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Samdani AF, Pahys JM, Ames RJ, Grewal H, Pelletier GJ, Hwang SW, Betz RR. Prospective Follow-up Report on Anterior Vertebral Body Tethering for Idiopathic Scoliosis: Interim Results from an FDA IDE Study. J Bone Joint Surg Am 2021; 103:1611-1619. [PMID: 34185722 DOI: 10.2106/jbjs.20.01503] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Anterior vertebral body tethering (aVBT) has emerged as a novel treatment option for patients with idiopathic scoliosis. We present the results from the first U.S. Food and Drug Administration (FDA) Investigational Device Exemption (IDE) study on aVBT. METHODS In this prospective review of a retrospective data set, eligible patients underwent aVBT at a single center from August 2011 to July 2015. Inclusion criteria included skeletally immature patients with Lenke type-1A or 1B curves between 30° and 65°. Clinical and radiographic parameters were collected, with the latter measured by an independent reviewer. RESULTS Fifty-seven patients (49 girls and 8 boys), with a mean age (and standard deviation) of 12.4 ± 1.3 years (range, 10.1 to 15.0 years), were enrolled in the study. The patients had a mean of 7.5 ± 0.6 levels tethered, the mean operative time was 223 ± 79 minutes, and the mean estimated blood loss was 106 ± 86 mL. The patients were followed for an average of 55.2 ± 12.5 months and had a mean Risser grade of 4.2 ± 0.9 at the time of the latest follow-up. The main thoracic Cobb angle was a mean of 40.4° ± 6.8° preoperatively and was corrected to 18.7° ± 13.4° at the most recent follow-up. In the sagittal plane, T5-T12 kyphosis measured 15.5° ± 10.0° preoperatively, 17.0° ± 10.1° postoperatively, and 19.6° ± 12.7° at the most recent follow-up. Eighty percent of patients had curves of <30° at the most recent follow-up. The most recent Scoliosis Research Society (SRS) scores averaged 4.5 ± 0.4, and scores on the self-image questionnaire averaged 4.4 ± 0.7. No major neurologic or pulmonary complications occurred. Seven (12.3%) of 57 patients had a revision: 5 were done for overcorrection and 2, for adding-on. CONCLUSIONS Anterior VBT is a promising technique that has emerged as a treatment option for patients with immature idiopathic scoliosis. We present the results from the first FDA-approved IDE study on aVBT, which formed the basis for the eventual Humanitarian Device Exemption approval. The findings affirm the safety and efficacy of this technique and suggest opportunities for improvement, particularly with respect to reoperation rates. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Amer F Samdani
- Shriners Hospitals for Children-Philadelphia, Philadelphia, Pennsylvania
| | - Joshua M Pahys
- Shriners Hospitals for Children-Philadelphia, Philadelphia, Pennsylvania
| | - Robert J Ames
- Lewis Katz School of Medicine at Temple University, Philadelphia Pennsylvania
| | - Harsh Grewal
- St. Christopher's Hospital for Children, Philadelphia, Pennsylvania
| | - Glenn J Pelletier
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Steven W Hwang
- Shriners Hospitals for Children-Philadelphia, Philadelphia, Pennsylvania
| | - Randal R Betz
- Institute for Spine & Scoliosis, Lawrenceville, New Jersey
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Castel A, Doré V, Fazio C. Spinal stabilisation using a polyvinilidine (Lubra) plate in a pot‐bellied pig. VETERINARY RECORD CASE REPORTS 2020. [DOI: 10.1136/vetreccr-2019-000990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Aude Castel
- Sciences CliniquesUniversité de MontréalFaculté de Médecine VétérinaireSaint‐HyacintheQuébecCanada
- Small Animal Clinical SciencesUniversity of Tennessee Knoxville College of Veterinary MedicineKnoxvilleTennesseeUSA
| | - Vincent Doré
- Sciences CliniquesUniversité de MontréalFaculté de Médecine VétérinaireSaint‐HyacintheQuébecCanada
- Large Animal Clinical SciencesUniversity of TennesseeKnoxvilleTennesseeUSA
