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Tsirikos AI, Ahuja K, Khan M. Minimally Invasive Surgery for Adolescent Idiopathic Scoliosis: A Systematic Review. J Clin Med 2024; 13:2013. [PMID: 38610778 PMCID: PMC11012693 DOI: 10.3390/jcm13072013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/15/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Minimally invasive surgical (MIS) techniques have gained popularity as a safe and effective alternative to open surgery for degenerative, traumatic, and metastatic spinal pathologies. In adolescent idiopathic scoliosis, MIS techniques comprise anterior thoracoscopic surgery (ATS), posterior minimally invasive surgery (PMIS), and vertebral body tethering (VBT). In the current systematic review, the authors collected and analyzed data from the available literature on MIS techniques in AIS. Methods: The articles were shortlisted after a thorough electronic and manual database search through PubMed, EMBASE, and Google Scholar. Results: The authors included 43 studies for the review; 14 described the outcomes with ATS, 13 with PMIS, and 16 with VBT. Conclusions: While the efficacy of the ATS approach is well-established in terms of comparable coronal and sagittal correction to posterior spinal fusion, the current use of ATS for instrumented fusion has become less popular due to a steep learning curve, high pulmonary and vascular complication rates, implant failures, and increased non-union rates. PMIS is an effective alternative to the standard open posterior spinal fusion, with a steep learning curve and longer surgical time being potential disadvantages. The current evidence, albeit limited, suggests that VBT is an attractive procedure that merits consideration in terms of radiological correction and clinical outcomes, but it has a high complication and re-operation rate, while the most appropriate indications and long-term outcomes of this technique remain unclear.
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Affiliation(s)
- Athanasios I. Tsirikos
- Scottish National Spine Deformity Centre, Royal Hospital for Children and Young People, Edinburgh EH16 4TJ, UK; (K.A.); (M.K.)
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Nicolini LF, Oliveira RC, Ribeiro M, Stoffel M, Markert B, Kobbe P, Hildebrand F, Trobisch P, Simões MS, de Mello Roesler CR, Fancello EA. Tether pre-tension within vertebral body tethering reduces motion of the spine and influences coupled motion: a finite element analysis. Comput Biol Med 2024; 169:107851. [PMID: 38113683 DOI: 10.1016/j.compbiomed.2023.107851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/30/2023] [Accepted: 12/11/2023] [Indexed: 12/21/2023]
Abstract
Anterior Vertebral Body Tethering (VBT) is a novel fusionless treatment option for selected adolescent idiopathic scoliosis patients which is gaining widespread interest. The primary objective of this study is to investigate the effects of tether pre-tension within VBT on the biomechanics of the spine including sagittal and transverse parameters as well as primary motion, coupled motion, and stresses acting on the L2 superior endplate. For that purpose, we used a calibrated and validated Finite Element model of the L1-L2 spine. The VBT instrumentation was inserted on the left side of the L1-L2 segment with different cord pre-tensions and submitted to an external pure moment of 6 Nm in different directions. The range of motion (ROM) for the instrumented spine was measured from the initial post-VBT position. The magnitudes of the ROM of the native spine and VBT-instrumented with pre-tensions of 100 N, 200 N, and 300 N were, respectively, 3.29°, 2.35°, 1.90° and 1.61° in extension, 3.30°, 3.46°, 2.79°, and 2.17° in flexion, 2.11°, 1.67°, 1.33° and 1.06° in right axial rotation, and 2.10°, 1.88°, 1.48° and 1.16° in left axial rotation. During flexion-extension, an insignificant coupled lateral bending motion was observed in the native spine. However, VBT instrumentation with pre-tensions of 100 N, 200 N, and 300 N generated coupled right lateral bending of 0.85°, 0.81°, and 0.71° during extension and coupled left lateral bending of 0.32°, 0.24°, and 0.19° during flexion, respectively. During lateral bending, a coupled extension motion of 0.33-0.40° is observed in the native spine, but VBT instrumentation with pre-tensions of 100 N, 200 N, and 300 N generates coupled flexion of 0.67°, 0.58°, and 0.42° during left (side of the implant) lateral bending and coupled extension of 1.28°, 1.07°, and 0.87° during right lateral bending, respectively. Therefore, vertebral body tethering generates coupled motion. Tether pre-tension within vertebral body tethering reduces the motion of the spine.
