Dr. Derek Lee

05/04/2026

What REALLY causes Adolescent Idiopathic Scoliosis (AIS)? 🤔

This is a topic I've been intensely interested in since my son was diagnosed. I’ve looked at many theories over the years, but my quest really kicked into high gear when I found a video describing the biomechanics of scoliosis unlike anything I had ever seen before. It featured Dr. Moyo Kruyt from the Netherlands giving a brilliant lecture on bipedalism, disc shearing forces, vertebral instability, and desynchronized growth. (Check out my interview with him from 5 years ago in the link below!)

Through that research, I was introduced to Dr. Rene Castelein. If you haven't seen my interview with him from 4 years ago, I highly recommend checking it out! We recently met up at IMAST 2026 in Toronto to discuss his latest insights on disc growth from childhood to adulthood, and how rotational disc instability can drive scoliosis.

Here is a breakdown of his eye-opening presentation at the IMAST Scoliosis Research Society Breakfast Workshop:

💡 Scoliosis is a Symptom, Not a Disease: Dr. Castelein argues that scoliosis is the result of a biomechanical imbalance. Compared to any other species, our upright posture loads the human spine in ways evolution never fully solved, making it rotationally challenged. He notes that this fragility shows up in three windows: the growing spine (where connective tissue and discs mature unevenly), the aging spine (where degenerated discs create instability), and in various genetic tissue diseases.

🦴 It Starts in the Disc: In idiopathic scoliosis, the deformity actually begins in the disc before the bony changes occur. The ring apophysis—the stage where the vertebral endplate matures and anchors the disc—is measurably delayed in AIS patients. This means a mature mechanical load meets an immature attachment, causing the disc to deform first and the bone to follow.

🏃 The Osgood-Schlatter Analogy: Dr. Castelein flips the script, viewing scoliosis not as a uniform pathology, but as a "stability failure." The closest analogy is Osgood-Schlatter disease: a growing skeleton subjected to forces it cannot yet carry. The body tries to adapt—sometimes well, sometimes not.

🛡️ A New Treatment Rationale: For decades, the field has asked why scoliosis occurs. Dr. Castelein asks a more useful question: What prevents it from occurring? What conditions allow the spine to stay stable through every developmental window? While the data is suggestive and still needs conclusive proof, there is a shift underway. Treating scoliosis as a stability failure to prevent—perhaps by temporarily stabilizing discs in adolescents—opens up a completely different, proactive clinical conversation focusing on earlier, less invasive, mechanism-driven treatments.

I am so excited to be interviewing him again soon to dive deeper into this preventive strategy! :)

Feel free to invite other parents navigating scoliosis to join our private group: https://www.facebook.com/groups/1198200727630801

Dr. Moyo Kruyt https://youtu.be/d4uMy1SuRxU
Dr. Rene Castelein https://youtu.be/XPVlCmM2-6I

04/29/2026

The Great Debate: When is the Right Time for Scoliosis Surgery? 📊🤔

Hey everyone! 👋 I want to break down an incredibly important, award-winning study (Whitecloud Award Nominee Paper #4 attached) presented by the European Spine Study Group at the recent IMAST 2026 conference. (Please note: we don't have the full published paper available yet, just the abstract that was presented at the meeting!)

This study tracked idiopathic scoliosis patients across their entire lifespan and revealed a massive "Catch-22" for anyone considering or delaying surgery. (See infographic attached)

✨ The Good News (Quality of Life): The abstract's results show that patients are responsive to scoliosis surgery at any age. In fact, older adults exhibit significantly greater improvements in pain and mental health after surgery. Self-image is the most affected area across all age groups, but it also demonstrates the greatest postoperative improvement for everyone.

