𝗲𝗮𝘀𝗲 𝗶𝗻 𝘁𝗵𝗲 𝗹𝘂𝗺𝗯𝗮𝗿 𝘀𝗽𝗶𝗻𝗲?”

“Well, that's a great question, and what we've found out over the last 12 years and now documented is that for at least five years or so, our impact on the discs in the lumbar spine with the releases is minimal. And while there's a lot of resistance to what we do, it's really a misunderstanding of what we do. But let me share the screen for a minute because this will be pretty obvious once I show some data.

Yeah, there we go. So let me just, this is a thoracic curve, but let's jump down to the lumbar data. But let me take one step back because the release is how did we get here, right? So if I go up to this slide, now this is a very busy slide, but this goes back to, we went back over 700 of our surgeries that I did from 2014 to 22, and we ended up grouping them into the early cases where I did, here's 20 of those, 19 in this group, 13 in this group, 25 in this group.

These are basically different time frames over the last 12 years, but the early cases were no releases, but they were still an open transthoracic surgery compared to the endoscopic VBT technique. I started with the first stage of what I did was to modify it to an open. So my results were still better than the VBT results endoscopically because I was doing the opens, but in that category of patients, that's no releases with a single screw line.

Then we did single screw line with less than three levels of releases. Then we did double screw lines with less than three releases, double screw lines with more than four releases, and like our most modern technique. This is applying to thoracic curves, but this next slide is going to be the lumbars.

And what you can clearly see over our history of the 12 years is dramatic improvements in terms of what? Well, the original surgeries of VBT was just like your reported VBT result, except a little bit better because we did the open technique and we could get better corrections. But our pre-op curves went down to about 23 to 28 degrees at final follow-up of about 75 months, so you know, five plus years of follow-up. But the revisions were slightly higher.

We had three to three out of 20, four to 20. Then as you increase the number of releases here, single screw line with less than three releases, all of a sudden we're going down a little bit on our revisions, we're going up a little bit on our success rates, now starting to break away from the original VBT results, which are still there today. The VBT results are about 50 to 60 percent success rates.

Then we migrated into the dual screw lines with less than three releases in the thoracic spine, and clearly you start to see a big drop or improvement in the correction. So from an average of 24 to 28 degrees, now we're between 16 and 21 degrees. And you start adding more than four releases with the two screw lines in the last, you know, less since 2020 on, 2020-19 on.

And we dramatically improve our correction rates down to 9 degrees to 17 degrees, 17 being the overall curve, 9 being the instrumented curve. And what you really dramatically see is a drop-off in revision rates and increase up to 96 percent success rates. Now that's a preliminary study of the different categories, but we followed that up this past year and just submitted this data, I presented it.

And we took 322 consecutive cases, we went for the thoracic curves 40 to 70 degrees, so we had 150 cases, we had 127 percent that we couldn't include more than two-year follow-ups, that's 85 percent follow-up. And we broke them down into less than three and over six releases. And what you can clearly see is even though the less than three did fairly well, 91 percent success of keeping them under 30 degrees, they had a high breakage rate, 55 percent.

The impact of the breakages did not translate into a higher revision rate, I believe that's because of my open technique. But once we went to over six releases, the data is overwhelmingly better. 96 percent success rate of getting every curve under 30 degrees, only 7 percent, there was only one case out of the 46 basically that increased above 30 degrees and did not require a revision anyway because it was balanced.

And then the pain scores that go along with that. So everyone's concerned, are you creating pain? Well, our pain scores keep showing the same general trend, which is the pain before a surgery on average is higher than the pain after the surgery. And this is at almost three years after surgery.

So that's the thoracic data. And then going to your question about, or the question about the lumbar, lumbar is even more striking. So what we were able to do was since prior to 2021, I was releasing all the thoracics but not releasing the lumbars.

I have a group and I went back and I pulled up 34 of them that had no releases in the lumbar spine. So basically they were getting open VBT in the lumbar. I don't like to call it VBT even in the lumbar because it was an open technique with the dual screw lines, whereas the endoscopic technique, a lateral approach of standard VBT, but basically the principle, no releases.

To 47 patients who had all releases in the lumbar spine. So the average number of releases was four and a half or so in the lumbar spine. Results are divergent.

You know, there's only 73% success rate and the patients had no releases, meaning I corrected them. And then over the next two years, they broke their cords and they rebounded. So they may have been, if you can look at the degree of improvement, the first standing x-ray is very similar, you know, a little bit better with the more releases could you get more D rotation.

So five to six degrees, six to 11 degrees in the ones with no releases. So pretty decent. But by 48 months, four years later, three years later, you broke your cords and you rebounded up to 23 to 27 degrees.

