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Anaspure OS, Baumann AN, Crawford MT, Davis P, Ndjonko LCM, Anari JB, Baldwin KD. Segmental range-of-motion by vertebral level in fused and unfused patients with adolescent idiopathic scoliosis: a systematic review of the literature. Spine Deform 2024:10.1007/s43390-024-00978-w. [PMID: 39342538 DOI: 10.1007/s43390-024-00978-w] [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: 07/30/2024] [Accepted: 09/21/2024] [Indexed: 10/01/2024]
Abstract
PURPOSE This study aims to understand global and segmental spinal ROM in surgical and nonsurgical AIS patients. METHODS This systematic review examined segmental vertebral ROM in AIS patients using PubMed, SPORTDiscus, MEDLINE, and Web of Science until October 8th, 2023. Inclusion criteria were articles on segmental motion in AIS patients, both operative and non-operative, under 18 years old. RESULTS Seventeen articles met eligibility criteria from 2511 initially retrieved. All patients (n = 996) had AIS (549 non-operative; 447 were operative), with a frequency-weighted mean age of 15.1 ± 1.6 years and a baseline Cobb angle of 51.4 ± 13.3 degrees. Studies showed heterogenous segmental flexibility in the unfused spine, with the apical curve and upper thoracic segments being more rigid and lower segments more flexible at -5 disk segments from the apex. Most studies showed a predictable loss of motion in fused spinal regions postoperatively and a variable loss of global motion depending on the LIV and number of fused segments. A 7° global loss of total trunk flexion per level was observed with increasingly caudal LIV, starting at L1. Anterior vertebral body tethering (AVBT) preserved motion post-surgery but reduced coronal plane motion. AVBT saw less motion loss compared to posterior spinal fusion (PSF) but had higher revision and complication rates. CONCLUSION Preservation of spinal segments correlated with improved motion postoperatively. Increasing caudal LIV in PSF showed sagittal flexion loss. AVBT preserved more sagittal ROM than PSF but increased coronal motion loss, complications, and revision rates, with the largest benefit at LIV L4. Data on segmental motion are limited and further research on postoperative segmental ROM is required.
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Affiliation(s)
- Omkar S Anaspure
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Anthony N Baumann
- College of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Marc T Crawford
- Department of Physical Therapy, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Pierce Davis
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Laura C M Ndjonko
- Department of Biological Sciences, Northwestern University, Chicago, IL, USA
| | - Jason B Anari
- Department of Orthopedic Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19140, USA
| | - Keith D Baldwin
- Department of Orthopedic Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19140, USA.
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Neal KM, Krombholz K, Doshi M. Accuracy of screw placement during vertebral body tethering using fluoroscopic guidance and anatomic landmarks. Spine Deform 2024:10.1007/s43390-024-00970-4. [PMID: 39289292 DOI: 10.1007/s43390-024-00970-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 09/06/2024] [Indexed: 09/19/2024]
Abstract
PURPOSE To determine the accuracy of screw placement using fluoroscopy and anatomic landmarks during vertebral body tethering (VBT) surgery. METHODS Ten patients with 73 VBT screws were converted to posterior spinal fusion (PSF) after continued curve progression. The positions of each VBT screw were analyzed using intraoperative computed tomography (CT) scans performed for image guidance during VBT. Differences for screws placed using an open versus thoracoscopic approach were noted for the screw position in each vertebra, distance from the spinal canal, unicortical versus bicortical placement, the distance of screw tips from the thoracic aorta, and impingement of screws on adjacent rib heads. RESULTS Seventy three (73) screws in ten (10) patients were available for analysis. Only 21% of screws were placed traversing the middle one-third of the vertebral body, without spinal canal penetration, with the distal tip placed unicortically or bicortically as planned, and without touching the thoracic aorta. The rates of non-ideal screw placement were not significantly different for screws placed via thoracoscopic versus open approaches. Five (5) screws (6.8%) penetrated the spinal canal 1-2 mm, but without known clinical sequelae. CONCLUSION The majority of VBT screws available for analysis were placed in non-ideal positions, suggesting that accurate screw placement using intraoperative fluoroscopy and anatomic landmarks can be challenging, but without adverse clinical consequences.
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Affiliation(s)
- Kevin M Neal
- Orthopaedics Department, Nemours Children's Health, Jacksonville, FL, USA
| | - Kylie Krombholz
- Florida State University College of Medicine, Tallahassee, FL, USA
| | - Mona Doshi
- Orthopaedics Department, Nemours Children's Health, Orlando, FL, USA.
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Braun JT, Federico SC, Lawlor DM, Paschos NJ, Croitoru DP, Grottkau BE. Anterior vertebral tethering for adolescent idiopathic scoliosis: our initial ten year clinical experience. Spine Deform 2024; 12:1355-1367. [PMID: 38796815 PMCID: PMC11344032 DOI: 10.1007/s43390-024-00897-w] [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: 10/27/2023] [Accepted: 05/01/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Anterior vertebral tethering (AVT) is a minimally invasive alternative to fusion surgery for adolescent idiopathic scoliosis (AIS) that offers the potential for definitive scoliosis treatment with the possibility of preservation of the growth, motion, function and overall health of the spine. This study represents our first ten years using AVT to treat AIS. METHODS In this retrospective review we analyzed our first 74 AIS patients treated with AVT 2010-2020. Multiple Lenke curve types 33-70° were treated with skeletal maturity spanning Risser -1 to 5. RESULTS Of 74 consecutive AIS patients treated with AVT, 52 patients (47 female, 5 male) had sufficient 2-year follow-up for inclusion. Forty-six of these 52 patients (88%) with 65 curves (35T, 30TL/L) were satisfactorily treated with AVT demonstrating curve correction from 48.6° pre-op (range 33°-70°) at age 15.1 years (range 9.2-18.8) and skeletal maturity of Risser 2.8 (range -1 to 5) to 23.2° post-op (range 0°-54°) and 24.0° final (range 0°-49°) at 3.3 years follow-up (range 2-10 years). Curve corrections from pre-op to post-op and pre-op to final were both significant (p < 0.001). The 0.8° change from post-op to final was not significant but did represent good control of scoliosis correction over time. Thoracic kyphosis and lumbar lordosis were maintained in a normal range throughout while axial rotation demonstrated a slight trend toward improvement. Skeletal maturity of Risser 4 or greater was achieved in all but one patient. Four of the 52 patients (8%) required additional procedures for tether rupture (3 replacements) or overcorrection (1 removal) to achieve satisfactory treatment status after AVT. An additional 6 of the 52 patients (12%), however, were not satisfactorily treated with AVT, requiring fusion for overcorrection (2) or inadequate correction (4). CONCLUSIONS In this study, AIS was satisfactorily treated with AVT in the majority of patients over a broad range of curve magnitudes, curve types, and skeletal maturity. Though late revision surgery for overcorrection, inadequate correction, or tether rupture was not uncommon, the complication of overcorrection was eliminated after our first ten patients by a refinement of indications. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- John T Braun
- Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Yawkey 3E, Boston, MA, 02114, USA.
| | - Sofia C Federico
- Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Yawkey 3E, Boston, MA, 02114, USA
| | - David M Lawlor
- Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Yawkey 3E, Boston, MA, 02114, USA
| | - Nikolaos J Paschos
- Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Yawkey 3E, Boston, MA, 02114, USA
| | - Daniel P Croitoru
- Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Brian E Grottkau
- Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Yawkey 3E, Boston, MA, 02114, USA
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James L, O'Connell B, De Varona-Cocero A, Robertson D, Zervos M, Cerfolio RJ, Chang S, Bizekis C, Rodriguez-Olaverri JC. Chest tube management following two row vertebral body tethering for adolescent idiopathic scoliosis. Curr Med Res Opin 2024; 40:1449-1452. [PMID: 38979585 DOI: 10.1080/03007995.2024.2378175] [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: 03/26/2024] [Revised: 07/02/2024] [Accepted: 07/05/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND The current gold standard of scoliosis correction procedures is still posterior spinal fusion, an extensively studied procedure. anterior vertebral body tethering is a newer surgical technique for the correction of scoliotic curves. Consequently, best practices have yet to be determined. METHODS A single-institution, retrospective, review of all patients diagnosed with adolescent idiopathic scoliosis who underwent two row anterior vertebral body tethering between June 2020 and April 2022 was performed. RESULTS Over the study period, 95 patients met inclusion: 79 females (83.2%) and 16 males (16.8%), age 14.4 ± 2.5 years, with a body mass index of 20.0 ± 2.9, and an average of 8.4 ± 2.1 levels treated. 28 (29.5%) procedures were for double curves and 67 (70.5%) for single curves. After tethering, a chest tube was positioned in each corrected side. A total of 123 chest tubes were analyzed, including 67 single curves and 28 double curves. The average chest tube duration was 2.5 ± 1.1 days and the average length of stay was 5.0 ± 2.0 days. The average chest tube output eight hours prior to removal was 61.1 ± 45.6 mL. There was no significant difference in average length of stay for patients who underwent correction of a single curve versus a double curve nor was there a difference in average length of stay or chest tube duration for revisions compared to primary procedures. For the entire cohort, the 30-day emergency department visit rate was 7.4% (n = 7) and the readmission rate was 4.2% (n = 4). CONCLUSIONS This early review of a 2-year two row vertebral body tethering postoperative experience provides a report of a safe and effective approach to chest tube management at a single academic center.