⚠️ The Catch (Complications): Dr. David Skaggs shared a crucial graph from Linkedin (attached). His take on the data was clear: "If you need scoliosis surgery, there are a LOT less complications if done before age 30, and a big jump after age 50." The graph he shared shows major, mechanical, neurological, and infectious complication rates—along with reoperations—spiking dramatically as patients enter their 50s and reaching their absolute peak in the 60-69 age group.

Why is this study so significant? It perfectly illustrates the clinical trade-off we all have to weigh. While it is incredibly encouraging that older adults can achieve massive pain, functional, and self-image improvements from surgery, delaying the procedure until later in life comes with a substantially higher risk of surgical complications. It is a critical balancing act that every family needs to discuss openly with their surgeon!

👇 Tell me in the comments: Does seeing Dr. Skaggs' graph and this data change how you view the idea of "delaying" surgery? For our adult warriors, what was your experience like navigating these risks?

🔗 Feel free to invite other parents navigating scoliosis to join our private group: https://www.facebook.com/groups/1198200727630801

04/24/2026

📸 Selfie time with the Shriners Philly "Dream Team" at IMAST 2026! 🚀

Hey everyone! As promised, I’m continuing to share my experiences from the IMAST 2026 conference in Toronto. It was fantastic to catch up and grab some selfies with Dr. Amer Samdani, Dr. Joshua Pahys, and Dr. Steven Hwang from Shriners Hospital for Children in Philadelphia.

This team is at the absolute forefront of non-fusion scoliosis surgery, and they presented a highly anticipated, long-term study (Paper #31) on the outcomes of Thoracic Vertebral Body Tethering (VBT) with a minimum of 5 years of follow-up.
Here is what the data showed us:

✨ The Successes: The results are very promising for maintaining flexibility! They found that 70% of patients who underwent thoracic VBT successfully maintained a Cobb angle of less than 35 degrees at more than 6 years of follow-up.

⚠️ The Trade-offs: As with any newer technology, transparency is key. The study also noted a 27% re-operation rate for these VBT patients, with 9% ultimately requiring a posterior spinal fusion.

The biggest takeaway from their research is the absolute necessity of "shared decision-making" between families and surgeons when weighing the flexibility of a tether against the predictability of a fusion.

🎥 Want to dive deeper? If you want to hear Dr. Samdani explain these exact trade-offs, the reasons behind tether breakages, and how they are perfecting VBT techniques (like hybrid surgeries), check out my recent long-form interview with him on the YouTube channel! https://youtu.be/kYeVJTcWZtY

04/19/2026

Exclusive IMAST 2026 Interview: The Future of Scoliosis Care with Dr. Suken Shah, President of the Scoliosis Research Society! 🇨🇦🚀

Hey everyone! 👋 I had the incredible honour of sitting down with Dr. Suken Shah, President of the Scoliosis Research Society (SRS), in my hometown of Toronto for the IMAST 2026 conference. We discussed this year's major theme of innovation and the exciting future of spine deformity care.

Here are some groundbreaking takeaways from our conversation:

🤖 Robotics & Foundational Skills: Dr. Shah clarified that robots aren't replacing surgeons; rather, they are physician-directed tools. He emphasized that surgeons must master freehand techniques through hundreds of cases before they can truly trust and verify robotic assistance.

🧠 AI & "Digital Twins": Artificial Intelligence is revolutionizing surgical planning. Surgeons can now simulate a procedure on a patient's "digital twin" to forecast outcomes 60 days, one year, or even two years in advance.

⌚ Remote Recovery Tracking: We also discussed how wearables can seamlessly collect data in the background. Doctors can monitor when a patient is off pain medication or when their step count returns to baseline, all without the patient needing to come into the clinic.

🔬 Evidence-Based Safety: To address concerns about new techniques, Dr. Shah highlighted how the SRS relies on a rigorous peer-review process and audience learning. This ensures that any surgical innovations brought to patients are proven, effective, and safe.

👇 Check out the full interview on my YouTube channel (link in bio)! Let me know in the comments which of these technologies you are most excited to see in the future of scoliosis care!