So still for the vast majority considered successful 25 out of 34 because it stayed below 30 degrees. But that's different than being neutral. It rebounds to 30.

In the groups that had the releases, it stays where we put them. So I got them down to eight to 11 degrees. I'm sorry, five to six degrees.

They're between eight and 11 degrees at three years after the surgery. The number of breakages, dramatically less. You're going to expect the cords to break.

And that's the whole concept of the release, which is that I don't count on the release to hold the curve correction. We're counting on the healing of the spine after the release of the contractures to reheal, which it does, and then hold it as opposed to the cord. So even if the cords break, they don't have a big impact.

So here 70% of the cords broke, eight out of 47 patients could find a slight increase in their curves, but not a big enough increase to do a revision. And so the revision rate in the unreleased lumbar curves was up to 21%. And the revision rate is one or two and a half percent or so out of the curves that were in this group.

And when we go back and fine tune that analysis, what's the most striking thing is that the breaks occur at the unreleased levels. So if you look here, all the, you know, obviously no releases in the lumbar group, they all occurred at released levels. In this group where the cord breakage occurred, it occurred at an unreleased level.

And so there were no breaks at release levels. And our data is so robust, not just this study, but the other ones we're coming out with, which I can break it down into, I released just the upper lumbar, and then I started to release more of the lumbar. And we can see that where I released in the upper lumbar holds, but then the lower lumbars that were not released break and rebound.

And they don't rebound as far because they're being held by the upper. But that's the big difference here is between the full release versus the no release lumbar. And that's quite significant data.

So here's an example, you know, get away from the data part. This case, she had no releases in the lumbar spine. So here on first standing, you can see a perfect correction.

Four years later, she broke a little bit, still not high enough for revision. It's under, you know, 17 degrees, not, you're not going to revise, it looks great. But she did break and she did rebound a little bit.

And then we have the bends now that we're going to be coming out with show that there's actually movement, even in the thoracic release levels and the lumbar release levels. And so I think that answered that as well. I think we can move on to the next question.”

07/17/2025

As part of our ASC Family, we invite our group members to Sumit questions for Dr. A to answer during our Bi-Weekly Webinars.

“𝗔𝗿𝗲 𝗰𝗲𝗿𝘁𝗮𝗶𝗻 𝘁𝘆𝗽𝗲𝘀 𝗼𝗳 𝗰𝘂𝗿𝘃𝗲𝘀 𝗲𝗮𝘀𝗶𝗲𝗿 𝘁𝗼 𝘁𝗿𝗲𝗮𝘁 𝗼𝗿 𝗵𝗮𝘃𝗲 𝗮 𝗯𝗲𝘁𝘁𝗲𝗿 𝗽𝗿𝗼𝗴𝗻𝗼𝘀𝗶𝘀 𝘁𝗵𝗮𝗻 𝗼𝘁𝗵𝗲𝗿𝘀?”

“And so the answer clearly to that is yes. And the most significant factor is stiffness. So the very simple way of looking at scoliosis for the way we correct it with ASC is simply in terms of basically three types of curves.

Your thoracic curve alone, thoracic curve that extends down into the lumbar curve, or lumbar curve alone. So a one-sided type curve for either thoracic or lumbar. And then a double.

And the doubles are your S's. And the S's can be low or high, but they're basically an S. And as I've talked about in a lot of videos, they're not angulations like this. They're actually rotations.

And the scoliosis origin is the fact that as you're growing, the surface ligaments stay tight and contracted and force the spine to spin around it so it can continue to grow. And that's where I think a little bit of the misunderstanding comes along in terms of what's the optimal way to correct it. Well, the optimal way to correct it then is a three-dimensional correction, right? It's not just a tilt.

And then it's what technique is strongest at doing that. And I think over the last 12 years, we've developed a technique that is more powerful than by far VBT, which is the original technique. And that's actually now outpacing metal rods in terms of that three-dimensional correction by avoiding the downside of the junctional failures that come with metal rods or the long-term pain that comes with metal rods.

But getting back to the question of do certain curves have a better prognosis or easier to treat, it all comes from the origin, which is that contracture. So if you have a 90-degree curve or 70-degree curve or 50-degree curve, but it's very flexible, it really doesn't matter how big the curve is because it can be a 90-degree curve that bends down to 15 or 20. That's an easy curve to correct.

But if you have a 50-degree curve that only bends to 45, that's a tough curve to correct because it's so stiff. And it then comes down to how you can loosen it in order to get it corrected. And obviously, if you have a very flexible curve to begin with, there's not a lot that has to be done to loosen it.