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Affiliation(s)
- Leslie James
- Department of Cardiothoracic Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Brooke O'Connell
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Abel De Varona-Cocero
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Djani Robertson
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Michael Zervos
- Department of Cardiothoracic Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Robert J Cerfolio
- Department of Cardiothoracic Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Stephanie Chang
- Department of Cardiothoracic Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Costas Bizekis
- Department of Cardiothoracic Surgery, NYU Grossman School of Medicine, New York, NY, USA
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Hoernschemeyer DG, Hawkins SD, Tweedy NM, Boeyer ME. Anterior Vertebral Body Tethering: A Single-Center Cohort with 4.3 to 7.4 Years of Follow-up. J Bone Joint Surg Am 2024:00004623-990000000-01152. [PMID: 38968364 DOI: 10.2106/jbjs.23.01229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2024]
Abstract
BACKGROUND Vertebral body tethering (VBT) is a well-recognized, non-fusion alternative for idiopathic scoliosis in children with growth remaining. To date, there have been almost no published outcome studies with postoperative follow-up of >2 years. We aimed to fill this gap by evaluating mid-term outcomes in our first 31 consecutive patients. METHODS We retrospectively assessed additional clinical and radiographic data (mean, 5.7 ± 0.7 years) from our first 31 consecutive patients. Assessments included standard deformity measures, skeletal maturity status, and any additional complications (e.g., suspected broken tethers or surgical revisions). Using the same definition of success (i.e., all residual deformities, instrumented or uninstrumented, ≤30° at maturity; no posterior spinal fusion), we revisited the success rate, revision rate, and suspected broken tether rate. RESULTS Of our first 31 patients treated with VBT, 29 (of whom 28 were non-Hispanic White and 1 was non-Hispanic Asian; 27 were female and 2 were male) returned for additional follow-up. The success rate dropped to 64% with longer follow-up as deformity measures increased, and the revision rate increased to 24% following 2 additional surgical revisions. Four additional suspected broken tethers were identified, for a rate of 55%, with only 1 occurring beyond 4 years. No additional patients had conversion to a posterior spinal fusion. We observed a mean increase of 4° (range, 2° to 8°) in main thoracic deformity measures and 8° (range, 6° to 12°) in thoracolumbar deformity measures. CONCLUSIONS With >5 years of follow-up, we observed a decrease in postoperative success, as progression of the deformity was observed in most subgroups, and an increase in the revision and suspected broken tether rates. No additional patients had conversion to a posterior spinal fusion, which may indicate long-term survivorship. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | | | - Nicole M Tweedy
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Melanie E Boeyer
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
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Ogura Y, Larson AN, Blakemore L, Miyanji F, Andras LM, Parent S, El-Hawary R, Welborn MC. Coronal decompensation following thoracic vertebral body tethering in idiopathic scoliosis. Spine Deform 2024; 12:1025-1031. [PMID: 38556582 DOI: 10.1007/s43390-024-00855-6] [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: 02/26/2024] [Indexed: 04/02/2024]
Abstract
PURPOSE Post-operative coronal decompensation (CD) continues to be a challenge in the treatment of adolescent idiopathic scoliosis (AIS). CD following selective spinal fusion has been studied. However, there is currently little information regarding CD following Vertebral Body Tethering (VBT). Thus, the goal of this study is to better understand the incidence and risk factors for CD after VBT. METHODS Retrospective review of a prospective multicenter database was used for analysis. Inclusion criteria were patients undergoing thoracic VBT, a minimum 2-year follow-up, LIV was L1 or above, skeletally immature (Risser ≤ 1), and available preoperative and final follow-up AP and lateral upright radiographs. Radiographic parameters including major and minor Cobb angles, curve type, LIV tilt/translation, L4 tilt, and coronal balance were measured. CD was defined as the distance between C7PL and CSVL > 2 cm. Multiple logistic regression model was used to identify significant predictors of CD. RESULTS Out of 136 patients undergoing VBT, 94 patients (86 female and 6 male) met the inclusion criteria. The mean age at surgery was 12.1 (9-16) and mean follow-up period was 3.4 years (2-5 years). Major and minor curves, AVR, coronal balance, LIV translation, LIV tilt, L4 tilt were significantly improved after surgery. CD occurred in 11% at final follow-up. Lenke 1A-R (24%) and 1C (26%) had greater incidence of CD compared to 1A-L (4%), 2 (0%), and 3 (0%). LIV selection was not associated with CD. Multivariate logistic regression analysis yielded 1A-R and 1C curves as a predictor of CD with the odds ratio being 17.0. CONCLUSION CD occurred in 11% of our thoracic VBT patients. Lenke 1A-R and 1C curve types were predictors for CD in patients treated with VBT. There were no other preoperative predictors associated with CD.
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Affiliation(s)
- Yoji Ogura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - A Noelle Larson
- Department of Pediatric Orthopedic Surgery, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Laurel Blakemore
- Department of Pediatric Orthopaedic Surgery, Pediatric Specialists of Virginia, Merrifield, VA, USA
| | - Firoz Miyanji
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Lindsay M Andras
- Department of Pediatric Orthopedic Surgery, Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Stefan Parent
- Department of Orthopaedic Surgery, Hospital Ste-Justine (HSJ), Montreal, QC, Canada
| | - Ron El-Hawary
- Department of Orthopaedic Surgery, IWK Health Centre, Halifax, NS, Canada
| | - Michelle Cameron Welborn
- Shriners Hospital for Children Portland, 3101 SW Sam Jackson Park Road, Portland, OR, 97229, USA.
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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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Aydogan M, Pehlivanoglu T, Erdag Y, Akturk UD, Akar A. Flexible posterior vertebral tethering for the management of Scheuermann's kyphosis: correction by using growth modulation-clinical and radiographic outcomes of the first 10 patients with at least 3 years of follow-up. 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; 33:2677-2687. [PMID: 38740612 DOI: 10.1007/s00586-024-08297-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 04/14/2024] [Accepted: 05/01/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE The present prospective cohort study was intended to present the minimum 3 years' results of flexible posterior vertebral tethering (PVT) applied to 10 skeletally immature patients with SK to question, if it could be an alternative to fusion. METHODS Ten skeletally immature patients with radiographically confirmed SK, who had flexible (minimum 35%) kyphotic curves (T2-T12), were included. A decision to proceed with PVT was based on curve progression within the brace, and/or persistent pain, and/or unacceptable cosmetic concerns of the patient/caregivers, and/or non-compliance within the brace. RESULTS Patients had an average age of 13.1 (range 11-15) and an average follow-up duration of 47.6 months (range 36-60). Posterior vertebral tethering (PVT) was undertaken to all patients by utilizing Wiltse approach and placing monoaxial pedicle screws intermittently. At the final follow-up: mean pre-operative thoracic kyphosis and lumbar lordosis improved from 73.6°-45.7° to 34.7°-32.1°. Mean sagittal vertical axis, vertebral wedge angle and total SRS-22 scores improved significantly. A fulcrum lateral X-ray obtained at the latest follow-up, showed that the tethered levels remained mobile. CONCLUSION This study, for the first time in the literature, concluded, that as a result of growth modulation applied to skeletally immature patients with SK, flexible PVT was detected to yield gradual correction of the thoracic kyphosis by reverting the pathological vertebral wedging process, while keeping the mobility of the tethered segments in addition to successful clinical-functional results. The successful results of the present study answered the role of the PVT as a viable alternative to fusion in skeletally immature patients with SK. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Mehmet Aydogan
- Department of Orthopaedic Surgery and Traumatology, Emsey Advanced Spine Surgery Center, Surgical Spine Center of Excellence Certified By EUROSPINE, Emsey Hospital, Çamlık Mahallesi, Selçuklu Caddesi; No:22, Pendik, 34912, Istanbul, Turkey
| | - Tuna Pehlivanoglu
- Department of Orthopedic Surgery and Traumatology, Liv Spine Center, Liv Hospital Ulus, Ulus Mahallesi, Ahmet Adnan Saygun Caddesi, Canan Sokak, No:4, Beşiktaş, 34340, Istanbul, Turkey.
- Department of Ortopedic Surgery and Traumatology, Faculty of Medicine, Istinye University, Hamidiye, Kâğıthane, 34408, Istanbul, Turkey.
| | - Yigit Erdag
- Department of Orthopedic Surgery and Traumatology, Medar Hospital, Osman Yılmaz Mahallesi, İstanbul Caddesi, No:26, Gebze, 41400, Kocaeli, Turkey
| | - Umut Dogu Akturk
- Department of Neurosurgery, Emsey Advanced Spine Surgery Center, Surgical Spine Center of Excellence Certified By EUROSPINE, Emsey Hospital, Çamlık Mahallesi, Selçuklu Caddesi, No:22, Pendik, 34912, Istanbul, Turkey
| | - Abdulhalim Akar
- Department of Orthopaedic Surgery and Traumatology, Emsey Advanced Spine Surgery Center, Surgical Spine Center of Excellence Certified By EUROSPINE, Emsey Hospital, Çamlık Mahallesi, Selçuklu Caddesi; No:22, Pendik, 34912, Istanbul, Turkey
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9
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Lau D, Kurland DB, Neifert S, Pahys J, Samdani A, Hwang S. Learning Curve Associated With Thoracoscopic Anterior Vertebral Body Tether and Double Anterior Vertebral Body Tether for Idiopathic Scoliosis: Analysis of Three Independent Surgeons. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01194. [PMID: 38888348 DOI: 10.1227/ons.0000000000001212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 03/13/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Anterior vertebral body tether (VBT) is a fusionless approach to treat idiopathic scoliosis, and surgeons are beginning to implement the technique into current practice. This study aims to evaluate the learning curve for single and double VBT. METHODS A retrospective review of 3 surgeons' first 40 single and 20 double VBT was performed. Skeletally immature patients with idiopathic scoliosis who underwent thoracic (single) or thoracolumbar (double) VBT were included. Thoracic VBT was done via video-assisted thoracoscopic surgery and lumbar VBT through a mini-open retroperitoneal approach. Primary outcomes of interest were operative time, radiation exposure, and radiographic correction. Pooled and individual-surgeon analyses were performed. RESULTS A total of 180 patients were included: 120 single and 60 double. Mean age was 12.7 years, and 87.8% were female. Mean segments tethered was 7.8 in single and 11.0 in double. Mean preoperative thoracic scoliosis was 51.5: single 50.5° and double 53.3°. Mean lumbar scoliosis was 36.4°: single 30.0° and double 49.0°. Average operating time was 276.2 minutes; double VBT was significantly longer (217.3 vs 394.0 minutes, P < .001). Mean blood loss was 198.5 mL, and mean fluoroscopy dose was 73.0 mGy. For single VBT, there was a decrease in operative time (283.3-174.8 minutes, P < .001) and fluoroscopy dose (70.1-53.5 mGy, P = .047) over time. Every 10 cases resulted in a 31.4 minute decrease in operative time (P < .001). There were no intraoperative complications. Single VBT resulted in 54.9% thoracic curve correction. Double VBT achieved 53.0% thoracic and 56.7% lumbar correction. There were no differences in curve correction across the learning curve. CONCLUSION VBT is viable fusionless surgical option for scoliosis. As expected, increased experience resulted in shorter operative time; the threshold for such improvement seems to be 10 cases. Importantly, adequate and consistent curve correction can be achieved at the start of the learning curve while mitigating complications.
