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Speirs JN, Parent S, Kelly M, Upasani VV, Petcharaporn M, Bryan TP, Newton PO. Three-dimensional vertebral shape changes confirm growth modulation after anterior vertebral body tethering for idiopathic scoliosis. Spine Deform 2024; 12:1017-1024. [PMID: 38578599 DOI: 10.1007/s43390-024-00856-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/26/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE To evaluate three-dimensional (3D) vertebra and disk shape changes over 2 years following anterior vertebral body tether (AVBT) placement in patients with idiopathic scoliosis (IS). METHODS Patients with right thoracic IS treated with AVBT were retrospectively evaluated. 3D reconstructions were created from biplanar radiographs. Vertebral body and disk height (anterior, posterior, left and right) and shape (wedging angle) were recorded over the three apical segments in the local vertebral reference planes. Changes in height and wedging were measured through 2 years postoperatively. Change in patient height was correlated with changes in the spine dimensions. RESULTS Forty-nine patients (Risser 0-3, Sanders 2-4) were included. The mean age was 12.2 ± 1.4 years (range 8-14). The mean coronal curve was 51 ± 10° preoperatively, 31 ± 9° at first postoperative time point and 27 ± 11° at 2-year follow-up (p < 0.001). The mean patient height increased 8 cm by 2 years (p < 0.001). The left side of the spine (vertebra + disc) grew in height by 2.2 mm/level versus 0.7 mm/level on the right side (p < 0.001). This differential growth was composed of 0.5 mm/vertebral level and 1.0 mm/disk level. Evaluation of the change in disk heights showed significantly decreased height anteriorly (- 0.4 mm), posteriorly (- 0.3 mm) and on the right (- 0.5 mm) from FE to 2 years. Coronal wedging reduced 2.3°/level with 1.1°/vertebral level change and 1.2°/disk level. There was no differential growth in the sagittal plane (anterior/posterior height). Patient height change moderately correlated with 3D measures of vertebra + disk shape changes. CONCLUSIONS Three-dimensional analysis confirms AVBT in skeletally immature patients results in asymmetric growth of the apical spine segments. The left (untethered) side length increased more than 3 × than the right (tethered) side length with differential effects observed within the vertebral bodies and disks, each correlating with overall patient height change.
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Affiliation(s)
- Joshua N Speirs
- Department of Orthopedics, University of Utah, Salt Lake City, UT, USA
| | - Stefan Parent
- Department of Orthopaedics, CHU Sainte-Justine, Montreal, QC, Canada
- Department of Surgery, University of Montreal, Montréal, QC, Canada
| | - Michael Kelly
- Division of Orthopedics and Scoliosis, Rady Children's Hospital, 3020 Children's Way, San Diego, CA, 92123, USA
- Department of Orthopaedics, University of California, San Diego, CA, USA
| | - Vidyadhar V Upasani
- Division of Orthopedics and Scoliosis, Rady Children's Hospital, 3020 Children's Way, San Diego, CA, 92123, USA
- Department of Orthopaedics, University of California, San Diego, CA, USA
| | | | - Tracey P Bryan
- Division of Orthopedics and Scoliosis, Rady Children's Hospital, 3020 Children's Way, San Diego, CA, 92123, USA
| | - Peter O Newton
- Division of Orthopedics and Scoliosis, Rady Children's Hospital, 3020 Children's Way, San Diego, CA, 92123, USA.
- Department of Orthopaedics, University of California, San Diego, CA, USA.