04/19/2026

Exclusive IMAST 2026 Interview: The Future of Scoliosis Care with Dr. Suken, Shah, President of the Scoliosis Research Society! 🚀🇨🇦

Hey ! 👋 I had the incredible opportunity to sit down with Dr. Suken Shah, the President of the Scoliosis Research Society (SRS), right here in my hometown of Toronto for the IMAST 2026 conference.

We discussed the major theme of the meeting—innovation—which Dr. Shah notes is built right into the DNA of the SRS. Here are some of the most exciting takeaways for our community:

✨ Remote Recovery Tracking: We talked about how new technologies can collect patient data in the background, allowing doctors to monitor when a patient is off pain medication or when their step count returns to baseline, all without the patient ever needing to step foot in a clinic.

✨ Improving Surgical Success: There is a huge focus on discovering ways to avoid reoperations and surgical episodes entirely, including preventing rod failure or implant pull-out, and ensuring that fusions heal better.

✨ Evidence-Based Safety: For those of us worried about new techniques, Dr. Shah emphasized that the SRS community relies heavily on a strict peer-review process to ensure that any new innovations brought to patients are proven and safe. He also noted that every research paper presented at the conference requires at least one year of patient follow-up data.

https://youtu.be/Fl--8zG4R_8

👇 Check out the full interview below!

Exciting insights from the 33rd IMAST in Toronto! 🇨🇦🚀. An Interview with Dr. Suken Shah, MD

04/16/2026

Upcoming IMAST 2026 Interview with SRS president, Dr. Suken Shah about innovation in spine surgery! 🙂

04/16/2026

That was a fun first day at IMAST 2026! 😊 I learned a lot today and got a chance to meet, in person, many of the surgeons, orthotists and PTs that I had previously interviewed over Zoom.

Will share some pics soon. I now realize that I'm shorter than pretty much everyone. 😁

https://www.facebook.com/share/r/1BZUX65WjQ/

04/13/2026

Exciting Tech Updates: IMAST 2026 Scoliosis Treatment Innovations! 🤖🚀

Hey everyone! 👋 As I comb through the official scientific programme for the 33rd International Meeting on Advanced Spine Techniques (IMAST) in Toronto this week, I am blown away by the sessions dedicated to the future of scoliosis care. If you are interested in non-fusion options, avoiding radiation, and the role of Artificial Intelligence, this year's research is incredible!
Here are the most highly anticipated treatment innovations and podium presentations I’ll be tracking for us on the floor:

📱 Radiation-Free Home Monitoring (Paper #44): A massive breakthrough for our kids! Researchers are presenting a smartphone app that accurately generates "digital twins" in paediatric patients, bringing us a step closer to monitoring idiopathic scoliosis at home without exposing kids to repeated x-ray radiation.

🩺 Portable 3D Spine Screening (Paper #43): A new non-irradiated portable 3D electronic spine measurement system has shown excellent agreement with full-spine radiography, making it a fast and cost-effective tool for large-scale adolescent scoliosis screening without the harmful radiation exposure.

🧠 AI Spotting Non-Idiopathic Curves (Paper #49): Dr. A. Noelle Larson's team developed a deep learning approach that outperforms experienced spine surgeons in accurately predicting non-idiopathic scoliosis straight from plain radiographs.

⚡ Safer Surgeries with Machine Learning (Paper #48): For those facing surgery, a new machine learning model integrating intraoperative neuromonitoring and hemodynamic data is able to detect neurological changes during pediatric spine surgery a remarkable 35 minutes earlier than clinical teams.