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Affiliation(s)
- Darryl Lau
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA
| | - David B Kurland
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA
| | - Sean Neifert
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA
| | - Joshua Pahys
- Department of Neurosurgery, Shriners Children's Philadelphia, Philadelphia, Pennsylvania, USA
| | - Amer Samdani
- Department of Neurosurgery, Shriners Children's Philadelphia, Philadelphia, Pennsylvania, USA
| | - Steven Hwang
- Department of Neurosurgery, Shriners Children's Philadelphia, Philadelphia, Pennsylvania, 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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Lonner B, Eaker L, Hoernschemeyer D, Zhang J, Wilczek A, Elliot P, Boeyer ME, Fletcher ND, Alanay A, Yilgor C, Newton P, Miyanji F. Double major curvature treated with vertebral body tethering of both curves: how do outcomes compare to posterior spinal fusion? Spine Deform 2024; 12:651-662. [PMID: 38285163 DOI: 10.1007/s43390-023-00803-w] [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: 04/24/2023] [Accepted: 12/09/2023] [Indexed: 01/30/2024]
Abstract
PURPOSE Vertebral body tethering (VBT) is a non-fusion alternative to posterior spinal fusion (PSF). There have been few reports on VBT of two curvatures. We aim to compare the radiographic outcomes between VBT and PSF in patients with double curvatures in which both curves were instrumented. METHODS 29 AIS patients matched by Lenke, age (± 2 years), triradiate cartilage closure status, major Cobb angle (± 8°), and T5-T12 kyphosis (± 10°). Variables were compared using Wilcoxon rank-sum tests, Student's t tests, and chi-Square. Clinical success was defined as major curve < 35°. RESULTS Group baseline demographics were similar. Major thoracic (T) curve types had significantly better major (VBT 51.5 ± 7.9° to 31.6 ± 12.0° [40%] vs. PSF 54.3 ± 7.4° to 17.4 ± 6.5° [68%]; p = 0.0002) and secondary curve correction in the PSF group. 71% of major T VBT patients were clinically successful versus 100% of PSF. Major thoracolumbar (TL) curve types experienced comparable major (VBT 52.3 ± 7.0° to 18.3 ± 11.4° (65%) vs. PSF 53.0 ± 5.2° to 23.8 ± 10.9° (56%); p = 0.2397) and secondary curve correction. 92% of major TL VBT patients were clinically successful versus 75% in the PSF group. There was no difference in T5-12 kyphosis or lumbar lordosis between groups for any curve type. There were 4 patients (13.8%) with major complications in the VBT group compared to 0 (0%) in the PSF. CONCLUSION Patients with double major AIS who underwent VBT with major T curve types had less correction than PSF; however, those with major TL curves experienced similar radiographic outcomes regardless of procedure. Complications were greater for VBT.
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Affiliation(s)
- Baron Lonner
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, Mount Sinai Spine, 5 E 98th St., New York, NY, 10029, USA.
| | - Lily Eaker
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, Mount Sinai Spine, 5 E 98th St., New York, NY, 10029, USA
| | | | - Jessica Zhang
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, Mount Sinai Spine, 5 E 98th St., New York, NY, 10029, USA
| | - Ashley Wilczek
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, Mount Sinai Spine, 5 E 98th St., New York, NY, 10029, USA
| | - Patrick Elliot
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
| | - Melanie E Boeyer
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
| | - Nicholas D Fletcher
- Department of Orthopaedics, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Caglar Yilgor
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Peter Newton
- Department of Orthopaedics, Rady Children's Hospital, San Diego, CA, USA
| | - Firoz Miyanji
- Department of Orthopedics, British Columbia Children's Hospital, Vancouver, BC, Canada
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13
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Alasadi H, Rajjoub R, Alasadi Y, Wilczek A, Lonner BS. Vertebral body tethering for adolescent idiopathic scoliosis: a review. Spine Deform 2024; 12:561-575. [PMID: 38285164 DOI: 10.1007/s43390-023-00806-7] [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: 07/25/2023] [Accepted: 12/09/2023] [Indexed: 01/30/2024]
Abstract
PURPOSE Adolescent Idiopathic Scoliosis (AIS) remains the most common type of pediatric scoliosis, mostly affecting children between ages 10 and 18. Vertebral body tethering (VBT) offers a non-fusion alternative to the gold standard spinal fusion that permits flexibility and some growth within instrumented segments. This article will serve as a comprehensive literature review of the current state-of-the-art of VBT in relation to radiographic and clinical outcomes, complications, and the learning curve associated with the procedure. METHODS A systematic literature review was conducted on PubMed, Scopus, and Web of Science from April 2002 to December 2022. Studies were included if they discussed VBT and consisted of clinical studies in which a minimum 2-years follow-up was reported, and series that included anesthetic considerations, learning curve, and early operative morbidity. RESULTS Forty-nine studies spanning the period from April 2002 to December 2022 were reviewed. CONCLUSION This article illustrates the potential benefits and challenges of the surgical treatment of AIS with VBT and can serve as a basis for the further study and refinement of this technique ideally as a living document that will be updated regularly.
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Affiliation(s)
- Husni Alasadi
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rami Rajjoub
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yazan Alasadi
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ashley Wilczek
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Baron S Lonner
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Chief of Minimally Invasive Scoliosis Surgery and Pediatric Spine, Department of Orthopaedic Surgery, Mount Sinai Hospital, Icahn School of Medicine, 5 E 98th St., 4th Floor, New York, NY, 10029, USA.
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14
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Hwang SW, Plachta S, Pahys JM, Quinonez A, Grewal H, Samdani AF. The Impact of Anterior Vertebral Body Tethering on Pulmonary Function. Spine (Phila Pa 1976) 2024; 49:E128-E132. [PMID: 38239017 DOI: 10.1097/brs.0000000000004926] [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: 11/02/2023] [Accepted: 01/05/2024] [Indexed: 04/11/2024]
Abstract
STUDY DESIGN Retrospective, single-center study. OBJECTIVE To examine pulmonary function tests (PFTs) in patients undergoing anterior vertebral body tethering (AVBT). SUMMARY OF BACKGROUND DATA The effect of AVBT on pulmonary status remains unclear. MATERIALS AND METHODS The authors examined preoperative and postoperative PFTs following AVBT in a retrospective, single-center cohort of patients. Outcomes were compared using percent predicted values as continuous and categorical variables (using 10% change as significant) and divided into categorical values based on the American Thoracic Society standards. RESULTS Fifty-eight patients with adolescent idiopathic scoliosis were included, with a mean age of 12.5±1.4 years and a follow-up of 4.2±1.1 years. The mean thoracic curve was 47°±9°, which improved to 21°±12°. At baseline, the mean forced expiratory volume in one second (FEV1%) and forced vital capacity (FVC%) values were 79% and 82%, respectively. Four patients had normal FEV1% (≥100%), 67% had mild restrictive disease (70%-99%) and the rest had worse FEV1%. Mean FEV1 improved from 2.2 to 2.6 L ( P <0.05) and FVC improved from 2.5 to 3.0 L ( P <0.05); however, % predicted values remained unchanged (FEV1%: 79%-80%; FVC%: 82-80%, P >0.05) with mean postoperative PFTs at 37±12 months postoperative. The use of miniopen thoracotomy was not associated with worsening PFTs, but extension of the lowest instrumented vertebra below T12 was correlated with decreasing FEV1% in the bivariate analysis ( P <0.05). Patients with worse preoperative FVC% (80±13% vs. 90±11%, P =0.03) and FEV1% (77±17% vs. 87±12%, P =0.06) also had a greater likelihood of declining postoperative FEV1%. CONCLUSION Pulmonary function in most patients undergoing AVBT remained stable (76%) or improved (14%); however, a subset may worsen (10%). Further studies are needed to identify the risk factors for this group, but worse preoperative PFTs and extension below T12 may be risk factors for worsening pulmonary function.
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Affiliation(s)
| | | | | | | | - Harsh Grewal
- St. Christopher's Hospital for Children, Philadelphia, PA
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15
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Vorhies JS, Hauth L, Garcia S, Roye BD, Poon S, Sturm PF, Glotzbecker M, Fletcher ND, Stone JD, Cahill PJ, Anari JB. A New Look at Vertebral Body Tethering (VBT): Through the Modified Clavien-Dindo-Sink (mCDS) Classification. J Pediatr Orthop 2024; 44:e389-e393. [PMID: 38454491 DOI: 10.1097/bpo.0000000000002653] [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] [Indexed: 03/09/2024]
Abstract
INTRODUCTION Anterior vertebral body tethering (AVBT) is increasingly popular as an option for surgical treatment of idiopathic scoliosis (IS). While the technology remains new, it is important for families and patients to be able to compare it to the current standard of care, posterior spinal fusion (PSF). The purpose of this study is to describe the complication rate of AVBT in IS using the mCDS and to compare it to the recently reported complication rate of PSF in IS. METHODS A multicenter pediatric spine deformity database was queried for all idiopathic scoliosis patients who underwent vertebral body tethering. There were 171 patients with a minimum 9-month follow-up included in this study. Complications were retrospectively graded by 2 attending pediatric spine surgeons using the mCDS classification system. RESULTS Data from 171 patients with idiopathic scoliosis was available for analysis, with 156/171 (91%) of patients being female and an average age of 12.2 years old at surgery. There were 156 thoracic tethers (1 with an LIV below L2), 5 lumbar tethers, 9 staged double tethers, and only 1 patient with same-day double tether. Fifty-five (55) (32%) patients experienced a total of 69 complications. The most common complication type for VBT by mCDS was Grade IIIb, encompassing 29/69 (42%) of complications. The second most frequent complication grade was Grade I at 23/69 (33%). Thirty-four (34) out of 69 (49%) of the VBT complications reported required either procedural/surgical intervention or admission to the ICU. CONCLUSIONS This is the first study to directly compare the complication profile of VBT to PSF using the mCDS. Forty-nine percent (49%) of the VBT complications reported were at least Grade III, while only 7% of complications in the control PSF cohort from the literature were Grade III or higher. The mCDS complication classification brings light to the early learning experience of a new technique compared to the widely accepted standard of PSF for IS. LEVEL OF EVIDENCE III - Retrospective comparative study.