| | - Connie Fazio
- Small Animal Clinical SciencesUniversity of Tennessee Knoxville College of Veterinary MedicineKnoxvilleTennesseeUSA
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3
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Amundson LA, Crenshaw TD. Lessons learned from the hypovitaminosis D kyphotic pig model. J Anim Sci 2020; 98:S52-S57. [PMID: 32810238 DOI: 10.1093/jas/skaa146] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 05/04/2020] [Indexed: 12/20/2022] Open
Affiliation(s)
- Laura A Amundson
- Department of Animal Sciences, University of Wisconsin Madison, Madison, WI.,Research and Nutritional Services, Zinpro Corporation, Eden Prairie, MN
| | - Thomas D Crenshaw
- Department of Animal Sciences, University of Wisconsin Madison, Madison, WI
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4
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Meng Z, Wang C, Tian LJ, Zhang XJ, Guo D, Zou Y. Pressure distributions inside intervertebral discs under unilateral pedicle screw fixation in a porcine spine model. J Orthop Surg Res 2018; 13:254. [PMID: 30326934 PMCID: PMC6192192 DOI: 10.1186/s13018-018-0962-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 09/28/2018] [Indexed: 11/10/2022] Open
Abstract
Background Little data are available regarding the effects of pedicle screws on the intervertebral disc stress for different spinal segments. The aim of this study was to analyze the intervertebral disc stress in response to the placement of pedicle screws. Methods T3–4, T11–12, T15–L1, L3–4, and L4–5 intervertebral disc segments from six porcine spine specimens were harvested. A compressive load of 200 N was applied both before and after the pedicle screw was implanted on the left side of each target segment; the resulting pressure was measured during vertical, 5° anterior flexion, 5° posterior extension, and 5° lateral bending. Results The posterior intradiscal pressures of the intervertebral disc were significantly lower in the fixed group than in the unfixed group for all segments during vertical, 5° anterior flexion, and 5° posterior extension. The left pressures of the intervertebral disc were significantly lower in the fixation group for all segments. During 5° lateral bending, the left intervertebral disc pressures were significantly lower in the fixation group. Lower mean pressures were observed in the fixed group. Conclusions Unilateral pedicle screws can effectively reduce the pressure of the fixed lateral intervertebral disc. Moreover, it can change the pressure distribution of the intervertebral disc and reduce the pressure of the entire intervertebral disc, especially the posterior side of the intervertebral disc.
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Affiliation(s)
- Zhao Meng
- Department of Orthopaedics, Children's Hospital of Hebei Province, No.133, Jianhua Street, Yuhua District, Shijiazhuang, 050031, China.
| | - Chen Wang
- Department of Orthopaedics, Children's Hospital of Hebei Province, No.133, Jianhua Street, Yuhua District, Shijiazhuang, 050031, China
| | - Li-Jun Tian
- Department of Orthopaedics, the Third Hospital of Shijiazhuang, No. 15 South of Tiyu Street, Shijiazhuang, 050011, Hebei, China
| | - Xue-Jun Zhang
- Department of Orthopaedics, Beijing Children's Hospital, Capital Medical University, No. 56 Nan-li-shi Road, Beijing, 100045, China
| | - Dong Guo
- Department of Orthopaedics, Beijing Children's Hospital, Capital Medical University, No. 56 Nan-li-shi Road, Beijing, 100045, China
| | - Yan Zou
- Department of Orthopaedics, Children's Hospital of Hebei Province, No.133, Jianhua Street, Yuhua District, Shijiazhuang, 050031, China
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5