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Louer CR, Upasani VV, Hurry JK, Nian H, Farnsworth CL, Newton PO, Parent S, El-Hawary R. Growth modulation response in vertebral body tethering depends primarily on magnitude of concave vertebral body growth. Spine Deform 2024:10.1007/s43390-024-00909-9. [PMID: 38834863 DOI: 10.1007/s43390-024-00909-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 05/25/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE There is variability in clinical outcomes with vertebral body tethering (VBT) partly due to a limited understanding of the growth modulation (GM) response. We used the largest sample of patients with 3D spine reconstructions to characterize the vertebra and disc morphologic changes that accompany growth modulation during the first two years following VBT. METHODS A multicenter registry was used to identify idiopathic scoliosis patients who underwent VBT with 2 years of follow-up. Calibrated biplanar X-rays obtained at longitudinal timepoints underwent 3D reconstruction to obtain precision morphological measurements. GM was defined as change in instrumented coronal angulation from post-op to 2-years. RESULTS Fifty patients (mean age: 12.5 ± 1.3yrs) were analyzed over a mean of 27.7 months. GM was positively correlated with concave vertebra height growth (r = 0.57, p < 0.001), 3D spine length growth (r = 0.36, p = 0.008), and decreased convex disc height (r = - 0.42, p = 0.002). High modulators (patients experiencing GM > 10°) experienced an additional 1.6 mm (229% increase) of mean concave vertebra growth during study period compared to the Poor Modulators (GM < - 10°) group, (2.3 vs. 0.7 mm, p = 0.039), while convex vertebra height growth was similar (1.3 vs. 1.4 mm, p = 0.91). CONCLUSION When successful, VBT enables asymmetric vertebra body growth, leading to continued postoperative coronal angulation correction (GM). A strong GM response is correlated with concave vertebral body height growth and overall instrumented spine growth. A poor GM response is associated with an increase in convex disc height (suspected tether rupture). Future studies will investigate the patient and technique-specific factors that influence increased growth remodeling.
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Affiliation(s)
- Craig R Louer
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, 2200 Childrens Way, Suite 4202, Nashville, TN, 37212, USA.
| | - Vidyadhar V Upasani
- Department of Orthopedics, Rady Children's Hospital, San Diego, CA, USA
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA, USA
| | - Jennifer K Hurry
- Division of Orthopaedic Surgery, IWK Health Centre, Halifax, NS, Canada
| | - Hui Nian
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, 2200 Childrens Way, Suite 4202, Nashville, TN, 37212, USA
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Peter O Newton
- Department of Orthopedics, Rady Children's Hospital, San Diego, CA, USA
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA, USA
| | - Stefan Parent
- Department of Surgery, Faculty of Medicine, Universite´ de Montre´Al, Montre´Al, QC, Canada
| | - Ron El-Hawary
- Division of Orthopaedic Surgery, IWK Health Centre, Halifax, NS, Canada
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Shaw KA, Miyanji F, Bryan T, Parent S, Newton PO, Murphy JS. Vertebral body tethering for Lenke 1A curves: the lumbar modifier predicts less optimal outcomes. Spine Deform 2024; 12:663-670. [PMID: 38340229 DOI: 10.1007/s43390-023-00815-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/23/2023] [Indexed: 02/12/2024]
Abstract
INTRODUCTION The addition of the L4 "AR" and "AL" lumbar modifier for Lenke 1A idiopathic scoliosis (IS) has been shown to direct treatment in posterior spinal fusion; however, its utility in vertebral body tethering (VBT) has yet to be evaluated. METHODS A review of a prospective, multicenter database for VBT in IS was performed for patients with Lenke 1A deformities and a minimum of 2 years follow-up. Patients were categorized by their lumbar modifier (AR vs AL). Less optimal VBT outcome (LOVO) was defined as a final coronal curve > 35°, lumbar adding-on, or revision surgery for deformity progression or adding-on. RESULTS Ninety-nine patients met inclusion criteria (81% female, mean 12.6 years), with 55.6% being AL curves. Overall, there were 23 instances of tether breakage (23.3%) and 20 instances of LOVO (20.2%). There was a higher rate of LOVO in AR curves (31.8% vs 10.9%, P = 0.01). Patients with LOVO had greater preoperative deformity, greater apical translation, larger coronal deformity on first erect radiographs, and less coronal deformity correction. Failure to correct the deformity < 30° on first erect was associated with LOVO, as was LIV selection short of the last touch vertebra (TV). Independent risk factors for LOVO included AR curves (OR 3.4; P = 0.04) and first erect curve magnitudes > 30 degrees (OR 6.0; P = 0.002). DISCUSSION There is a 20.2% rate of less optimal VBT following VBT for Lenke 1A curves. AR curves are independently predictive of less optimal outcomes following VBT and require close attention to LIV selection. Surgeons should consider achieving an initial coronal correction < 30 degrees and extending the LIV to at least the TV to minimize the risk of LOVO.