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Affiliation(s)
- Luis Fernando Nicolini
- Group of Analysis and Mechanical Design - GRANTE, Dep. of Mechanical Engineering, Federal University of Santa Catarina, Brazil; Mechanical and Aerospace Technology Laboratory (NUMAE), Dep. of Mechanical Engineering, Federal University of Santa Maria, Brazil.
| | - Rafael Carreira Oliveira
- Group of Analysis and Mechanical Design - GRANTE, Dep. of Mechanical Engineering, Federal University of Santa Catarina, Brazil
| | - Marx Ribeiro
- Group of Analysis and Mechanical Design - GRANTE, Dep. of Mechanical Engineering, Federal University of Santa Catarina, Brazil; Department of Orthopedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Marcus Stoffel
- Institute of General Mechanics (IAM), RWTH Aachen University, Germany
| | - Bernd Markert
- Institute of General Mechanics (IAM), RWTH Aachen University, Germany
| | - Philipp Kobbe
- Department of Orthopedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Frank Hildebrand
- Department of Orthopedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany
| | | | - Marcelo Simoni Simões
- Biomechanical Engineering Laboratory - LEBm, Dep. of Mechanical Engineering, Federal University of Santa Catarina, Brazil
| | - Carlos Rodrigo de Mello Roesler
- Group of Analysis and Mechanical Design - GRANTE, Dep. of Mechanical Engineering, Federal University of Santa Catarina, Brazil; Biomechanical Engineering Laboratory - LEBm, Dep. of Mechanical Engineering, Federal University of Santa Catarina, Brazil
| | - Eduardo Alberto Fancello
- Group of Analysis and Mechanical Design - GRANTE, Dep. of Mechanical Engineering, Federal University of Santa Catarina, Brazil; Biomechanical Engineering Laboratory - LEBm, Dep. of Mechanical Engineering, Federal University of Santa Catarina, Brazil
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Metaizeau JD, Denis D. Posterior Vertebral Body Tethering: A Preliminary Study of a New Technique to Correct Lenke 5C Lumbar Curves in Adolescent Idiopathic Scoliosis. CHILDREN (BASEL, SWITZERLAND) 2024; 11:157. [PMID: 38397271 PMCID: PMC10887278 DOI: 10.3390/children11020157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/21/2023] [Accepted: 01/24/2024] [Indexed: 02/25/2024]
Abstract
Vertebral body tethering has been approved for adolescent scoliosis correction. The usual approach is anterior, which is relatively easy for the thoracic spine, but becomes much more challenging for the lumbar curves, with a higher rate of complications. The purpose of this study was to describe and evaluate the first results of a new posterior vertebral body tethering (PVBT) technique using pedicle screws through a posterolateral Wiltse approach. Twenty-two patients with 5C idiopathic scoliosis (Lenke classification) were included in this retrospective study, with a follow up of 2 years after surgery. The lumbar and thoracic curves were measured pre-operatively (POS), at first standing (FS) and at 2 years (2Y). Complications were also analysed. A significant improvement of 30.7° was observed for lumbar curve magnitude between POS and 2Y. Both the thoracic kyphosis and the lumbar lordosis remained stable. Thirteen complications were noted: three led to posterior arthrodesis, three needed a revision with a good outcome, and the seven others (overcorrections, screw breakage or pull-out) achieved a good result. PVBT seems an effective technique for the management of type 5 C adolescent idiopathic scoliosis. The complication rate seems high but is probably secondary to the learning curve of this new technic as it concerns only the first half of the patients.