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Halanski MA, Hildahl B, Amundson LA, Leiferman E, Gendron-Fitzpatrick A, Chaudhary R, Hartwig-Stokes HM, McCabe R, Lenhart R, Chin M, Birstler J, Crenshaw TD. Maternal Diets Deficient in Vitamin D Increase the Risk of Kyphosis in Offspring: A Novel Kyphotic Porcine Model. J Bone Joint Surg Am 2018; 100:406-415. [PMID: 29509618 PMCID: PMC6818982 DOI: 10.2106/jbjs.17.00182] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to explore the role of perinatal vitamin-D intake on the development and characterization of hyperkyphosis in a porcine model. METHODS The spines of 16 pigs were assessed at 9, 13, and 17 weeks of age with radiography and at 17 weeks with computed tomography (CT), magnetic resonance imaging (MRI), histology, and bone-density testing. An additional 169 pigs exposed to 1 of 3 maternal dietary vitamin-D levels from conception through the entire lactation period were fed 1 of 4 nursery diets supplying different levels of vitamin D, calcium, and phosphorus. When the animals were 13 weeks of age, upright lateral spinal radiography was performed with use of a custom porcine lift and sagittal Cobb angles were measured in triplicate to determine the degree of kyphosis in each pig. RESULTS The experimental animals had significantly greater kyphotic sagittal Cobb angles at all time points when compared with the control animals. These hyperkyphotic deformities demonstrated no significant differences in Hounsfield units, contained a slightly lower ash content (46.7% ± 1.1% compared with 50.9% ± 1.6%; p < 0.001), and demonstrated more physeal irregularities. Linear mixed model analysis of the measured kyphosis demonstrated that maternal diet had a greater effect on sagittal Cobb angle than did nursery diet and that postnatal supplementation did not completely eliminate the risk of hyperkyphosis. CONCLUSIONS Maternal diets deficient in vitamin D increased the development of hyperkyphosis in offspring in this model. CLINICAL RELEVANCE This study demonstrates that decreased maternal dietary vitamin-D intake during pregnancy increases the risk of spinal deformity in offspring. In addition, these data show the feasibility of generating a large-animal spinal-deformity model through dietary manipulation alone.
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Affiliation(s)
- Matthew A. Halanski
- Departments of Orthopedics and Rehabilitation (M.A.H., B.H., E.L., R.C., H.M.H.-S., R.M., and R.L.) and Animal Sciences (L.A.A. and T.D.C.), Comparative Pathology Laboratory (A.G.-F.), and Department of Biostatistics and Medical Informatics (J.B.), University of Wisconsin-Madison, Madison, Wisconsin,E-mail address for M.A. Halanski:
| | - Blake Hildahl
- Departments of Orthopedics and Rehabilitation (M.A.H., B.H., E.L., R.C., H.M.H.-S., R.M., and R.L.) and Animal Sciences (L.A.A. and T.D.C.), Comparative Pathology Laboratory (A.G.-F.), and Department of Biostatistics and Medical Informatics (J.B.), University of Wisconsin-Madison, Madison, Wisconsin
| | - Laura A. Amundson
- Departments of Orthopedics and Rehabilitation (M.A.H., B.H., E.L., R.C., H.M.H.-S., R.M., and R.L.) and Animal Sciences (L.A.A. and T.D.C.), Comparative Pathology Laboratory (A.G.-F.), and Department of Biostatistics and Medical Informatics (J.B.), University of Wisconsin-Madison, Madison, Wisconsin
| | - Ellen Leiferman
- Departments of Orthopedics and Rehabilitation (M.A.H., B.H., E.L., R.C., H.M.H.-S., R.M., and R.L.) and Animal Sciences (L.A.A. and T.D.C.), Comparative Pathology Laboratory (A.G.-F.), and Department of Biostatistics and Medical Informatics (J.B.), University of Wisconsin-Madison, Madison, Wisconsin
| | - Annette Gendron-Fitzpatrick
- Departments of Orthopedics and Rehabilitation (M.A.H., B.H., E.L., R.C., H.M.H.-S., R.M., and R.L.) and Animal Sciences (L.A.A. and T.D.C.), Comparative Pathology Laboratory (A.G.-F.), and Department of Biostatistics and Medical Informatics (J.B.), University of Wisconsin-Madison, Madison, Wisconsin
| | - Rajeev Chaudhary