It's already very loose, and we can loosen it a little bit more with the releases and taking the scar contractures out. And that allows it to get to that final correction. So the most important predictor of outcome is really the preoperative bend.

And we do get bend x-rays before the surgery to see how flexible they are. But the looser it is to begin with, the easier it is to treat and the better curve correction you'll get because it's also an indicator of the adjacent curves. So if you have a stiff middle curve and we're only treating the middle curve, those other curves are going to be reasonably stiff too and have limited ability to balance what we correct it to.

So the looser it is, the better it is, whether it's thoracic or lumbar or double. And then you can say, well, in terms of treatment categories, like under age 21 or under age 40. So those are categories where if you're under age 21, everyone bounces back easily from those kinds of surgeries.

Not everyone, I shouldn't say everyone, but it's a lot easier for a 15-year-old to bounce back than a 35-year-old. And so there are going to be some age restrictions going along there as well. So if you're under 21, that's the main group of patients.

21 to 40, another very successful group. You start getting above 50 and you're dealing with really stiff adult scoliosis, which is much more difficult, whether it's a metal rod or ASC to correct. And then I would just go back to the point of ASC's risk profile is much safer than metal rods from our data.

And so if you're a 45-year-old having a metal rod, you have significant higher risk than the 48-year-old having ASC, but it's the risk profiles related to age often. So anyway, I think I addressed that.”

06/25/2025

Woo Hoo! Drs. ABC have reached a 𝗪𝗢𝗥𝗟𝗗 𝗥𝗘𝗖𝗢𝗥𝗗 of 1000 Anterior Scoliosis Correction (ASC) patients they have treated for scoliosis. More than any other scoliosis team anywhere! And you know that is a LOT of curves, twists, and corrections.

Write your comments and congrats below!

06/25/2025

Shae did not let scoliosis stop her from pursuing her dreams and desires for an active life. Scoliosis can be treated without fusion and metal rods.

If you have scoliosis and are told you need surgery, please visit our website and provide your case information with X-rays and medical history > http://bit.ly/DrAntonacci-Case-Review

Dr Antonacci and his team will personally review the information you provide to determine if you qualify for ASC by Drs ABC.

06/24/2025

With her busy life, not everyone is as exceptionally active as Shae Smith; recently crowned Miss Missouri 2025! From dance and zip lining to cheerleading and owning the runway, Shae is an amazing person. We are honored to be part of her scoliosis journey.

(video transcript below)

“All right, so tell us a little bit about your story too because this directly connects to your platform. What's been your greatest challenge with scoliosis and tell us a little bit about your story.

Yeah, so dating back to when I found out that I had scoliosis at the age of 15, I underwent anterior scoliosis correction surgery at a 63 degree curve. So my spine quite literally looks like an S shape. And so today, I'm excited to even be able to stand here and walk in heels and do a pageant and dance. So that's been the biggest struggle for me so far. And I know that many adolescents are going through the same thing.

Well, talk to us about your story. How did you get into this?

Because we were talking on the commercial break and your mom actually carried you on to your first pageant. So talk to us about that.
Exactly. Yes, I couldn't even walk yet when I had my very first appearance on a pageant stage. So it's kind of led me to where I am today. And I'm so thankful for pageants like the Miss USA organization that have allowed me to have the speaking skills that I do today, allowed me to share my story with so many people.
So yeah, I'm very thankful for the Miss USA organization for getting me here and being able to speak.

Yeah, you've had incredible success too because we talked about it. I mean, sometimes there are people that go years and years and years in the pageants, I guess, industry and try and win this title.

You got runner up the first time and then you won your second time doing it. But what advice would you give to others facing similar challenges going back to sort of your struggles with scoliosis?

Yeah, I would say to stay true to yourself. I know that when I was braced before I had surgery, and even during the recovery process for surgery, I was very hard on myself.

I was wearing baggy clothes because I didn't want people to see my scars. I didn't want people to see my brace. So I would say to stay true to yourself and know that you're not alone throughout this journey.

All right, well, you touched on it a little bit, but how has the Miss USA system really impacted your life? Because you did touch on, you're able to speak and you're able to do these things. But what are some other factors that’s really impacted you with it?

So I feel like there's a lot of stereotypes that go into pageantry. It's a lot deeper than just the crown and banner.

And I'm really excited to have this title and opportunity to be able to share my message about scoliosis. So now I get to go to Miss USA and put scoliosis on a national platform, whereas before it can kind of get swept under the rug.

Oh, absolutely. How excited are you for the Miss USA pageant?

