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Trobisch PD, Kim HJ, Himpe B, Chang DG. Radiological Outcomes of Re-tethering for Adolescent Idiopathic Scoliosis: A 2-to-5-year Follow-Up Case Series After Index Vertebral Body Tethering Failure. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024:10.1007/s00586-024-08363-x. [PMID: 38888800 DOI: 10.1007/s00586-024-08363-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/24/2024] [Accepted: 06/10/2024] [Indexed: 06/20/2024]
Abstract
PURPOSE Vertebral Body Tethering (VBT) has been shown to have a less predictable outcome compared to spinal fusion in patients with adolescent idiopathic scoliosis (AIS). Tether breakage is a common mechanical event that sometimes leads to loss of correction. No data has been published that evaluates the outcome of re-tethering in patients who underwent revision surgery for failed VBT, which was the purpose of this study. METHODS This is an analysis of a prospectively collected single center database of 290 patients who have had VBT. Patients for this study were included if they have had re-tethering after failed VBT and a minimum follow up of 24 months after index surgery as well as a minimum follow up of 12 months after revision surgery. Revision surgeries included tether exchange, tether reinforcement and/or mono- and bisegmental lateral fusion. Main outcome of interest was curve magnitude at latest follow up. RESULTS 11 patients were identified who received VBT for 16 curves of which 13 curves have had failed index surgery. Mean follow up from index surgery was 40 months, time between index and revision surgery was 22 months and latest follow up after revision surgery 19 months. Re-tethering resulted in an additional correction of 42% for thoracic and 63% for thoracolumbar curves. These results remained clinically stable with only minor loss of correction at final follow up. No patient underwent or was indicated for spinal fusion. CONCLUSION Re-tethering is feasible and able to achieve additional correction and a sustainable result.
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Affiliation(s)
- Per D Trobisch
- Department of Spine Surgery, Eifelklinik St. Brigida, Simmerath, Germany.
- Department of Spine Surgery, St. Elisabethenkrankenhaus Frankfurt, Frankfurt, Germany.
| | - Hong Jin Kim
- Department of Orthopedic Surgery, College of Medicine, Inje University Sanggye Paik Hospital, Inje University, Seoul, Korea
| | - Bastian Himpe
- Department of Spine Surgery, St. Elisabethenkrankenhaus Frankfurt, Frankfurt, Germany
| | - Dong-Gune Chang
- Department of Orthopedic Surgery, College of Medicine, Inje University Sanggye Paik Hospital, Inje University, Seoul, Korea
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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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Siu JW, Wu HH, Saggi S, Allahabadi S, Katyal T, Diab M. Radiographic and perioperative outcomes following anterior thoracic vertebral body tethering and posterior lumbar spine tethering: a pilot series. Spine Deform 2023; 11:1399-1408. [PMID: 37355490 PMCID: PMC10587020 DOI: 10.1007/s43390-023-00717-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/03/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND AND CONTEXT In patients with adolescent idiopathic scoliosis (AIS) of main thoracic and lumbar spine regions, combined anterior thoracic vertebral body tethering and posterior lumbar spine tethering (ATVBT/PLST) is a novel non-fusion treatment option for growth modulation and conservation of motion. METHODS Fourteen patients with AIS who underwent ATVBT/PLST with at least 2-year follow-up were included. Primary outcomes included quality of life as assessed by SRS-22 instruments, radiographic analysis, and revision operations. We secondarily reported perioperative metrics and post-operative opiate morphine equivalents (OME). Clinical success was defined as patients who achieved skeletal maturity with ≤ 30° curve magnitude of both their main thoracic and thoracolumbar/lumbar curves and who did not undergo posterior spine instrumentation and fusion (PSIF). RESULTS Patients had a mean age of 11.6 years (range 10-14 years), majority were girls (92%), and mean follow-up was 3.0 years (range 2-4.8 years). All patients were skeletally immature with a Risser ≤ 2. Included curves were Lenke 1C, 3C, or 6C. Mean preoperative curve magnitudes were 53° ± 8° (range 45°-65°) main thoracic and 49° ± 9° (range 40°-62°) thoracolumbar/lumbar curves. At most recent follow-up, patients had a mean main thoracic curve of 29° ± 8° (range 15°-40°) and a mean thoracolumbar/lumbar curve of 20° ± 15° (range 4°-35°). 50% required a revision operation. Cable breakage occurred in 43%, which did not always require revision. One patient progressed to thoracic fusion, but no patient underwent lumbar fusion. Patients had a mean SRS-22 outcome score of 4.2 ± 0.4. CONCLUSIONS ATVBT/PLST is a potential alternative to spine fusion for select immature patients with AIS at a minimum 2-year follow-up. ATVBT/PLST potentially offers motion conservation at the cost of a higher revision rate. Further study and reporting of results are necessary to refine indications and techniques, which in turn will improve outcomes of this procedure. LEVEL OF EVIDENCE Level IV-Case series without comparative group.
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Affiliation(s)
- Jeremy W. Siu
- San Francisco School of Medicine, University of California, San Francisco, CA USA
| | - Hao-Hua Wu
- Department of Orthopaedic Surgery, University of California, San Francisco, CA USA
| | - Satvir Saggi
- San Francisco School of Medicine, University of California, San Francisco, CA USA
| | - Sachin Allahabadi
- Department of Orthopaedic Surgery, University of California, San Francisco, CA USA
| | - Toshali Katyal
- Department of Orthopaedic Surgery, University of California, San Francisco, CA USA
| | - Mohammad Diab
- Department of Orthopaedic Surgery, University of California, San Francisco, CA USA
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