- Departments of Orthopedics and Rehabilitation (M.A.H., B.H., E.L., R.C., H.M.H.-S., R.M., and R.L.) and Animal Sciences (L.A.A. and T.D.C.), Comparative Pathology Laboratory (A.G.-F.), and Department of Biostatistics and Medical Informatics (J.B.), University of Wisconsin-Madison, Madison, Wisconsin
| | - Heather M. Hartwig-Stokes
- Departments of Orthopedics and Rehabilitation (M.A.H., B.H., E.L., R.C., H.M.H.-S., R.M., and R.L.) and Animal Sciences (L.A.A. and T.D.C.), Comparative Pathology Laboratory (A.G.-F.), and Department of Biostatistics and Medical Informatics (J.B.), University of Wisconsin-Madison, Madison, Wisconsin
| | - Ronald McCabe
- Departments of Orthopedics and Rehabilitation (M.A.H., B.H., E.L., R.C., H.M.H.-S., R.M., and R.L.) and Animal Sciences (L.A.A. and T.D.C.), Comparative Pathology Laboratory (A.G.-F.), and Department of Biostatistics and Medical Informatics (J.B.), University of Wisconsin-Madison, Madison, Wisconsin
| | - Rachel Lenhart
- Departments of Orthopedics and Rehabilitation (M.A.H., B.H., E.L., R.C., H.M.H.-S., R.M., and R.L.) and Animal Sciences (L.A.A. and T.D.C.), Comparative Pathology Laboratory (A.G.-F.), and Department of Biostatistics and Medical Informatics (J.B.), University of Wisconsin-Madison, Madison, Wisconsin
| | - Matthew Chin
- Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania
| | - Jennifer Birstler
- Departments of Orthopedics and Rehabilitation (M.A.H., B.H., E.L., R.C., H.M.H.-S., R.M., and R.L.) and Animal Sciences (L.A.A. and T.D.C.), Comparative Pathology Laboratory (A.G.-F.), and Department of Biostatistics and Medical Informatics (J.B.), University of Wisconsin-Madison, Madison, Wisconsin
| | - Thomas D. Crenshaw
- Departments of Orthopedics and Rehabilitation (M.A.H., B.H., E.L., R.C., H.M.H.-S., R.M., and R.L.) and Animal Sciences (L.A.A. and T.D.C.), Comparative Pathology Laboratory (A.G.-F.), and Department of Biostatistics and Medical Informatics (J.B.), University of Wisconsin-Madison, Madison, Wisconsin,Swine Research and Teaching Center, Arlington, Wisconsin,E-mail address for T.D. Crenshaw:
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Barrios C, Lloris JM, Alonso J, Maruenda B, Burgos J, Llombart-Blanco R, Gil L, Bisbal V. Novel porcine experimental model of severe progressive thoracic scoliosis with compensatory curves induced by interpedicular bent rigid temporary tethering. J Orthop Res 2018; 36:174-182. [PMID: 28548698 DOI: 10.1002/jor.23617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 05/19/2017] [Indexed: 02/04/2023]
Abstract
UNLABELLED Using flexible tethering techniques, porcine models of experimental scoliosis have shown scoliotic curves with vertebral wedging but very limited axial rotation. The aim of this experimental work was to induce a severe progressive scoliosis in a growing porcine model for research purposes. A unilateral spinal bent rigid tether was anchored to two ipsilateral pedicle screws in eight pigs. The spinal tether was removed after 8 weeks. Ten weeks later, the animals were sacrificed. Conventional radiographs and 3D CT-scans were taken to evaluate changes in the alignment of the thoracic spine. After the first 8 weeks of rigid tethering, all animals developed scoliotic curves (mean Cobb angle: 24.3°). Once the interpedicular tether was removed, the scoliotic curves progressed in all animals during 10 weeks reaching a mean Cobb angle of 49.9°. The sagittal alignment of the thoracic spine showed loss of physiologic kyphosis (Mean: -18.3°). Axial rotation ranged from 10° to 49° (Mean 25.7°). Release of the spinal tether results in progression of the deformity with the development of proximal and distal compensatory curves. In conclusion, temporary interpedicular tethering at the thoracic spine induces severe scoliotic curves in pigs, with significant wedging and rotation of the vertebral bodies, and true compensatory curves. CLINICAL RELEVANCE The tether release model will be used to evaluate corrective non-fusion technologies in future investigations. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:174-182, 2018.