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Affiliation(s)
- John S Vorhies
- Department of Orthopaedics, Stanford Medicine Children's Health, Palo Alto, CA
| | - Lucas Hauth
- Department of Orthopaedics, The Children's Hospital of Philadelphia
| | - Samantha Garcia
- Department of Orthopaedics, The Children's Hospital of Philadelphia
| | - Benjamin D Roye
- Department of Orthopaedics, Columbia University, New York, NY
| | - Selina Poon
- Department of Orthopaedics, Shriners Children's Southern California, CA
| | - Peter F Sturm
- Department of Orthopaedics, Cincinnati Children's Hospital
- Department of Orthopaedic Surgery, The University of Cincinnati, Cincinnati
| | | | | | - Joseph D Stone
- Department of Orthopaedics, The University of North Carolina, Chapel Hill, NC
| | - Patrick J Cahill
- Department of Orthopaedics, The Children's Hospital of Philadelphia
- Department of Orthopaedic Surgery, The University of Pennsylvania, Philadelphia, PA
| | - Jason B Anari
- Department of Orthopaedics, The Children's Hospital of Philadelphia
- Department of Orthopaedic Surgery, The University of Pennsylvania, Philadelphia, PA
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16
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Cahill PJ, Miyanji F, Lullo BR, Samdani AF, Lonner BS, Pahys JM, Hwang SW, Haber LL, Alanay A, Shah SA, Parent S, Blakemore LC, Hoernschemeyer DG, Neal KM, Newton PO. Incidence of Tether Breakage in Anterior Vertebral Body Tethering. J Pediatr Orthop 2024; 44:e323-e328. [PMID: 38251438 DOI: 10.1097/bpo.0000000000002619] [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] [Indexed: 01/23/2024]
Abstract
BACKGROUND Thoracic anterior vertebral body tethering (TAVBT) is an emerging treatment for adolescent idiopathic scoliosis. Tether breakage is a known complication of TAVBT with incompletely known incidence. We aim to define the incidence of tether breakage in patients with adolescent idiopathic scoliosis who undergo TAVBT. The incidence of tether breakage in TAVBT is hypothesized to be high and increase with time postoperatively. METHODS All patients with right-sided, thoracic curves who underwent TAVBT with at least 2 and up to 3 years of radiographic follow-up were included. Tether breakage between 2 vertebrae was defined a priori as any increase in adjacent screw angle >5 degrees from the minimum over the follow-up period. The presence and timing of tether breakage were noted for each patient. A Kaplan-Meier survival analysis was performed to calculate expected tether breakage up to 36 months. χ 2 analysis was performed to examine the relationship between tether breakage and reoperations. Independent t test was used to compare the average final Cobb angle between cohorts. RESULTS In total, 208 patients from 10 centers were included in our review. Radiographically identified tether breakage occurred in 75 patients (36%). The initial break occurred at or beyond 24 months in 66 patients (88%). Kaplan-Meier survival analysis estimated the cumulative rate of expected tether breakage to be 19% at 24 months, increasing to 50% at 36 months. Twenty-one patients (28%) with a radiographically identified tether breakage went on to require reoperation, with 9 patients (12%) requiring conversion to posterior spinal fusion. Patients with a radiographically identified tether breakage went on to require conversion to posterior spinal fusion more often than those patients without identified tether breakage (12% vs. 2%; P =0.004). The average major coronal curve angle at final follow-up was significantly larger for patients with radiographically identified tether breakage than for those without tether breakage (31 deg±12 deg vs. 26 deg±12 deg; P =0.002). CONCLUSIONS The incidence of tether breakage in TAVBT is high, and it is expected to occur in 50% of patients by 36 months postoperatively. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Patrick J Cahill
- Children's Hospital of Philadelphia
- Perelman School of Medicine at the University of Pennsylvania
| | | | | | | | | | | | | | | | - Ahmet Alanay
- Acibadem Maslak Hospital, Maslal, Istanbul, Turkey
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17
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Sullivan MH, Jackson TJ, Milbrandt TA, Larson AN, Kepler CK, Sebastian AS. Evidence-based Indications for Vertebral Body Tethering in Spine Deformity. Clin Spine Surg 2024; 37:82-91. [PMID: 37684718 DOI: 10.1097/bsd.0000000000001521] [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: 09/21/2022] [Accepted: 06/21/2023] [Indexed: 09/10/2023]
Abstract
Posterior spinal fusion has long been established as an effective treatment for the surgical management of spine deformity. However, interest in nonfusion options continues to grow. Vertebral body tethering is a nonfusion alternative that allows for the preservation of growth and flexibility of the spine. The purpose of this investigation is to provide a practical and relevant review of the literature on the current evidence-based indications for vertebral body tethering. Early results and short-term outcomes show promise for the first generation of this technology. At this time, patients should expect less predictable deformity correction and higher revision rates. Long-term studies are necessary to establish the durability of early results. In addition, further studies should aim to refine preoperative evaluation and patient selection as well as defining the benefits of motion preservation and its long-term effects on spine health to ensure optimal patient outcomes.
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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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19
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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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20
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Samdani AF, Plachta SM, Pahys JM, Quinonez A, Samuel SP, Hwang SW. Results of posterior spinal fusion after failed anterior vertebral body tethering. Spine Deform 2024; 12:367-373. [PMID: 38142246 DOI: 10.1007/s43390-023-00796-6] [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: 04/06/2023] [Accepted: 11/18/2023] [Indexed: 12/25/2023]
Abstract
PURPOSE In patients with adolescent idiopathic scoliosis (AIS) undergoing anterior vertebral tethering (AVBT), some will subsequently require posterior spinal fusion (PSF). Limited data exist on clinical and radiographic outcomes of fusion after tether failure. METHODS 490 patients who underwent AVBT were retrospectively analyzed. Twenty patients (4.1%) subsequently underwent conversion to PSF. A control group of patients with primary PSF (no previous AVBT) was matched for comparison. Data were compared using paired t-tests and Fisher Exact Tests. RESULTS There was a significant increase in estimated blood loss (EBL) (p = 0.002), percent estimated blood volume (%EBV) (p = 0.013), operative time (p = 0.002), and increased amount of fluoroscopy (mGy) (p = 0.04) as well as number of levels fused (p = 0.02) in the AVBT conversion group compared to primary fusion. However, no difference was found in implant density (p = 0.37), blood transfusions (p = 0.11), or intraoperative neuromonitoring events (p > 0.99). Both groups attained similar thoracic and lumbar percent correction (major coronal curve angle) from pre-op to the latest follow-up (thoracic p = 0.507, lumbar p = 0.952). CONCLUSION A subset of patients with AVBT will require conversion to PSF. Although technically more challenging, revision surgery can be safely performed with similar clinical and radiographic outcomes to primary PSF. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Amer F Samdani
- Shriners Children's-Philadelphia, 3551 N Broad St, Philadelphia, PA, 19140, USA.
| | - Stephen M Plachta
- Shriners Children's-Philadelphia, 3551 N Broad St, Philadelphia, PA, 19140, USA
| | - Joshua M Pahys
- Shriners Children's-Philadelphia, 3551 N Broad St, Philadelphia, PA, 19140, USA
| | - Alejandro Quinonez
- Shriners Children's-Philadelphia, 3551 N Broad St, Philadelphia, PA, 19140, USA
| | - Solomon P Samuel
- Shriners Children's-Philadelphia, 3551 N Broad St, Philadelphia, PA, 19140, USA
| | - Stephen W Hwang
- Shriners Children's-Philadelphia, 3551 N Broad St, Philadelphia, PA, 19140, USA
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Heegaard M, Tøndevold N, Dahl B, Andersen TB, Gehrchen M, Ohrt-Nissen S. The influence of night-time bracing on curve progression is not affected by curve magnitude in adolescent idiopathic scoliosis: a study of 299 patients. Acta Orthop 2024; 95:108-113. [PMID: 38347730 PMCID: PMC10863495 DOI: 10.2340/17453674.2024.39965] [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: 10/24/2023] [Accepted: 01/06/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND AND PURPOSE The efficacy of bracing larger curves in adolescent idiopathic scoliosis (AIS) patients is uncertain. We aimed to assess the influence of night-time bracing in AIS patients with main curves exceeding 40° Cobb angle at brace initiation. METHODS We reviewed AIS patients treated with nighttime braces between 2005 and 2018. Patients with curves ≥ 25° and estimated growth potential were included. Patients were monitored with radiographs from brace initiation until brace weaning at skeletal maturity. Patients were grouped based on curve magnitude at initial evaluation: a control group (25-39°) and a large-curves group (≥ 40°). Progression was defined as > 5° increase. RESULTS We included 299 patients (control group, n = 125; large-curves group, n = 174). In the control group, 65 (52%) patients progressed compared with 101 (58%) in the large-curves group (P = 0.3). The lower-end vertebra (LEV) shifted distally post-bracing in 41 (23%) patients in the largecurves group. Patients with progressive large curves were younger (age 13.2 [SD 1.5] vs. 13.9 [SD 1.1], P = 0.009) and more premenarchal (n = 36 [42%] vs. n = 6 [9%], P < 0.001) compared with non-progressive large curves. CONCLUSION Progression risk in patients with curves exceeding 40° treated with night-time bracing is similar to smaller curves. The LEV moved distally in almost one-fourth of the larger curves, possibly affecting fusion levels in cases of surgery.
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Affiliation(s)
- Martin Heegaard
- Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Niklas Tøndevold
- Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Benny Dahl
- Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Thomas B Andersen
- Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Martin Gehrchen
- Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Søren Ohrt-Nissen
- Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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22
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Hoernschemeyer DG, Elliott P, Lonner BS, Eaker L, Boeyer ME. Bilateral vertebral body tethering: identifying key factors associated with successful outcomes. 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; 33:723-731. [PMID: 38180517 DOI: 10.1007/s00586-023-08074-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/25/2023] [Accepted: 11/29/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE The treatment of operative double major pediatric spinal deformities (e.g., Lenke 3 or 6) with bilateral vertebral body tethering (VBT) can be significantly more challenging when compared to other deformity patterns (e.g., Lenke 1) or treatment with a posterior spinal fusion. We aimed to identify preoperative and perioperative characteristics that were associated with successful postoperative outcomes in patients treated with both a thoracic and thoracolumbar (e.g., bilateral) tether. METHODS We retrospectively assessed radiographic and clinical data from patients enrolled in a large multi-center study who had a minimum postoperative follow-up of two years. Standard radiographic parameters were extracted from standing spine and left hand-wrist radiographs at various timepoints. We classified patients based on their preoperative deformity pattern (Primary Thoracic [TP] vs. Primary Thoracolumbar [TLP]) and assessed: (1) deformity balance, (2) tilt of the transitional vertebra, and (3) postoperative success. RESULTS We analyzed data from thirty-six patients (TP: 19 and TLP: 17). We observed no relationship between deformity balance at first erect and postoperative success (p = 0.354). Patients with a horizontal transitional vertebra at first erect were significantly (p = 0.001) more likely to exhibit a successful outcome when compared to those who exhibited a tilted transitional vertebra (83% vs. 62%). Patients who had TLP were also more likely to exhibit a successful outcome when compared to patients who exhibited TP (76% vs. 50%). CONCLUSION These data indicate that double major deformities can be successfully treated with VBT, particularly for those who exhibit TLP.
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Affiliation(s)
| | - Patrick Elliott
- School of Medicine, University of Missouri, Columbia, MO, USA
| | - Baron S Lonner
- Department of Orthopaedic Surgery, The Mount Sinai Hospital, New York, NY, USA
| | - Lily Eaker
- Department of Orthopaedic Surgery, The Mount Sinai Hospital, New York, NY, USA
| | - Melanie E Boeyer
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA.
- Missouri Orthopaedic Institute, 1100 Virginia Ave, Columbia, MO, 65212, USA.
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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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Alfraihat A, Samdani AF, Balasubramanian S. Predicting radiographic outcomes of vertebral body tethering in adolescent idiopathic scoliosis patients using machine learning. PLoS One 2024; 19:e0296739. [PMID: 38215180 PMCID: PMC10786366 DOI: 10.1371/journal.pone.0296739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/18/2023] [Indexed: 01/14/2024] Open
Abstract
Anterior Vertebral Body Tethering (AVBT) is a growing alternative treatment for adolescent idiopathic scoliosis (AIS), offering an option besides spinal fusion. While AVBT aims to correct spinal deformity through growth correction, its outcomes have been mixed. To improve surgical outcomes, this study aimed to develop a machine learning-based tool to predict short- and midterm spinal curve correction in AIS patients who underwent AVBT surgery, using the most predictive clinical, radiographic, and surgical parameters. After institutional review board approval and based on inclusion criteria, 91 AIS patients who underwent AVBT surgery were selected from the Shriners Hospitals for Children, Philadelphia. For all patients, longitudinal standing (PA or AP, and lateral) and side bending spinal Radiographs were retrospectively obtained at six visits: preop and first standing, one year, two years, five years postop, and at the most recent follow-up. Demographic, radiographic, and surgical features associated with curve correction were collected. The sequential backward feature selection method was used to eliminate correlated features and to provide a rank-ordered list of the most predictive features of the AVBT correction. A Gradient Boosting Regressor (GBR) model was trained and tested using the selected features to predict the final correction of the curve in AIS patients. Eleven most predictive features were identified. The GBR model predicted the final Cobb angle with an average error of 6.3 ± 5.6 degrees. The model also provided a prediction interval, where 84% of the actual values were within the 90% prediction interval. A list of the most predictive features for AVBT curve correction was provided. The GBR model, trained on these features, predicted the final curve magnitude with a clinically acceptable margin of error. This model can be used as a clinical tool to plan AVBT surgical parameters and improve outcomes.