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Affiliation(s)
- K Aaron Shaw
- Department of Pediatric Orthopaedic Surgery, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Firoz Miyanji
- Department of Orthopaedic Surgery, BC Children's Hospital, Vancouver, BC, Canada
| | - Tracey Bryan
- Department of Orthopaedic Surgery, Rady's Children's Hospital, San Diego, CA, USA
| | - Stefan Parent
- Department of Orthopaedic Surgery, University of Montreal, Montreal, QC, Canada
| | - Peter O Newton
- Department of Orthopaedic Surgery, Rady's Children's Hospital, San Diego, CA, USA
| | - Joshua S Murphy
- Department of Pediatric Orthopaedic Surgery, CPG-Orthopaedics, Children's Healthcare of Atlanta Scottish Rite, Atlanta, GA, USA.
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Photopoulos G, Hurry J, Bansal A, Miyanji F, Parent S, Murphy J, El-Hawary R. Differential vertebral body growth is maintained after vertebral body tethering surgery for idiopathic scoliosis: 4-year follow-up on 888 peri-apical vertebrae and 592 intervertebral discs. Spine Deform 2024:10.1007/s43390-024-00874-3. [PMID: 38634997 DOI: 10.1007/s43390-024-00874-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 03/30/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE To radiographically evaluate if vertebral body tethering (VBT) can maintain differential peri-apical vertebral growth at medium-term follow-up of 4 years. METHODS A prospective, international, multicenter database was queried to identify idiopathic scoliosis patients treated with thoracic VBT. Concave vs. convex vertebral body height, vertebral wedging, and disc wedging of the 3 peri-apical vertebrae were measured by two independent observers at 5 timepoints (pre-operative to 4-year follow-up). RESULTS 65 skeletally immature patients (60 female, mean 12.8 years old, 21 with open triradiate cartilages) met inclusion criteria. Mean pre-operative maximum scoliosis of 50 ± 8° decreased significantly post-operatively to 27 ± 9° (p < 0.001), which remained stable at 4-year follow-up 30 ± 17° (p = 0.38 vs. post-operative). Mean instrumented scoliosis was 21 ± 14° at 4-year follow-up, which was significantly different than 4-year maximum scoliosis (p < 0.001). Mean pre-operative kyphosis of 30 ± 12° did not significantly change post-operatively (p = 1.0) and remained stable at 4-year follow-up (35 ± 18°; p = 0.05). Mean individual convex vertebral height increased from 17.7 ± 1.9 mm to 19.8 ± 1.5 mm (p < 0.001), while mean individual concave height increased from 14.8 ± 1.9 mm to 17.6 ± 1.6 mm (p < 0.001). Summing the peri-apical heights, the difference in height from pre-operative to 4-year follow-up was greater on the concave (8.3 ± 4.7 mm) than on the convex side (6.2 ± 4.7 mm) (p < 0.001). Mean individual vertebral wedging decreased from 6 ± 2° at pre-operative to 4 ± 2° at 4-year follow-up (p < 0.001). Mean total vertebral and disc wedging started at 29 ± 7° pre-operatively, decreased to 16 ± 6° at post-operative (p < 0.001), then further decreased to 14 ± 8° at 4-year follow-up (p < 0.001). Patients with open triradiate cartilages at the time of surgery had a larger height change over the 4 years compared to those with closed triradiate cartilages (p < 0.001). CONCLUSION Patients with idiopathic scoliosis treated with VBT demonstrated differential vertebral growth which was maintained at minimum 4-year follow-up. This effect was more pronounced in patients whose triradiate cartilages were open at the time of surgery. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Gregory Photopoulos
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Division of Orthopedic Surgery, IWK Health Centre, Orthopaedic Clinic, IWK Health Centre, 5850 University Avenue, PO Box 9700, Halifax, NS, B3K 6R8, Canada
| | - Jennifer Hurry
- Division of Orthopedic Surgery, IWK Health Centre, Orthopaedic Clinic, IWK Health Centre, 5850 University Avenue, PO Box 9700, Halifax, NS, B3K 6R8, Canada
| | - Ankita Bansal
- Division of Orthopedic Surgery, IWK Health Centre, Orthopaedic Clinic, IWK Health Centre, 5850 University Avenue, PO Box 9700, Halifax, NS, B3K 6R8, Canada
| | - Firoz Miyanji
- Orthopaedics Research Department, BC Children's Hospital, Vancouver, BC, Canada
| | - Stefan Parent
- Department of Orthopaedics, CHU Sainte-Justine, Montreal, QC, Canada
- Department of Surgery, University of Montreal, Montreal, QC, Canada
| | - Joshua Murphy
- Department of Orthopaedic Surgery, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Ron El-Hawary
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
- Division of Orthopedic Surgery, IWK Health Centre, Orthopaedic Clinic, IWK Health Centre, 5850 University Avenue, PO Box 9700, Halifax, NS, B3K 6R8, Canada.