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Affiliation(s)
- Carlos Barrios
- lnstitute for Research on Musculoskeletal Disorders, Valencia Catholic University, Valencia, Spain
| | - José Miguel Lloris
- Department of Surgery, Valencia University Medical School, Valencia, Spain
| | - Juan Alonso
- lnstitute for Research on Musculoskeletal Disorders, Valencia Catholic University, Valencia, Spain
| | - Borja Maruenda
- Department of Orthopedic Surgery, Hospital de la Ribera, Alzira, Valencia, Spain
| | - Jesús Burgos
- Division of Pediatric Orthopedics, Hospital Ramon y Cajal, Madrid, Spain
| | | | - Luis Gil
- lnstitute for Research on Musculoskeletal Disorders, Valencia Catholic University, Valencia, Spain
| | - Viviana Bisbal
- Animal Facility Services, Prince Felipe Research Center, Valencia, Spain
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7
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Sun D, McCarthy M, Dooley AC, Ramakrishnaiah RH, Shelton RS, McLaren SG, Skinner RA, Suva LJ, McCarthy RE. Utility of an allograft tendon for scoliosis correction via the costo-transverse foreman. J Orthop Res 2017; 35:183-192. [PMID: 26990453 DOI: 10.1002/jor.23231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 02/25/2016] [Indexed: 02/04/2023]
Abstract
Current convex tethering techniques for treatment of scoliosis have centered on anterior convex staples or polypropylene tethers. We hypothesized that an allograft tendon tether inserted via the costo-transverse foramen would correct an established spinal deformity. In the pilot study, six 8-week-old pigs underwent allograft tendon tethering via the costo-transverse foreman or sham to test the strength of the transplanted tendon to retard spine growth. After 4 months, spinal deformity in three planes was induced in all animals with allograft tendons. In the treatment study, the allograft tendon tether was used to treat established scoliosis in 11 8-week-old pigs (spinal deformity > 50°). Once the deformity was observed (4 months) animals were assigned to either no treatment group or allograft tendon tether group and progression assessed by monthly radiographs. At final follow-up, coronal Cobb angle and maximum vertebral axial rotation of the treatment group was significantly smaller than the non-treatment group, whereas sagittal kyphosis of the treatment group was significantly larger than the non-treatment group. In sum, a significant correction was achieved using a unilateral allograft tendon spinal tether, suggesting that an allograft tendon tethering approach may represent a novel fusion-less procedure to correct idiopathic scoliosis. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:183-192, 2017.
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Affiliation(s)
- Dong Sun
- Orthopedic Department of Southwest Hospital, Third Military Medical University, 30 Gao Tan-Yan Road, Chongqing 400038, P.R. China.,Department of Orthopedic Surgery, Center for Orthopedic Research University of Arkansas for Medical Sciences, 4301 W. Markham, Slot 644, Little Rock 72205, Arkansas
| | - Michael McCarthy
- Department of Orthopedic Surgery, Center for Orthopedic Research University of Arkansas for Medical Sciences, 4301 W. Markham, Slot 644, Little Rock 72205, Arkansas
| | - Adam C Dooley
- Department of Orthopedic Surgery, Center for Orthopedic Research University of Arkansas for Medical Sciences, 4301 W. Markham, Slot 644, Little Rock 72205, Arkansas
| | - Raghu H Ramakrishnaiah
- Department of Radiology, Arkansas Children's Hospital, 1 Children's Way, Slot 839, Little Rock 72202, Arkansas
| | - R Shane Shelton
- Department of Orthopedic Surgery, Center for Orthopedic Research University of Arkansas for Medical Sciences, 4301 W. Markham, Slot 644, Little Rock 72205, Arkansas
| | - Sandra G McLaren
- Department of Orthopedic Surgery, Center for Orthopedic Research University of Arkansas for Medical Sciences, 4301 W. Markham, Slot 644, Little Rock 72205, Arkansas
| | - Robert A Skinner
- Department of Orthopedic Surgery, Center for Orthopedic Research University of Arkansas for Medical Sciences, 4301 W. Markham, Slot 644, Little Rock 72205, Arkansas
| | - Larry J Suva
- Department of Orthopedic Surgery, Center for Orthopedic Research University of Arkansas for Medical Sciences, 4301 W. Markham, Slot 644, Little Rock 72205, Arkansas
| | - Richard E McCarthy
- Department of Orthopedic Surgery, Center for Orthopedic Research University of Arkansas for Medical Sciences, 4301 W. Markham, Slot 644, Little Rock 72205, Arkansas.,Department of Orthopedic Surgery, Arkansas Children's Hospital, 1 Children's Way, Slot 839, Little Rock 72202, Arkansas
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Bobyn JD, Little DG, Gray R, Schindeler A. Animal models of scoliosis. J Orthop Res 2015; 33:458-67. [PMID: 25492698 DOI: 10.1002/jor.22797] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 12/03/2014] [Indexed: 02/04/2023]
Abstract
Multiple techniques designed to induce scoliotic deformity have been applied across many animal species. We have undertaken a review of the literature regarding experimental models of scoliosis in animals to discuss their utility in comprehending disease aetiology and treatment. Models of scoliosis in animals can be broadly divided into quadrupedal and bipedal experiments. Quadrupedal models, in the absence of axial gravitation force, depend upon development of a mechanical asymmetry along the spine to initiate a scoliotic deformity. Bipedal models more accurately mimic human posture and consequently are subject to similar forces due to gravity, which have been long appreciated to be a contributing factor to the development of scoliosis. Many effective models of scoliosis in smaller animals have not been successfully translated to primates and humans. Though these models may not clarify the aetiology of human scoliosis, by providing a reliable and reproducible deformity in the spine they are a useful means with which to test interventions designed to correct and prevent deformity.