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Affiliation(s)
- Ausilah Alfraihat
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, United States of America
- Hashemite University, Zarqa, Jordan
| | - Amer F. Samdani
- Shriners Hospitals for Children, Philadelphia, PA, United States of America
| | - Sriram Balasubramanian
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, United States of America
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Larson AN, Marks MC, Gonzalez Sepulveda JM, Newton PO, Devlin VJ, Peat R, Tarver ME, Babalola O, Chen AL, Gebben D, Cahill P, Shah S, Samdani A, Bachmann K, Lonner B. Non-Fusion Versus Fusion Surgery in Pediatric Idiopathic Scoliosis: What Trade-Offs in Outcomes Are Acceptable for the Patient and Family? J Bone Joint Surg Am 2024; 106:2-9. [PMID: 37943944 DOI: 10.2106/jbjs.23.00503] [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] [Indexed: 11/12/2023]
Abstract
BACKGROUND Vertebral body tethering and other non-fusion techniques for the treatment of pediatric idiopathic scoliosis are increasing in popularity. There is limited physician consensus on this topic as the result of a paucity of published data regarding which patients most benefit from non-fusion strategies. Thus, much of the decision-making is left to patients and parents, who must select a treatment based on their goals and values and the information available from health-care providers, the internet, and social media. We sought to understand patient and family preferences regarding the attributes of fusion versus non-fusion surgery that drive these choices. METHODS Patients and families were recruited from 7 pediatric spine centers and were asked to complete a survey-based choice experiment that had been jointly developed with the U.S. Food and Drug Administration (FDA) to evaluate patient preferences. Choices between experimentally designed alternatives were analyzed to estimate the relative importance of outcomes and requirements associated with the choice options (attributes). The attributes included appearance, confidence in the planned correction, spinal motion, device failure, reoperation, and recovery period. The inclusion criteria were (1) an age of 10 to 21 years and (2) a diagnosis of adolescent idiopathic scoliosis in patients who were considering, or who had already undergone, treatment with fusion or non-fusion surgery. Preference weights were estimated from the expected changes in choice given changes in the attributes. RESULTS A total of 344 respondents (124 patients, 92 parents, and 128 parent/patient dyads) completed the survey. One hundred and seventy-three patients were enrolled prior to surgery, and 171 were enrolled after surgery. Appearance and motion were found to be the most important drivers of choice. For the entire cohort, fusion was preferred over non-fusion. For patients who were considering surgery, the most important attributes were preservation of spinal motion and appearance. CONCLUSIONS Patients and families seeking treatment for idiopathic scoliosis value appearance and preservation of spinal motion and, to a lesser extent, reoperation rates when considering fusion versus non-fusion surgery.
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Affiliation(s)
- A Noelle Larson
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | | | - Peter O Newton
- Setting Scoliosis Straight Foundation, El Cajon, California
- Division of Orthopedics, Rady Children's Hospital, San Diego, California
| | - Vincent J Devlin
- Office of Product Evaluation and Quality, Office of Health Technology-6: Orthopedic Devices, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland
| | - Raquel Peat
- Office of Product Evaluation and Quality, Office of Health Technology-6: Orthopedic Devices, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland
| | - Michelle E Tarver
- Office of Strategic Partnerships and Technology Innovation, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland
| | - Olufemi Babalola
- Office of Strategic Partnerships and Technology Innovation, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland
| | - Allen L Chen
- Office of Strategic Partnerships and Technology Innovation, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland
| | - David Gebben
- Office of Strategic Partnerships and Technology Innovation, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland
| | - Patrick Cahill
- Division of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Suken Shah
- Department of Orthopaedic Surgery, Nemours Children's Hospital, Wilmington, Delaware
| | - Amer Samdani
- Department of Pediatric Orthopedic Surgery, Shriners Children's Philadelphia, Philadelphia, Pennsylvania
| | - Keith Bachmann
- Department of Orthopedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Baron Lonner
- Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY
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Silk ZM, Tishelman JC, Eaker L, Lonner B. Reducing Uncertainty in Anterior Vertebral Body Tethering: Predicting Postoperative Curvature With Fulcrum Bending Radiographs. Global Spine J 2024; 14:219-224. [PMID: 35510409 PMCID: PMC10676183 DOI: 10.1177/21925682221100444] [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] [Indexed: 11/04/2022] Open
Abstract
STUDY DESIGN Retrospective Cohort Study. OBJECTIVES Mid-term Anterior Vertebral Body Tethering (AVBT) results demonstrate an acceptable degree of clinical success, yet the revision rate remains notably higher than fusion. Fulcrum-bending radiographs have previously been shown to more reliably predict radiological outcomes in Adolescent Idiopathic Scoliosis (AIS) as compared to supine-lateral bending radiographs. This study aims to discern how Fulcrum Flexibility Rate (FFR) correlates with Correction Rate (CR) and establish whether this can reliably predict residual deformity following AVBT surgery. METHODS A review of 38 consecutive AIS patients undergoing thoracic AVBT between 2015 - 2020 was performed. Preoperative (standing and fulcrum-bending) and postoperative (first-erect) radiographs were evaluated for curve magnitude using the Cobb-method. The FFR, CR and Fulcrum Bending Correction Index (FBCI) were calculated. Patients were also percentile-ranked according to their FFR and dichotomized into flexible and rigid cohorts for comparison. Student t-test, Pearson correlation and linear stepwise regression was applied. RESULTS AVBT resulted in a significant improvement in the major Cobb angle (Preoperative: 50.9±7.5° vs Postoperative: 19.9±9.4°; P < .0001) with a mean FBCI of 98.0%. Bivariate correlation revealed a moderate relationship between fulcrum-bending and first-erect Cobb angle (r = .5306, P = .0006). Linear regression demonstrated a predictive relationship between fulcrum-bending and first-erect Cobb using the equation 'Postoperative Cobb = 7.5 + .65(Fulcrum-bending Cobb).' CONCLUSION This is the first study to demonstrate the ability of fulcrum-bending radiographs to predict early radiographic outcomes following AVBT, 'timepoint-zero' for the growth modulation process.
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Affiliation(s)
| | - Jared C. Tishelman
- Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY, USA
| | - Lily Eaker
- Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY, USA
| | - Baron Lonner
- Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY, USA
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27
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Oeding JF, Siu J, O'Donnell J, Wu HH, Allahabadi S, Saggi S, Flores M, Brown K, Baldwin A, Diab M. Combined Anterior Thoracic Vertebral Body Tethering and Posterior Lumbar Tethering Results in Quicker Return to Sport and Activity Compared to Posterior Spinal Instrumented Fusion in Patients with Adolescent Idiopathic Scoliosis. Global Spine J 2023:21925682231222887. [PMID: 38097271 DOI: 10.1177/21925682231222887] [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] [Indexed: 12/22/2023] Open
Abstract
STUDY DESIGN Retrospective comparative study. OBJECTIVE To compare patient-reported physical activity between anterior thoracic vertebral body tethering and posterior lumbar spine tethering (ATVBT/PLST) and posterior spinal instrumentation and fusion (PSIF) with minimum 2 year follow-up. METHODS Consecutive skeletally immature patients with idiopathic scoliosis and a thoracic and lumbar curve magnitude ≥40° who underwent either ATVBT/PLST or PSIF from 2015-2019 were included. The primary outcome was rate of returning to sport. Secondary outcomes included ability to bend and satisfaction with sport performance as well as weeks until return to sport, school, physical education (PE) classes, and running. RESULTS Ten patients underwent ATVBT/PLST and 12 underwent PSIF. ATVBT/PLST patients reported significantly faster return to sport (13.5 weeks vs 27.9 weeks, P = .04), running (13.3 weeks vs 28.8 weeks, P = .02), and PE class (12.6 weeks vs 26.2 weeks, P = .04) compared to PSIF patients. ATVBT/PLST patients reported that they had to give up activities due to their ability to bend at lower rates than PSIF patients while reporting "no changes" in their ability to bend after surgery at higher rates than PSIF patients (0% vs 4% giving up activities and 70% vs 0% reporting no changes in bending ability for ATVBT/PLST and PSIF, respectively, P = .01). Compared to PSIF patients, ATVBT/PLST patients experienced less main thoracic and thoracolumbar/lumbar curve correction at most recent follow-up (thoracic: 41 ± 19% vs 69 ± 18%, P = .001; thoracolumbar/lumbar: 59 ± 25% vs 78 ± 15%, P = .02). No significant differences in the number of revision surgeries were observed between ATVBT/PLST and PSIF patients (4 (40%) and 1 (8%) for ATVBT/PLST and PSIF, respectively, P = .221). CONCLUSIONS ATVBT/PLST patients reported significantly faster rates of returning to sport, running, and PE. In addition, ATVBT/PLST patients were less likely to have to give up activities due to bending ability after surgery and reported no changes in their ability to bend after surgery more frequently than PSIF patients. However, the overall rate of return to the same or higher level of sport participation was high amongst both groups, with no significant difference observed between ATVBT/PLST and PSIF patients.
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Affiliation(s)
- Jacob F Oeding
- School of Medicine, Mayo Clinic Alix School of Medicine, Rochester, MN, USA
- Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
| | - Jeremy Siu
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Jennifer O'Donnell
- Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, CA USA
| | - Hao-Hua Wu
- Department of Orthopaedic Surgery, University of California, Irvine, CA, USA
| | - Sachin Allahabadi
- Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, CA USA
| | - Satvir Saggi
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Michael Flores
- Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, CA USA
| | - Kelsey Brown
- Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, CA USA
| | - Avionna Baldwin
- Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, CA USA
| | - Mohammad Diab
- Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, CA USA
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Aziz RI, Blattes JB. Thoracoscopic Surgery in the Management of Idiopathic Scoliosis: Systematic Literature Review according to the Prisma Protocol. Rev Bras Ortop 2023; 58:e833-e838. [PMID: 38077771 PMCID: PMC10708982 DOI: 10.1055/s-0043-1776885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/23/2022] [Indexed: 08/03/2024] Open
Abstract
Idiopathic scoliosis is characterized by a three-dimensional deformity of the spine with axial rotation and lateral inclination with an angle greater than 10° according to the Cobb method. Its approach can be conservative or surgical, depending on the degree of angulation, musculoskeletal development and age of the affected child or adolescent, or even depending on the functional impairment resulting from the condition. The aim of this study was to analyze the impact of videoassisted thoracoscopic surgery in the management of idiopathic scoliosis. This is a systematic literature review, built according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol and registered with PROSPERO under number CRD42022351466. The search for studies was performed between August 2022 and September of the same year, in bibliographic databases including MEDLINE, The Cochrane Library and Web of Science. The technique is a minimally invasive alternative to thoracotomy that has shown great evolution in recent years. The main advantages include less blood loss during the procedure, shorter hospital stay and improved post-surgical esthetics. One of the disadvantages mentioned by the authors is the greater complexity and technological requirement, longer surgical time and the need for careful selection of patients, according to degrees of vertebral deviation. The use of analgesics and anti-inflammatory drugs had no significant difference between traditional procedures (thoracotomy) or thoracoscopic surgery.