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Shah SA, Kraft DB, Miyanji F. Anterior Vertebral Body Tethering: A Review of the Available Evidence. J Am Acad Orthop Surg 2024; 32:247-256. [PMID: 38271681 DOI: 10.5435/jaaos-d-23-00312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 12/17/2023] [Indexed: 01/27/2024] Open
Abstract
Idiopathic scoliosis is a complex three-dimensional deformity of the spine with anterior overgrowth (hypokyphosis), coronal curvature, and axial rotation. Scoliosis treatment in the skeletally immature spine is therapeutically challenging because of growth and was commonly limited to observation, bracing treatment, or fusion. Fusion accomplishes powerful deformity correction at the expense of future growth and mobility of the involved segments, increasing the risk of adjacent segment degeneration and intervertebral disk disease later in life. Anterior vertebral body tethering is a motion-preserving technique that exploits the Hueter-Volkmann principle by applying compression at the anterior and convex aspects of the curve to stimulate differential vertebral growth for gradual deformity reduction without fusion. The appropriate timing, curve magnitude, tensioning, growth prediction, indications, and limitations of tethering are being refined as this technique becomes more prevalent. Early outcome studies show that growth modulation with vertebral body tethering is safe, can achieve good results, and preserve motion in select patients.
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Affiliation(s)
- Suken A Shah
- From the Department of Orthopaedic Surgery, Nemours Children's Health, Wilmington, DE (Shah), the Department of Orthopaedic Surgery, MedStar Georgetown University Hospital, Washington, DC (Dr. Kraft), and the Department of Orthopaedic Surgery, British Columbia Children's Hospital, Vancouver, British Columbia, Canada (Dr. Miyanji)
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Mladenov KV, Pinnschmidt HO, Stücker R. Anterior Vertebral Body Tethering for Skeletally Immature Patients with AIS: Indication for Spinal Fusion at Skeletal Maturity Is Not Obviated in 60% of Cases. J Clin Med 2023; 12:3933. [PMID: 37373628 DOI: 10.3390/jcm12123933] [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: 04/19/2023] [Revised: 05/30/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
The role of anterior vertebral body tethering (aVBT) in obviating the need for spinal fusion in patients with AIS remains unclear, and a large amount of variation exists in the data among different studies. The present study aims to investigate and analyze what factors have a potential influence on aVBT outcome. Skeletally immature patients with AIS who underwent aVBT for scoliosis correction were followed up until skeletal maturity. The mean age at the time of surgery was 13.4 ± 1.1, and the mean follow-up time was 2.5 ± 0.5 years. The Cobb angle of the main curve was 46.6 ± 9° at the time of surgery and was significantly corrected to 17.7 ± 10.4° (p < 0.001) immediately postoperatively. A significant loss of correction was observed during the latest follow-up (Cobb angle 33.8 ± 18.7°; p < 0.001). An indication for spinal fusion at skeletal maturity was not obviated in 60% of the patients. The factors identified as having an influence on the outcome were preoperative bone age and the magnitude of the major curve. Patients with advanced bone age and larger curves were more likely to reach an indication for spinal fusion at skeletal maturity. In conclusion, no general recommendation for aVBT can be made for AIS patients. The method can be discussed as a treatment option in skeletally very immature preadolescent patients (Sanders Stadium ≤ 2) with a moderate Cobb angle (≤50°) who failed previous brace therapy.