I'm so excited. As I was telling you guys, this has always been the end goal for me. It's every girl's dream to be able to go to Miss USA.

And so I'm really excited to be able to see footage of it right now. I can't even imagine that moment for you.

Oh my gosh, it was surreal for sure.

Was it like an out of body experience too? And it was like your name called, putting on the crown?

A little bit. It's like you envision it, you dream about it. You're like, how would I react whenever the time comes, but you can't really plan for it.
So as you can see, I did not plan for that.

I would be frozen in that. Well, quickly tell us what's next for you. What do you hope to accomplish even more so in your future with this?

Yes. So we are currently awaiting a date for the Miss USA pageant and location. So I'll be excited to share that when the time comes and when it's announced.

But as of right now with my title, it's on scoliosis awareness. So I get to visit children's hospitals where I can read a book that I authored myself to children in the hospital. So I'm excited to do that today.

Actually, after I leave this interview.

Where can people follow along if they want to follow along on your journey throughout all this?
Yeah. So you can follow me on my Facebook, which I believe is down below, but also on Instagram at shae.smith as well.

Awesome. Well, thank you so, so much for being here.

Thank you for having me.”

Miss Missouri USA 2025 Shae Smith joins Shane and Kerrigan to chat about how she is using her platform to spread awareness during Scoliosis Awareness Month.

06/02/2025

𝗡𝗮𝘁𝗶𝗼𝗻𝗮𝗹 𝗦𝗰𝗼𝗹𝗶𝗼𝘀𝗶𝘀 𝗔𝘄𝗮𝗿𝗲𝗻𝗲𝘀𝘀 𝗠𝗼𝗻𝘁𝗵: Empowering Patients and Families with Knowledge and Hope!

June is National Scoliosis Awareness Month, a vital time dedicated to educating the public about scoliosis, promoting early detection, and highlighting the advancements in treatment that are changing lives. It's important to know your options when it comes to scoliosis treatment. Metal Rod fusion is not the only choice. ASC is 100% Muscle-Sparing, with no metal rods and no fusion. Want to learn more? (click the image below)

Founders and Pioneers of ASC: Anterior Scoliosis Correction

03/21/2025

𝐑𝐞𝐚𝐝 𝐃𝐫 𝐀𝐧𝐭𝐨𝐧𝐚𝐜𝐜𝐢'𝐬 𝐋𝐚𝐭𝐞𝐬𝐭 𝐁𝐥𝐨𝐠 𝐏𝐨𝐬𝐭: In the 1990’s when metal rod bone fusion of the spine became erroneously common place to treat “low back pain” by spine surgeons using “abnormal” findings of disc desiccation, disc dehydration, disc degeneration, herniated disks, arthrosis and stenosis documented on so-called “abnormal” MRIs, Dr. Scott D. Boden's published a groundbreaking study. His research significantly altered the understanding of spinal imaging in ASYMPTOMATIC individuals and began a multi-year clarification of the understanding that disc change (desiccation, degeneration etc.) is a natural and commonplace change in the spine.

https://bit.ly/ASC-vs-Metal-Fusion

In the 1990’s when metal rod bone fusion of the spine became erroneously common place to treat “low back pain” by spine surgeons using “abnormal” findings of disc desiccation, disc dehydration, disc degeneration, herniated disks, arthrosis and stenosis documented on so-called “abnormal.....

02/18/2025

Metal Rod Fusion VS ASC by Drs ABC - Part 2

(0:04 - 0:33)
“So, after all the case studies I've gone through, I thought it was worth showing this slide again with the motion of comparison between metal rod and the ASC technique. Because you've seen several cases of the ASC technique, you know the motion. But when you go back and you see what happens with the metal rod, it's hard to swallow to see what is currently still being done through the vast majority of the world is the metal rod fusion technique.

(0:34 - 0:52)
And as I've said multiple times, the metal rod fusion technique destroys your back muscles as you can clearly see. Limits your motion to a pivot, not an arching motion. And for wherever the metal rod is from top to bottom, you're rigid and fused and every single disk space is destroyed in between.

(0:53 - 1:14)
This then puts tremendous amount of stress on the lower portion of your spine. And then over the next 15 to 20 years, well, well documented that up to 25 or 30% of people develop breakdown of the disks below it because it has so much stress for those years. And then you need to extend the metal rod fusion even further down.

(1:14 - 1:40)
So the question one of the, you know, what happens to the disk, I think we pretty clearly have shown that in the slides above. And the technique of metal rod fusion surgery has not essentially changed at all since 1999. It's essentially the same principle of technique, different screws, different companies and things like that, but the same technique.