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Affiliation(s)
- Rodrigo Ibrahim Aziz
- Médico residente do Hospital Nossa Senhora das Graças, Canoas, Rio Grande do Sul, Brasil
| | - Juliano Boemo Blattes
- Médico residente do Hospital Nossa Senhora das Graças, Canoas, Rio Grande do Sul, Brasil
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Roser MJ, Askin GN, Labrom RD, Zahir SF, Izatt M, Little JP. Vertebral body tethering for idiopathic scoliosis: a systematic review and meta-analysis. Spine Deform 2023; 11:1297-1307. [PMID: 37432604 PMCID: PMC10587225 DOI: 10.1007/s43390-023-00723-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 06/17/2023] [Indexed: 07/12/2023]
Abstract
PURPOSE Vertebral body tethering (VBT) is a recent procedure to correct and reduce spinal curves in skeletally immature patients with adolescent idiopathic scoliosis (AIS). The purpose of this systematic review and meta-analysis is to determine the expected curve reduction and potential complications for adolescent patients after VBT. METHODS PubMed, Embase, Google Scholar and Cochrane databases were searched until February 2022. Records were screened against pre-defined inclusion and exclusion criteria. Data sources were prospective and retrospective studies. Demographics, mean differences in Cobb angle, surgical details and complication rates were recorded. Meta-analysis was conducted using a random-effects model. RESULTS This systematic review includes 19 studies, and the meta-analysis includes 16 of these. VBT displayed a statistically significant reduction in Cobb angle from pre-operative to final (minimum 2 years) measurements. The initial mean Cobb angle was 47.8° (CI 95% 42.9-52.7°) and decreased to 22.2° (CI 95% 19.9-24.5°). The mean difference is - 25.8° (CI 95% - 28.9-22.7) (p < 0.01). The overall complication rate was 23% (CI 95% 14.4-31.6%), the most common complication was tether breakage 21.9% (CI 95% 10.6-33.1%). The spinal fusion rate was 7.2% (CI 95% 2.3-12.1%). CONCLUSION VBT results in a significant reduction of AIS at 2 years of follow-up. Overall complication rate was relatively high although the consequences of the complications are unknown. Further research is required to explore the reasons behind the complication rate and determine the optimal timing for the procedure. VBT remains a promising new procedure that is effective at reducing scoliotic curves and preventing spinal fusion in the majority of patients. LEVEL OF EVIDENCE Systematic review of Therapeutic Studies with evidence level II-IV.
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Affiliation(s)
- Megan J. Roser
- Orthopaedics Department, Queensland Children’s Hospital, South Brisbane, Australia
- Biomechanics and Spine Research Group (BSRG), Centre for Children’s Health Research, Queensland University of Technology (QUT), Brisbane, Australia
| | - Geoffrey N. Askin
- Orthopaedics Department, Queensland Children’s Hospital, South Brisbane, Australia
- Biomechanics and Spine Research Group (BSRG), Centre for Children’s Health Research, Queensland University of Technology (QUT), Brisbane, Australia
| | - Robert D. Labrom
- Orthopaedics Department, Queensland Children’s Hospital, South Brisbane, Australia
- Biomechanics and Spine Research Group (BSRG), Centre for Children’s Health Research, Queensland University of Technology (QUT), Brisbane, Australia
| | - Syeda Farah Zahir
- Queensland Cyber Infrastructure Foundation (QCIF), Facility for Advanced Bioinformatics, The University of Queensland (UQ), Brisbane, Australia
| | - Maree Izatt
- Orthopaedics Department, Queensland Children’s Hospital, South Brisbane, Australia
- Biomechanics and Spine Research Group (BSRG), Centre for Children’s Health Research, Queensland University of Technology (QUT), Brisbane, Australia
| | - J. Paige Little
- Biomechanics and Spine Research Group (BSRG), Centre for Children’s Health Research, Queensland University of Technology (QUT), Brisbane, Australia
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30
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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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Pereira-Duarte M, Roy-Beaudry M, Turgeon I, Joncas J, Mac-Thiong JM, Labelle H, Barchi S, Parent S. Pre-operative parameters influencing vertebral body tethering outcomes: patient's characteristics play an important role in determining the outcomes at a minimum of 2 years post-op. Spine Deform 2023; 11:1389-1397. [PMID: 37528248 DOI: 10.1007/s43390-023-00739-1] [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: 02/15/2023] [Accepted: 07/15/2023] [Indexed: 08/03/2023]
Abstract
PURPOSE The aim of this study is to determine preoperative predictors of good radiographic outcomes in VBT patients at a minimum 2-year follow-up. METHODS From a single-center dataset, we reviewed patients who underwent VBT from January 2014 to November 2018. Data analysis included age, gender, Risser grade and biometric data. Radiographically, maximum Cobb angle, C-DAR and apical vertebral and disc wedging were measured preop and at a minimum 2-year follow-up. Patients were divided into two cohorts following two different outcome measures: (1) vertebral growth modulation, those patients that growth modulated or corrected ≥ 5° and those who did not; and (2) Maximum Cobb angle at 2 years, < and ≥ 40°. Student T and Chi2 tests were used for comparison and a multiple linear correlation test was implemented between statistically significant variables. RESULTS 79 patients were recruited. 26 patients (33%) did growth modulate their spine at 2-year follow-up. These patients were significantly younger, and more skeletally immature with less height (147 cm vs 155 cm; p < 0.0001), weight (38 kg vs. 45 kg; p = 0.0009) and BMI (17 vs 18.8; p = 0.0229) as those who did not. Multiple linear regression model with these variables resulted in a moderate correlation (r2 = 0.234). 67 patients (85%) finished at a 2-year follow-up with a maximum Cobb angle < 40°. These patients were also younger and skeletally immature. We found significant differences in outcome 2 regarding the average preoperative maximum Cobb angle (48.5° ± 9.5 vs. 59.1° ± 10), average C-DAR (7 ± 1.5 vs. 8.5 ± 2.1), average apical vertebral wedging (6.5° vs. 8.3°), average vertebral/disc wedging ratio (1.5 vs. 2.4) and the average immediate postoperative Cobb angle (25° vs. 38°). These variables predicted a 36% of the variation in final Cobb angle measurement at a 2-year follow-up (r2 = 0.362). CONCLUSION Curve severity determined by a preoperative C-DAR, preoperative Cobb angles and immediate postoperative Cobb angle are significantly related to curves < 40° at a minimum 2-year follow-up, while the potential to growth modulate the spine is more dependent on skeletal maturity, lower body weight and lower BMI. These patients' characteristics should be considered preoperatively.
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Affiliation(s)
- Matias Pereira-Duarte
- Université de Montréal, Montréal, QC, Canada
- Research Center, Sainte-Justine University Hospital Center, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
| | - Marjolaine Roy-Beaudry
- Research Center, Sainte-Justine University Hospital Center, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
| | - Isabelle Turgeon
- Research Center, Sainte-Justine University Hospital Center, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
| | - Julie Joncas
- Research Center, Sainte-Justine University Hospital Center, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
| | - Jean-Marc Mac-Thiong
- Université de Montréal, Montréal, QC, Canada
- Research Center, Sainte-Justine University Hospital Center, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
| | - Hubert Labelle
- Université de Montréal, Montréal, QC, Canada
- Research Center, Sainte-Justine University Hospital Center, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
| | - Soraya Barchi
- Research Center, Sainte-Justine University Hospital Center, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
| | - Stefan Parent
- Université de Montréal, Montréal, QC, Canada.
- Research Center, Sainte-Justine University Hospital Center, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada.
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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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Boeyer M, Tweedy N, Hoernschemeyer D, Wiesemann S. Central Airway Obstruction with Persistent Pulmonary Decline After Vertebral Body Tethering: A Case Report. JBJS Case Connect 2023; 13:01709767-202312000-00007. [PMID: 37831807 DOI: 10.2106/jbjs.cc.23.00258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
CASE An 11-year-old girl with pectus excavatum presented with an acute airway obstruction and persistent pulmonary compromise after vertebral body tethering (VBT). The anterior instrumentation was occluding her right basilar bronchus, resulting in hyperinflation. Removal of the instrumentation reversed the hyperinflation. CONCLUSION This case illustrates the difficulty of performing VBT in a small patient with severe scoliosis and significant asymmetric pectus excavatum. We recommend using low-profile instrumentation and ensuring the trajectory of the instrumentation is anterior to the rib head and parallel to the articular facets.
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Affiliation(s)
- Melanie Boeyer
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Nicole Tweedy
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
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Wong DLL, Mong PT, Ng CY, Ong CK, Qian Z, Shao MH, Sin LKE, Wong BY, Wong CM, Cheung JPY, To M. Can anterior vertebral body tethering provide superior range of motion outcomes compared to posterior spinal fusion in adolescent idiopathic scoliosis? A systematic review. 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; 32:3058-3071. [PMID: 37256367 DOI: 10.1007/s00586-023-07787-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/03/2023] [Accepted: 05/17/2023] [Indexed: 06/01/2023]
Abstract
PURPOSE Anterior vertebral body tethering (AVBT) was introduced as a fusionless alternative to treating adolescent idiopathic scoliosis (AIS) while preserving range of motion (ROM). This is the first systematic review to compare the ROM outcomes between AVBT and PSF in treating AIS. METHODS We conducted a comprehensive search on PubMed, EMBASE, MEDLINE, and Cochrane Library. Inclusion criteria were patients with AIS treated with AVBT or PSF or both, and clearly defined ROM outcomes; exclusion criteria were scoliosis other than AIS, biomechanical or cadaveric studies, non-English publications, case reports, conference summaries, unpublished literature, commentaries, and reviews. Primary outcome was ROM. Secondary outcomes included Cobb angle correction, quality of life (QOL), complications, and muscle strength and endurance. RESULTS Twelve studies were included in this review. We found moderate evidence to support that AVBT results in superior ROM outcomes than PSF while achieving comparable Cobb angle correction with low evidence. The comparison of QOL outcomes between AVBT and PSF remained inconclusive. In addition to the complications noted conventionally in PSF, AVBT could result in over-correction and distal adding-on. We also found very low evidence to support that AIS patients treated with AVBT have superior muscle strength and endurance when compared to those treated with PSF. CONCLUSIONS AVBT provides better preservation of ROM and muscle strength postoperatively when compared with PSF, while achieving comparable curve correction. Future studies should explore the spinal growth trajectory to determine the window of opportunity for AVBT in AIS.