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Courvoisier A, Maximin MC, Daniel O, Gouron R, Evain JN, Baroncini A. Clinical experience and complications with limited pleural dissection combined with a novel, simplified technique for thoracic Redon-like drain in vertebral body tethering. Spine Deform 2024; 12:165-171. [PMID: 37668954 PMCID: PMC10770196 DOI: 10.1007/s43390-023-00760-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/20/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE To report on our experience with a simplified, suction-bottle-drain technique of thoracic drain (Redon-like) combined with fully thoracoscopic vertebral body tethering (VBT) and a limited pleural approach, with particular focus on the rate of pulmonary complications. METHODS A retrospective study was performed on all consecutive patients who underwent VBT for adolescent idiopathic scoliosis. For all subjects, a 10G Redon drain, an active drain system consisting of a perforated tube and a suction bottle, was placed intrathoracically and tunneled under the skin. All drains were removed on the first postoperative day. Perioperative and postoperative data such as type of access, length of surgery, amount of fluid collection in the drain, and length of hospital stay were collected. The type and number of pulmonary complications occurring in the first 3 months after surgery, along with their symptoms and management, were recorded. RESULTS One Hundred eighty-two patients were included in the analysis. The mean length of surgery was 97 min (75-120). The average fluid collection in the drain was 30 ml (5-50), the mean length of hospital stay was 3 days (2-4). During the observation period, pulmonary complications occurred in five patients (2%). Two patients presented an aseptic right pleural effusion; for two patients, a residual pneumothorax was diagnosed on the X-rays in the recovery room and one patient developed a chylothorax. All patients recovered without sequelae. CONCLUSION The simplified, Redon-like drain combined with a fully thoracoscopic VBT and limited pleural approach seems a safe and effective alternative to the chest drain. This technique allows to remove the drain on the first postoperative day, thus simplifying the management of the patients and improving their comfort.
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Affiliation(s)
- Aurélien Courvoisier
- TIMC, University Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, 38000, Grenoble, France
- Grenoble Alps Scoliosis and Spine Center, Grenoble Alps University Hospital, Bvd de la Chantourne, CEDEX 09, 38043, Grenoble, France
| | - Marie-Christine Maximin
- Grenoble Alps Scoliosis and Spine Center, Grenoble Alps University Hospital, Bvd de la Chantourne, CEDEX 09, 38043, Grenoble, France
| | - Olivier Daniel
- TIMC, University Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, 38000, Grenoble, France
- Grenoble Alps Scoliosis and Spine Center, Grenoble Alps University Hospital, Bvd de la Chantourne, CEDEX 09, 38043, Grenoble, France
| | - Richard Gouron
- Service d'Orthopédie Pédiatrique, CHU d'Amiens, Université Picardie Jules Verne, Chemin du Thil-CS 52501, 80025, Amiens Cedex 1, France
| | - Jean-Noël Evain
- TIMC, University Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, 38000, Grenoble, France
- Pediatric Anesthesia Department, Grenoble Alps University Hospital, Bvd de la Chantourne, CEDEX 09, 38043, Grenoble, France
| | - Alice Baroncini
- Department of Orthopaedics, RWTH Uniklinik Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
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Jackson TJ, Sullivan MH, Larson AN, Milbrandt TA, Sebastian AS. Controversies in Spine Surgery: Is Vertebral Body Tethering Superior to Selective Thoracic Fusion for Adolescent Idiopathic Scoliosis? Clin Spine Surg 2023; 36:291-294. [PMID: 37448175 DOI: 10.1097/bsd.0000000000001484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/17/2023] [Indexed: 07/15/2023]
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Braun S, Brenneis M, Schönnagel L, Caffard T, Diaremes P. Surgical Treatment of Spinal Deformities in Pediatric Orthopedic Patients. Life (Basel) 2023; 13:1341. [PMID: 37374124 DOI: 10.3390/life13061341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Scoliosis and Scheuermann's disease are common spinal deformities that affect a substantial population, particularly adolescents, often impacting their quality of life. This comprehensive review aims to present a detailed understanding of these conditions, their diagnosis, and various treatment strategies. Through an extensive exploration of current literature, the review discusses the etiology of these spinal deformities and the use of diagnostic tools such as X-rays and MRI. It further delves into the range of treatment options available, from conservative approaches such as physiotherapy and bracing to more invasive surgical interventions. The review underscores the necessity of an individualized treatment approach, taking into account factors such as the patient's age, the severity of the curvature, and overall health. This all-encompassing perspective on scoliosis and Scheuermann's disease will aid in evidence-based decision making in their management with the goal of improving patient outcomes.