https://www.srs.org/Files/IMAST/IMAST-2026/IMAST26-FP-v6.pdf

04/13/2026

Exciting Tech Updates: IMAST 2026 Scoliosis Treatment Innovations! 🤖🚀

Hey everyone! 👋 As I comb through the official scientific programme for the 33rd International Meeting on Advanced Spine Techniques (IMAST) in Toronto this week, I am blown away by the sessions dedicated to the future of scoliosis care. If you are interested in non-fusion options, avoiding radiation, and the role of Artificial Intelligence, this year's research is incredible!
Here are the most highly anticipated treatment innovations and podium presentations I’ll be tracking for us on the floor:

📱 Radiation-Free Home Monitoring (Paper #44): A massive breakthrough for our kids! Researchers are presenting a smartphone app that accurately generates "digital twins" in paediatric patients, bringing us a step closer to monitoring idiopathic scoliosis at home without exposing kids to repeated x-ray radiation.

🩺 Portable 3D Spine Screening (Paper #43): A new non-irradiated portable 3D electronic spine measurement system has shown excellent agreement with full-spine radiography, making it a fast and cost-effective tool for large-scale adolescent scoliosis screening without the harmful radiation exposure.

🧠 AI Spotting Non-Idiopathic Curves (Paper #49): Dr. A. Noelle Larson's team developed a deep learning approach that outperforms experienced spine surgeons in accurately predicting non-idiopathic scoliosis straight from plain radiographs.

⚡ Safer Surgeries with Machine Learning (Paper #48): For those facing surgery, a new machine learning model integrating intraoperative neuromonitoring and hemodynamic data is able to detect neurological changes during pediatric spine surgery a remarkable 35 minutes earlier than clinical teams.

Send a message to learn more

01/15/2026

09/09/2025

NEW INTERVIEW PREMIERE! 🎙️Robot Assisted Spondylolysis Repair in Young Athletes, with Dr. David L. Skaggs of Cedars-Sinai!

Join me for a deep dive interview into the cutting-edge world of pediatric spine surgery. Dr. Skaggs is a true innovator in his field, and he shares incredible insights into his groundbreaking techniques that are changing young lives.

You won't want to miss this conversation! Here are a few highlights to look forward to:
- The "Miracle" of Outpatient Spine Surgery: Learn how Dr. Skaggs uses robotics to repair spinal fractures in young athletes through a tiny 2cm incision, allowing them to go home the same day.
- Function Over a "Perfect" X-Ray: Dr. Skaggs explains his philosophy on treating high-grade spinal conditions, prioritizing a patient's safety and return to function over correcting an image.
- Honest Lessons from the OR: In a fascinating and transparent discussion, Dr. Skaggs shares cases where things didn't go as planned and the importance of having the manual skills to adapt when technology falters.
- Helping Elite Athletes Return to Play: Hear the inspiring stories of young athletes who faced career-ending injuries but returned to surfing, professional baseball, and D1 gymnastics pain-free.
- The Future of Surgical Training: Is there a risk of new surgeons losing the critical "feel" of surgery by relying too heavily on robotics? Dr. Skaggs weighs in on this important debate.

Time Stamp:
00:00 Robot Assisted Spondylolysis Repair in Young Athletes with Dr. David Skaggs, MD
01:03 Robotics in Pediatric Spine Surgery
02:01 Robot-Assisted Spondylolysis Repair in Young Athletes
05:25 Outpatient Pediatric Spine Surgery
07:16 Challenges and Solutions in Robotic Surgery
08:08 Surgical Training and Robotics
11:32 Case Study: Robot-Assisted Larger Spondy Gap Repair
13:48 Robot Assisted High-Grade Spondylolisthesis Surgery

This is a video about Robot Assisted Spondylolysis Repair in Young Athletes with Dr. David L. Skaggs, MD, MMMThis video is not an endorsement. Viewers shoul...

08/15/2025

Dr. Rigo's wisdom: Maximum correction isn't always optimal correction.⁣
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Chasing 50% when the spine gives you 30% creates compensatory problems. Sometimes 20% correction with compliance beats aggressive overcorrection.⁣
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Full interview: https://youtu.be/Pv5mRNQl21E 🎯