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Affiliation(s)
- Darren Li Liang Wong
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Pak Tung Mong
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Chun Yin Ng
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Chun Kwan Ong
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Zhekai Qian
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Mang Hong Shao
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Ling Kwan Ernest Sin
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Bao Yi Wong
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Chun Ming Wong
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China.
| | - Michael To
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China.
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Vatkar A, Najjar E, Patel M, Quraishi NA. Vertebral body tethering in adolescent idiopathic scoliosis with more than 2 years of follow-up- systematic review and meta-analysis. 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; 32:3047-3057. [PMID: 37306799 DOI: 10.1007/s00586-023-07724-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/01/2022] [Accepted: 04/17/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND CONTEXT Whilst spinal fusion remains the gold standard in the treatment of adolescent idiopathic scoliosis (AIS), anterior vertebral body tethering (AVBT) is gaining momentum with relatively few studies on its efficacy thus far. PURPOSE To conduct a systematic review reporting on the early results of AVBT for patients undergoing surgery for AIS. We aimed to systematically evaluate the relevant literature pertaining to the efficacy of AVBT with respect to degree of correction of the major curve Cobb angle, complications and revision rates. STUDY DESIGN/SETTING Systematic review. PATIENT SAMPLE Of a total of 259 articles, 9 studies met the inclusion criteria and were analysed. Overall, 196 patients of (mean age 12.08 years) underwent an AVBT procedure for correction of AIS with a mean follow-up of 34 months. OUTCOME MEASURES Degree of Cobb angle correction, complications and revision rates were used as outcome measures. METHODS A systematic review of the literature on AVBT was performed for studies published between Jan 1999-March 2021 applying the PRISMA guidelines. Isolated case reports were excluded. RESULTS Overall, 196 patients of (mean age 12.08 years) underwent an AVBT procedure for correction of AIS with a mean follow-up of 34 months. There was a significant correction of the main thoracic curve of scoliosis (mean preoperative Cobb angle 48.5°, post-operative Cobb angle at final follow-up of 20.1°, P = 0.01). Overcorrection and mechanical complications were seen in 14.3% and 27.5% of cases, respectively. Pulmonary complications including atelectasis and pleural effusion were seen in 9.7% of patients. Tether revision was performed in 7.85%, and revision to a spinal fusion in 7.88%. CONCLUSION This systematic review incorporated 9 studies of AVBT and 196 patients with AIS. The complication and revision to spinal fusion rates were 27.5% and 7.88%, respectively. The current literature on AVBT is restricted largely to retrospective studies with non-randomised data. We would recommend a prospective, multi-centre trial of AVBT with strict inclusion criteria and standardised outcome measures.
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Affiliation(s)
- Arvind Vatkar
- The Centre for Spinal Studies and Surgery (CSSS), Queen's Medical Centre, Nottingham University Hospitals, Derby Rd, Lenton, Nottingham, NG7 2UH, UK.
| | - Elie Najjar
- The Centre for Spinal Studies and Surgery (CSSS), Queen's Medical Centre, Nottingham University Hospitals, Derby Rd, Lenton, Nottingham, NG7 2UH, UK
| | - Mohammed Patel
- The Centre for Spinal Studies and Surgery (CSSS), Queen's Medical Centre, Nottingham University Hospitals, Derby Rd, Lenton, Nottingham, NG7 2UH, UK
| | - Nasir A Quraishi
- The Centre for Spinal Studies and Surgery (CSSS), Queen's Medical Centre, Nottingham University Hospitals, Derby Rd, Lenton, Nottingham, NG7 2UH, UK
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Boeyer ME, Farid S, Wiesemann S, Hoernschemeyer DG. Outcomes of vertebral body tethering in the lumbar spine. Spine Deform 2023; 11:909-918. [PMID: 36820998 DOI: 10.1007/s43390-023-00662-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/21/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE The use of vertebral body tethering (VBT) for the treatment of main thoracic deformities in adolescent idiopathic scoliosis patients is becoming increasingly more common, but limited data exist on its safety and efficacy in thoracolumbar deformities. We aimed to evaluate the postoperative outcomes of patients with thoracolumbar (TL) deformities that were treated with VBT. METHODS We assessed clinical and radiographic data from twenty-eight consecutive patients that were surgically managed with VBT, all of whom exhibited a TL deformity with at least two years (mean: 44.7 ± 14.5 months) of postoperative follow-up. Standard radiographic parameters were extracted from left hand wrist and standing posterior-anterior and lateral spine radiographs at various timepoints. Outcome variables were assessed based on preoperative Lenke Classification and included: deformity measures, complications, surgical revisions, and postoperative success. RESULTS The mean age at the time of instrumentation was 13.4 ± 1.3 years, with an average preoperative Sanders Stage of 4.6 ± 1.4. A significant reduction in preoperative deformities was observed at most postoperative timepoints. A perioperative complication was observed in three patients and surgical revision was required in another four patients. A suspected broken tether was observed in sixteen patients, most of which occurred at the apex of the lumbar deformity. Only one patient required surgical revision due to a suspected broken tether. We observed an overall success rate of 57%, regardless of Lenke Classification. CONCLUSIONS These data indicate that VBT can successfully correct TL deformity patterns in 57% of patients without an increase in the rate of perioperative complications, suspected broken tethers, or surgical revisions.
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Affiliation(s)
- Melanie E Boeyer
- Department of Orthopaedic Surgery, University of Missouri, 204 N. Keene Street #102, Columbia, MO, 65201, USA
- Missouri Orthopaedic Institute, Columbia, MO, USA
| | - Sophi Farid
- School of Medicine, University of Missouri, Columbia, MO, USA
| | - Sebastian Wiesemann
- Division of Thoracic Surgery, Department of Surgery, University of Missouri, Columbia, MO, USA
| | - Daniel G Hoernschemeyer
- Department of Orthopaedic Surgery, University of Missouri, 204 N. Keene Street #102, Columbia, MO, 65201, USA.
- Missouri Orthopaedic Institute, Columbia, MO, USA.
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O'Donnell JM, Gornitzky AL, Wu HH, Furie KS, Diab M. Anterior vertebral body tethering for adolescent idiopathic scoliosis associated with less early post-operative pain and shorter recovery compared with fusion. Spine Deform 2023; 11:919-925. [PMID: 36809648 PMCID: PMC10261228 DOI: 10.1007/s43390-023-00661-6] [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: 07/22/2022] [Accepted: 02/04/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE While posterior spinal instrumentation and fusion (PSIF) for severe adolescent idiopathic scoliosis (AIS) is the gold standard, anterior vertebral body tethering (AVBT) is becoming an alternative for select cases. Several studies have compared technical outcomes for these two procedures, but no studies have compared post-operative pain and recovery. METHODS In this prospective cohort, we evaluated patients who underwent AVBT or PSIF for AIS for a period of 6 weeks after operation. Pre-operative curve data were obtained from the medical record. Post-operative pain and recovery were evaluated with pain scores, pain confidence scores, PROMIS scores for pain behavior, interference, and mobility, and functional milestones of opiate use, independence in activities of daily living (ADLs), and sleeping. RESULTS The cohort included 9 patients who underwent AVBT and 22 who underwent PSIF, with a mean age of 13.7 years, 90% girls, and 77.4% white. The AVBT patients were younger (p = 0.03) and had fewer instrumented levels (p = 0.03). Results were significant for decreased pain scores at 2 and 6 weeks after operation (p = 0.004, and 0.030), decreased PROMIS pain behavior at all time points (p = 0.024, 0.049, and 0.001), decreased pain interference at 2 and 6 weeks post-operative (p = 0.012 and 0.009), increased PROMIS mobility scores at all time points (p = 0.036, 0.038, and 0.018), and faster time to functional milestones of weaning opiates, independence in ADLs, and sleep (p = 0.024, 0.049, and 0.001). CONCLUSION In this prospective cohort study, the early recovery period following AVBT for AIS is characterized by less pain, increased mobility, and faster recovery of functional milestones, compared with PSIF. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Jennifer M O'Donnell
- Department of Orthopaedic Surgery, University of California San Francisco, 505 Parnassus Ave MU 320W, San Francisco, CA, 94143, USA.
| | - Alex L Gornitzky
- Department of Orthopaedic Surgery, University of California San Francisco, 505 Parnassus Ave MU 320W, San Francisco, CA, 94143, USA
| | - Hao-Hua Wu
- Department of Orthopaedic Surgery, University of California San Francisco, 505 Parnassus Ave MU 320W, San Francisco, CA, 94143, USA
| | - Kira S Furie
- University of California San Francisco School of Medicine, San Francisco, CA, 94143, USA
| | - Mohammad Diab
- Department of Orthopaedic Surgery, University of California San Francisco, 505 Parnassus Ave MU 320W, San Francisco, CA, 94143, USA
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Guldeniz O, Yip CCH, Nafo W, Cheung KMC. Biomechanics of the tether breakage: tensile behaviour of a single-unit vertebral body tethering construct. Spine Deform 2023; 11:825-831. [PMID: 36763247 PMCID: PMC10261170 DOI: 10.1007/s43390-023-00657-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/29/2023] [Indexed: 02/11/2023]
Abstract
PURPOSE Tether breakage was reported as the most common complication of vertebral body tethering. However, as the literature suggests the physiological loads do not have the potential to cause the failure of the tether. Currently, the biomechanical reason behind the tether breakage is unknown. The current study aims to elucidate the effects of the tension forces on the failure mechanisms of the VBT and provide mechanical justification for how it can be identified radiographically. METHODS Tensile tests (20%/min strain rate) were performed on single-unit VBT samples. Failure modes and mechanical characteristics were reported. RESULTS The failure took place prematurely due to the slippage of the tether at the screw-tether junction where the tether is damaged significantly by the locking cap. Slippage was initiated at 10-13% tensile strain level where the tensile stress and tension force were 50.4 ± 1.5 MPa and 582.2 ± 30.8 N, respectively. CONCLUSION The failure occurs because of high-stress concentrations generated within the locking region which damages the tether surface and leads to the slippage of the tether. We observed that the loads leading to failure are within the physiological limits and may indicate the high likelihood of the tether breakage. The failure mode observed in our study is shown to be the dominant failure mode, and a design improvement on the gripping mechanism is suggested to avoid failure at the screw-tether junction. We observed that the tether elongates 10-13% prior to the breakage, which can be employed as a diagnostic criterion to screen for tether breakages radiographically.
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Affiliation(s)
- Ogulcan Guldeniz
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Christopher C H Yip
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Wanis Nafo
- Department of Mechanical System Engineering, Jeonbuk National University, Jeonju, Republic of Korea
| | - Kenneth M C Cheung
- Department of Orthopaedic Surgery, HKU-Shenzhen Hospital, Shenzhen, China.
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.