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Affiliation(s)
- Justin D Bobyn
- Orthopaedic Research & Biotechnology Unit, The Children's Hospital at Westmead, Sydney, Australia; Discipline of Paediatrics and Child Health, Faculty of Medicine, University of Sydney, Sydney, Australia
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Burke JG, Vettorato E, Schöffmann G, Clutton RE, Drew TS, Gibson JNA. Creation of an ovine model of progressive structural lordo-scoliosis using a unilateral laminar tether. 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 2014; 24:1382-90. [DOI: 10.1007/s00586-014-3609-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Revised: 09/30/2014] [Accepted: 10/01/2014] [Indexed: 10/24/2022]
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10
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Roth AK, Bogie R, Jacobs E, Arts JJ, van Rhijn LW. Large animal models in fusionless scoliosis correction research: a literature review. Spine J 2013; 13:675-88. [PMID: 23582429 DOI: 10.1016/j.spinee.2013.02.043] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 02/18/2013] [Accepted: 02/18/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Numerous prenatal, systemic, or local procedures have been described that have created an experimental scoliosis within different animal species. Compression-based fusionless scoliosis correction devices have been used to induce scoliosis (inverse approach) as an indication for their potential corrective efficacy in large animals. Deformities that most closely approximate the three-dimensional nature of an idiopathic-like scoliosis have been created in large animals using a posterior spinal tether. Fusionless scoliosis correction devices have subsequently been tested in these models. PURPOSE To provide an overview of large animal models used for preclinical testing of fusionless scoliosis correction devices and to describe recent advances in the creation of an idiopathic-like scoliosis large animal model. STUDY DESIGN Literature review of large animal models in fusionless scoliosis correction research. METHODS MEDLINE electronic database was searched for studies in which large animal models for spinal or vertebral growth modulation or the creation of an experimental scoliosis were described. The literature search was limited to articles written in the English language. RESULTS The pig appears to be the most suitable animal species for preclinical testing of fusionless scoliosis correction devices because of its large growth potential and the possibility for early weaning. With the inverse approach, it is difficult to gain insight into the possible corrective efficacy of the tested device, and therefore, a two-step approach is preferred. Using a posterior spinal tether, persistent spinal deformities are attained when the deformity has approximately doubled in comparison to the postoperative measure in a time span of approximately 12 weeks. Sufficient tether midline offset is required to render rib procedures unnecessary. CONCLUSIONS An idiopathic-like scoliosis animal model can be created using a posterior spinal tether in a fully reversible procedure. Experimental results will need to be reproduced to establish a standard idiopathic-like scoliosis large animal model.