(1:41 - 1:49)
So then you can start to question like, well, why hasn't anyone else started doing this? And I'll try to answer that in the next slide.”

02/14/2025

Evolution of ASC by Drs ABC

“This is one of my favorite slides because it's apropos to the entire scoliosis world, but also our practice and where we evolved over the last 12 years. But you have to understand that the vast majority of the world does metal rod surgery, and they've done it for decades, has not changed, as I've mentioned, since about 1999. Then in the 2013-14 time period, even myself in this practice went through a phase of starting with VBT in 2013, which had significant limitations.

We started evolving the ASC technique early this way, and then there was even a phase in 2013-14 where we had really severe thoracic curves, so I had to do a metal rod there and then do the ASC technique in the lumbar spine at that time. We did about a half a dozen dozen, and what happens over time is the lumbar curve tends to recur, and then you have a rigid junction between the top and the bottom. It doesn't even look nice on an x-ray, but it did have advantages over the metal rod top to bottom, but not anything in comparison to our current version of ASC.

But I took these steps, and this was my growth process, my educational process. We started in 2013. I've been doing this for 12 years.

At that time in 2013, I had already been in practice about 12 or 13 years as an adult and pediatric spine surgeon, highly qualified, went to one of the best fellowships in the country in 98-99, been at the top hospitals since top practices, and in 2013-14, we knew there had to be a better way than the metal rod surgery, and like I said today, 99.9% of everyone does a metal rod surgery, and even in 2013-14, there were only eight people or so that were starting to do the VBT technique, which is a single cord, single screw, no releasing, and you can see just how flat the spines end up being. Out of those eight people or so, it wasn't until about 2018 or 19 that a bunch of other individuals started to do VBT because the companies got marketing approval for the instrumentation, and that led to a lot of weekend workshops and things of learning how to do VBT. In this practice, we always knew that VBT was going to ultimately be a less successful technique with high revision rates because it relies on the cord for longevity.

ASC with the releases, as we've talked about, relies on the disc healing for longevity, not the cords, and so this slide summarizes this whole process of where we are in 2025 versus where the rest of the world is. 99% doing metal rods, and those VBT surgeons that started having the revisions, they start converting back to metal rod hybrids, and if you went to one of them today, they said, well, we're going to do a hybrid, metal rods, thoracic spine, and the cords and lumbar spine. So it gives you a perspective actually of where the world is, and then people ask me, well, why are you the only one doing this? And I said, well, we pioneered it.

We coined the word ASC. We coined the word ASC with the disc release. Everything was in this practice.

There are five surgical technique patents, and this is not to stop other doctors from performing the surgery, but it's to document who developed, pioneered it, and developed it to the point where it is today. If you're going to become a spine surgeon who does scoliosis surgery with metal rods, you're an orthopedic resident for five years, and then you do a spine fellowship, and that spine fellowship for scoliosis, it's about a year, and so you take a year to learn how to do this technique under the guidance apprenticeship of other senior doctors, and you expect someone else then to go ahead from this technique to ASC technique with what? No training? With a weekend workshop? That's the issue. The issue is developing fellowship training programs where you spend a year learning how to do ASC technique and then start to do the surgery, and so unfortunately, it's a matter of education.

It's a matter of fellowship as to why others do not do the surgery. There are a few individuals, as I mentioned, in the world who I've taught personally. They've come and spent weeks at a time here, but I'm also, that's not my day job.

My day job is to do scoliosis surgery with the ASC, and so it's going to take time. At the same time, the metal rod surgeons understandably are very resistant to what we do because they don't understand it. You can't do what you don't know.

They don't know the results of it. They don't know the data that we've been putting out, but at the same time, the onus is on them to look. The data we published over the last several years is out there, but they haven't looked.

We're putting more and more out, and so then it will take more and more persuasion, but this is where we are today. This is where we are today with ASC, and really, you can sum up where I think the world of VBT, VBT hybrids, and metal rod fusions is. Another analogy I put out there all the time is the iPhone analogy.

You know, going from metal rods to VBT and these hybrids was like going from the rotary phone to the first flip phone, and going from the VBT to the first ASC is like going from the flip phone to the first iPhone. Now, we're on iPhone 14, 16, but even BlackBerry, if you remember, when iPhone came out in early 2000, it took like another 10 years for BlackBerry to go out of business, and so it's just the natural evolution of things. Hopefully, with the talk I gave you just now and the data we're continuing to put out of the successful results from 40 to 70 rig curves and also the evidence for the disk restoration of function, et cetera, this helps to sway the opinion of the metal rod surgeons.”

VIEW: https://vimeo.com/1055566270