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Affiliation(s)
- Sebastian Braun
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany
- Stavros Niarchos Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY 10021, USA
| | - Marco Brenneis
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany
- Stavros Niarchos Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY 10021, USA
| | - Lukas Schönnagel
- Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, 10117 Berlin, Germany
- Spine Care Institute, Hospital for Special Surgery, New York, NY 10021, USA
| | - Thomas Caffard
- Spine Care Institute, Hospital for Special Surgery, New York, NY 10021, USA
- Department of Orthopaedic Surgery, University of Ulm, 89075 Ulm, Germany
| | - Panagiotis Diaremes
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany
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Courvoisier A, Baroncini A, Jeandel C, Barra C, Lefevre Y, Solla F, Gouron R, Métaizeau JD, Maximin MC, Cunin V. Vertebral Body Tethering in AIS Management-A Preliminary Report. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020192. [PMID: 36832321 PMCID: PMC9955337 DOI: 10.3390/children10020192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 12/30/2022] [Accepted: 01/17/2023] [Indexed: 01/22/2023]
Abstract
Vertebral Body Tethering (VBT) is a recently developed surgical technique for the treatment of progressive and severe scoliosis in patients with significant growth potential. It has been used since the first exploratory series, which showed encouraging results on the progressive correction of the major curves. This study reports on a retrospective series of 85 patients extracted from a French cohort, with a follow-up at a minimum of two years after a VBT with recent screws-and-tether constructs. The major and compensatory curves were measured pre-operatively, at the 1st standing X-ray, at 1 year, and at the last available follow-up. The complications were also analyzed. A significant improvement was observed in the curve magnitude after surgery. Thanks to growth modulation, both the main and the secondary curves continued to progress over time. Both the thoracic kyphosis and lumbar lordosis remained stable over time. Overcorrection occurred in 11% of the cases. Tether breakage was observed in 2% of the cases and pulmonary complications in 3% of the cases. VBT is an effective technique for the management of adolescent idiopathic scoliosis patients with residual growth potential. VBT opens an era of a more subtle and patient-specific surgical management of AIS that considers parameters such as flexibility and growth.
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Affiliation(s)
- Aurélien Courvoisier
- TIMC, University Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, 38000 Grenoble, France
- Grenoble Alps Scoliosis and Spine Center, Grenoble Alps University Hospital, Bvd de la Chantourne, CEDEX 09, 38043 Grenoble, France
- Correspondence: ; Tel.: +33-6-74-82-56-61
| | - Alice Baroncini
- Department of Orthopaedics, RWTH Uniklinik Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Clément Jeandel
- Grenoble Alps Scoliosis and Spine Center, Grenoble Alps University Hospital, Bvd de la Chantourne, CEDEX 09, 38043 Grenoble, France
| | - Clémentine Barra
- Service d’Orthopédie Pédiatrique, Hôpital Femme Mère Enfant, Hôpitaux civils de Lyon, 59 Bd Pinel, 69500 Bron, France
| | - Yan Lefevre
- Service d’Orthopédie Pédiatrique, CHU de Bordeaux, Pl. Amélie Raba Léon, 33000 Bordeaux, France
| | - Federico Solla
- Service d’Orthopédie Pédiatrique, Fondation Lenval, 57 Avenue de la Californie, 06200 Nice, France
| | - Richard Gouron
- Service d’Orthopédie Pédiatrique, CHU d’Amiens, Université Picardie Jules Verne, Chemin du Thil, CS 52501, CEDEX 1, 80025 Amiens, France
| | - Jean-Damien Métaizeau
- Service d’Orthopédie Pédiatrique, Centre Hospitalier Universitaire F.Mitterrand Dijon-Bourgogne, 14 Rue Paul Gaffarel, 21000 Dijon, France
| | - Marie-Christine Maximin
- Grenoble Alps Scoliosis and Spine Center, Grenoble Alps University Hospital, Bvd de la Chantourne, CEDEX 09, 38043 Grenoble, France
| | - Vincent Cunin
- Service d’Orthopédie Pédiatrique, Hôpital Femme Mère Enfant, Hôpitaux civils de Lyon, 59 Bd Pinel, 69500 Bron, France
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