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Affiliation(s)
- Kiril V Mladenov
- Pediatric Orthopedic Department, Altona Children's Hospital, Bleickenallee 38, D-22763 Hamburg, Germany
- Department of Orthopedics, University Medical Center Hamburg-Eppendorf, D-20246 Hamburg, Germany
| | - Hans O Pinnschmidt
- Center for Experimental Medicine, Institute for Medical Biometry & Epidemiology, University Medical Center Hamburg-Eppendorf, Chrisoph-Probst-Weg 1, D-20246 Hamburg, Germany
| | - Ralf Stücker
- Pediatric Orthopedic Department, Altona Children's Hospital, Bleickenallee 38, D-22763 Hamburg, Germany
- Department of Orthopedics, University Medical Center Hamburg-Eppendorf, D-20246 Hamburg, Germany
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Trobisch PD, Castelein R, Da Paz S. Radiographic outcome after vertebral body tethering of the lumbar spine. 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 2023:10.1007/s00586-023-07740-2. [PMID: 37133761 DOI: 10.1007/s00586-023-07740-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/21/2023] [Accepted: 04/22/2023] [Indexed: 05/04/2023]
Abstract
INTRODUCTION Multiple studies have analyzed the outcome after thoracic Vertebral Body Tethering (VBT). The results seem reproducible with most studies reporting coronal correction rates around 50% and a tether breakage rate near 20% at two years follow-up. There is a paucity of data on lumbar VBT, and no study has yet analyzed the radiographic outcome after lumbar VBT in a double tether technique at two years follow-up, which was the aim of this study. METHODS This is a retrospective, single surgeons' data analysis of all consecutive immature patients who have had VBT of the lumbar spine (to L3 or L4) between January 2019 and September 2020. Primary interest focused on coronal curve correction at two years post-operatively. Suspected tether breakages were analyzed separately and defined as an angular change of more than 5° between two adjacent screws. RESULTS Forty-one patients were eligible for this study and 35 (85%) had complete two-year follow-up data. Average age at surgery was 14.3 years. All patients had a Sanders stage of 7 or below. Average curve correction for thoracolumbar/lumbar curves at two years follow-up was 50%. 90% of patients had at least one level with a suspected tether breakage. No patient required a revision surgery within two years from surgery but two patients were surgically revised after two years. CONCLUSION VBT in the lumbar spine resulted in 50% coronal curve correction two years post-operatively despite a tether breakage in 90% of patients.
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Affiliation(s)
- Per D Trobisch
- Eifelklinik St. Brigida, Spine Surgery, Kammerbruchstr. 8, 52152, Simmerath, Germany.
| | - Rene Castelein
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CZ, Utrecht, The Netherlands
| | - Stephanie Da Paz
- Eifelklinik St. Brigida, Spine Surgery, Kammerbruchstr. 8, 52152, Simmerath, 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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Vertebral Body Tethering: Indications, Surgical Technique, and a Systematic Review of Published Results. J Clin Med 2022; 11:jcm11092576. [PMID: 35566702 PMCID: PMC9099651 DOI: 10.3390/jcm11092576] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/28/2022] [Accepted: 04/30/2022] [Indexed: 02/01/2023] Open
Abstract
Vertebral body tethering (VBT) represents a new surgical technique to correct idiopathic scoliosis using an anterior approach, spinal instrumentation with vertebral body screws, and a cable compressing the convexity of the curve. According to the Hueter-Volkmann principle, compression reduces and distraction increases growth on the growth plates. VBT was designed to modulate spinal growth of vertebral bodies and hence, the term ‘growth modulation’ has also been used. This review describes the indications and surgical technique of VBT. Further, a systematic review of published studies was conducted to critically evaluate the results and complications of this technique. In a total of 23 included studies on 843 patients, the preoperative main thoracic curve corrected from 49 to 23 degrees in a minimum 2 year follow-up. The complication rate of VBT was 18%. The results showed that 15% of VBT patients required reoperations for pulmonary or tether-related issues (10%) and less than 5% required conversion to spinal fusion. While the reported median-term results of VBT appear promising, long-term results of this technique are currently lacking.
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