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Affiliation(s)
- Alex K Roth
- Department of Orthopaedic Surgery, Research School Caphri, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
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Ouellet J, Odent T. Animal models for scoliosis research: state of the art, current concepts and future perspective applications. 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 2013; 22 Suppl 2:S81-95. [PMID: 23099524 PMCID: PMC3616476 DOI: 10.1007/s00586-012-2396-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 05/21/2012] [Accepted: 05/28/2012] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this study was to provide the readers with a reliable source of animal models currently being utilized to perform state-of-the-art scoliotic research. MATERIALS AND METHODS A comprehensive search was undertaken to review all publications on animal models for the study of scoliosis within the database from 1946 to January 2011. RESULTS The animal models have been grouped under specific headings reflecting the underlying pathophysiology behind the development of the spinal deformities produced in the animals: genetics, neuroendocrine, neuromuscular, external constraints, internal constraints with or without tissue injury, vertebral growth modulation and iatrogenic congenital malformations, in an attempt to organize and classify these multiple scoliotic animal models. As it stands, there are no animal models that mimic the human spinal anatomy with all its constraints and weaknesses, which puts it at risk of developing scoliosis. What we do have are a multitude of models, which produce spinal deformities that come close to the idiopathic scoliosis deformity. CONCLUSION All these different animal models compel us to believe that the clinical phenotype of what we call idiopathic scoliosis may well be caused by a variety of different underlying pathologies.
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Affiliation(s)
- Jean Ouellet
- />McGill Scoliosis and Spinal Research Chair, Deputy Chief Shriners Hospital, Montreal, Canada
- />Division of Orthopaedic Surgery, McGill University Health Hospital, Centre, Montreal Children Hospital, 2300 Tupper Street, Montreal, QC H3H 1P3 Canada
| | - Thierry Odent
- />Department of Orthopaedic Surgery, Hopital des Enfants Malade, Necker, Paris Descartes, France
- />Université Paris Descartes - Sorbonne Paris Cité - Service d’orthopédie pédiatrique - Hôpital Universitaire Necker - Enfants-Malades, Paris, France
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Abstract
Early Onset Scoliosis (EOS) may be associated with long-term pulmonary morbidity, which is not commonly seen in Adolescent Idiopathic Scoliosis. Initial evaluation is based on determining any underlying etiology related to congenital or syndromic conditions. Assessing the impact of scoliosis on thoracic development may help guide treatment, which is often required at a young age in these children to prevent irreversible pulmonary insufficiency. Treatment is based on multiple factors but may include non-surgical strategies, such as casting or bracing, along with growth-sparing surgical procedures using growing rods or chest wall expansion. Definitive fusion is rarely indicated in young patients. This chapter will cover the diagnosis, evaluation, and treatment of children with EOS.
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Affiliation(s)
- Nicholas D Fletcher
- Emory University Orthopaedics and Spine Center, 59 Executive Park South NE, Atlanta, GA, 30329, USA,
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Porcine model of early onset scoliosis based on animal growth created with posterior mini-invasive spinal offset tethering: a preliminary report. 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 2011; 20:1869-76. [PMID: 21559770 DOI: 10.1007/s00586-011-1830-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2009] [Revised: 04/15/2011] [Accepted: 04/20/2011] [Indexed: 10/18/2022]
Abstract
Several models of scoliosis were developed in the past 10 years. In most of them, deformations are induced in old animals and required long time observation period and a chest wall ligation ± resection. The purpose of the study was to create a scoliosis model with a size similar to an early onset scoliosis and an important growth potential without chest wall injuring. An original offset implant was fixed posteriorly and connected with a cable in seven (6 + 1 control) one-month-old Landrace pigs. The mean initial spinal length (T1-S1) was 25 cm and the mean weight was 9 kg. After 2 months observation, spinal deformities were assessed with a three dimension stereographic analysis. In four animals, the cable was sectioned and the deformities followed-up for next 2 months. No post-operative complication was observed. Mean weight growth was 10 kg/month and mean spine lengthening (T1-S1) was 7 cm/month. In 2 months, we obtained structural scoliotic curves with vertebral and disk wedging which were maximal at the apex of the curve. Mean frontal and sagittal Cobb angles was 45°. Chest wall associated deformities were similar to those observed in scoliotic deformities and were correlated to spinal deformities (p = 0.03). The cable section resulted in a partial curve regression influenced by disk elasticity and could probably be influenced by gravity loads (Decrease of the Cobb angle of 30% in the sagittal plane and 45% in the frontal plane). According to the results, the model creates a structural scoliosis and chest wall deformity that is similar to an early onset scoliosis. The spinal deformities were obtained quickly, and were consistent between animals in term of amount and characteristic.
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