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Welborn MC, Blakemore L, Handford C, Miyanji F, Parent S, El-Hawary R. Thoracolumbar curve behavior after selective thoracic anterior vertebral body tethering in Lenke 1A vs Lenke 1C curve patterns. Spine Deform 2023; 11:897-907. [PMID: 36892744 PMCID: PMC9996552 DOI: 10.1007/s43390-023-00664-3] [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: 11/09/2022] [Accepted: 02/04/2023] [Indexed: 03/10/2023]
Abstract
STUDY DESIGN Retrospective review of a prospective database. OBJECTIVES The purpose of this study is to evaluate changes in the thoracic and thoracolumbar/lumbar curves and truncal balance in patients treated with selective thoracic anterior vertebral body tethering (AVBT) with Lenke 1A vs 1C curves at a minimum of 2 years follow-up. Lenke 1C curves treated with selective thoracic AVBT demonstrate equivalent thoracic curve correction and reduced thoracolumbar/lumbar curve correction compared to Lenke 1A curves. Additionally, at the most recent follow-up, both curve types demonstrate comparable coronal alignment at C7 and the lumbar curve apex, though 1C curves have better alignment at the lowest instrumented vertebra (LIV). Rates of revision surgery are equivalent between the two groups. METHODS A matched cohort of 43 Risser 0-1, Sanders Maturity Scale (SMS) 2-5 AIS pts with Lenke 1A (1A group)and 19 pts with Lenke 1C curves (1C group) treated with selective thoracic AVBT and a minimum of 2-year follow-up were included. Digital radiographic software was used to assess Cobb angle and coronal alignment on preoperative, postoperative and subsequent follow-up radiographs. Coronal alignment was assessed by measuring the distance from the center sacral vertical line (CSVL) to the midpoint of the LIV, apical vertebra for thoracic and lumbar curves and C7. RESULTS There was no difference in the thoracic curve measured preoperatively, at first erect, pre-rupture or at the most recent follow-up, nor was there a significant difference in C7 alignment (p = 0.057) or apical thoracic alignment (p = 0.272) between the 1A and 1C groups. Thoracolumbar/lumbar curves were smaller in the 1A group at all-time points. However, there was no significant difference between the percent correction between the two groups thoracic (p = 0.453) and thoracolumbar/lumbar (p = 0.105). The Lenke 1C curves had improved coronal translational alignment of the LIV at the most recent follow-up p = 0.0355. At the most recent follow-up the number of patients considered to have successful curve correction (Cobb angle correction of both the thoracic and thoracolumbar//lumbar curves to ≤ 35 degrees), was equivalent between Lenke 1A and Lenke 1C curves (p = 0.80). There was also no difference in the rate of revision surgery between the two groups (p = 0.546). CONCLUSION This is the first study to compare the impact of lumbar curve modifier type on outcomes in thoracic AVBT. We found that Lenke 1C curves treated with selective thoracic AVBT demonstrate less absolute correction of the thoracolumbar/lumbar curve at all time points but have equivalent percent correction of the thoracic and thoracolumbar/lumbar curves. The two groups have equivalent alignment at C7 and the thoracic curve apex, and Lenke 1C curves have better alignment at the LIV at the most recent follow-up. Furthermore, they have an equivalent rate of revision surgery compared to Lenke 1A curves. Selective thoracic AVBT is a viable option for selective Lenke 1C curves, but despite equivalent correction of the thoracic curve, there is less correction of the thoracolumbar/lumbar curve at all-time points.
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Affiliation(s)
| | - Laurel Blakemore
- , 3101 SW Sam Jackson Park Road, Portland, OR, 97229, USA
- CEO, Pediatric Specialists of Virginia, Fairfax, VA, USA
| | - Cameron Handford
- , 3101 SW Sam Jackson Park Road, Portland, OR, 97229, USA
- Department of Orthopaedics, Royal North Shore Hospital, St. Leonards, NSW, Australia
| | - Firoz Miyanji
- , 3101 SW Sam Jackson Park Road, Portland, OR, 97229, USA
- Department of Orthopedics, British Columbia Children's Hospital, Vancouver, Canada
| | - Stefan Parent
- , 3101 SW Sam Jackson Park Road, Portland, OR, 97229, USA
- Département de Chirurgie, Sainte-Justine University Hospital Center, Université de Montréal, 3175 Côte-Sainte-Catherine, Montreal, Canada
| | - Ron El-Hawary
- , 3101 SW Sam Jackson Park Road, Portland, OR, 97229, USA
- Department of Surgery, IWK Health Centre Dalhousie University, Halifax, Canada
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Jeandel C, Bremond N, Christine de Maximin M, Lefèvre Y, Courvoisier A. Thoracoscopic Anterior Vertebral Body Tethering in Lenke Type-1 Right Adolescent Idiopathic Scoliosis. JBJS Essent Surg Tech 2023; 13:e22.00027. [PMID: 38304437 PMCID: PMC10833648 DOI: 10.2106/jbjs.st.22.00027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
Background Vertebral body tethering (VBT) is indicated for skeletally immature patients with progressive adolescent idiopathic scoliosis (AIS) who have failed or are intolerant of bracing and who have a major coronal curve of 40° to 65°. The vertebral body must be structurally and dimensionally adequate to accommodate screw fixation, as determined radiographically. The best indication for VBT is a flexible single major thoracic curve with nonstructural compensating lumbar and proximal thoracic curves (Lenke 1A or 1B). VBT allows for progressive correction of the deformity without spinal fusion by utilizing a minimally invasive fluoroscopic technique. Description The procedure for a right thoracic curve is performed with use of a right thoracoscopic approach with the patient in the left lateral decubitus position. The thoracoscope is introduced through a portal at the apex of the curvature in the posterior axillary line. Instrument portals are created lateral to each vertebral body in the mid-axillary line. Screws are inserted into each vertebral body under biplanar fluoroscopic control and with intraoperative neuromonitoring. An electroconductivity probing device, while not mandatory, is routinely utilized at our practice. The tether is attached to the most proximal screw of the construct, and then reduction is obtained sequentially by tensioning the tether from one vertebral screw to the next. Alternatives Bracing is the gold-standard treatment for progressive AIS involving the immature spine. The most commonly utilized surgical treatment is posterior spinal fusion (PSF), which should be considered when the major coronal curve exceeds 45°. Rationale PSF has proven to be a dependable technique to correct scoliotic deformities. It has a low complication rate and good long-term outcomes. However, concerns exist regarding the stiffness conferred by PSF and the long-term effects of adjacent segment disease. Thus, interest had developed in non-fusion solutions for AIS correction. VBT utilizes the Hueter-Volkmann principle to guide growth and correct deformity. Compressive forces applied to the convexity of the deformity by a polyethylene tether allow the patient's growth to realign the spine. Intraoperative correction triggers growth modulation, and most of the modulation seems to occur during the first 12 months postoperatively. The best results have been seen with a short Lenke type-1A curve in a patient with closed triradiate cartilage, a Risser 3 or lower (ideally Risser 0) iliac apophysis, and a flexible curve characterized by a 50% reduction of the major coronal curve angle on side-bending radiographs. Expected Outcomes In 57 immature patients with a Lenke type-1A or 1B curve (i.e., a 30° to 65° preoperative Cobb angle), Samdani et al.3 found a main thoracic Cobb angle reduction from 40° ± 7° preoperatively to 19° ± 13° at 2 years after VBT. In the sagittal plane, the T5-T12 kyphosis measured 15° ± 10° preoperatively, 17° ± 10° postoperatively, and 20° ± 13° at 2 years. No major neurologic or pulmonary complications occurred. A total of 7 (12.3%) of the 57 patients underwent surgical revision, including 5 for overcorrection and 2 to span additional vertebrae. In a study of 21 skeletally mature patients, Pehlivanoglu et al.4 found that the Cobb angle was reduced from 48° preoperatively to 16° on the first-erect postoperative radiograph and finally to 10° at the latest follow-up (mean, 27.4 months). The 2 main complications of VBT reported in the literature are overcorrection and tether breakage. Both may require revision, which explains the higher rate of revision observed for VBT compared with PSF. Important Tips Good patient selection is important. VBT is most appropriate in cases of a flexible Lenke type-1A or 1B curve in an immature child before Risser stage 3 and after triradiate cartilage closure.Always monitor and control screw positioning in both anteroposterior and lateral planes fluoroscopically.The screws should be placed parallel to the vertebral end plates or, even better, be angled inferiorly for the upper vertebrae and angled superiorly for the lower vertebrae to decrease the risk of pull-out when tensioning the device and during growth modulation. Less tension on the uppermost and lowermost instrumented vertebrae than at the apex, as controlled by the tensioning device, can also help to limit pull-out. Acronyms and Abbreviations VBT = vertebral body tetheringAIS = adolescent idiopathic scoliosisIONM = intraoperative neuromonitoringPSF = posterior spinal fusionUIV = upper instrumented vertebraLIV = lower instrumented vertebraAP = anteroposteriorK-wire = Kirschner wire.
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Affiliation(s)
- Clément Jeandel
- Centre hospitalier Universitaire de Montpellier, Hôpital Lapeyronie, Montpellier, France
- Polyclinique Saint Roch, Montpellier, France
| | - Nicolas Bremond
- Centre alpin de la scoliose, Centre hospitalier Universitaire de Grenoble, Hôpital Couple Enfant, La Tronche, France
| | - Marie Christine de Maximin
- Centre alpin de la scoliose, Centre hospitalier Universitaire de Grenoble, Hôpital Couple Enfant, La Tronche, France
| | - Yan Lefèvre
- Hôpital des Enfants-Groupe hospitalier Pellegrin, Centre hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Aurélien Courvoisier
- Centre alpin de la scoliose, Centre hospitalier Universitaire de Grenoble, Hôpital Couple Enfant, La Tronche, France
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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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An JK, Berman D, Schulz J. Back pain in adolescent idiopathic scoliosis: A comprehensive review. J Child Orthop 2023; 17:126-140. [PMID: 37034188 PMCID: PMC10080242 DOI: 10.1177/18632521221149058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/10/2022] [Indexed: 04/11/2023] Open
Abstract
Purpose Adolescent idiopathic scoliosis (AIS) is a common spinal deformity that affects millions of children worldwide. A variety of treatment algorithms exist for patients based on radiographic parameters such as the Cobb angle and the Risser stage. However, there has been a growing focus on nonradiographic outcomes such as back pain, which can cause functional disability and reduced quality of life for patients. In spite of this, back pain in AIS is poorly characterized in the literature. We aimed to summarize various factors that may influence back pain in AIS and the impact of different treatment methods on pain reduction. Methods A comprehensive systematic review was undertaken using the PubMed and Cochrane database. Keywords that were utilized and combined with "Adolescent Idiopathic Scoliosis" included, "back pain," "treatment," "biomechanics," "biochemistry," "epidemiology," and "biopsychosocial." The literature was subsequently evaluated and deemed relevant or not relevant for inclusion. Results A total of 93 articles were ultimately included in this review. A variety of contradictory literature was present for all sections related to epidemiology, underlying biomechanics and biochemistry, biopsychosocial factors, and treatment methodologies. Conclusion Back pain in AIS is common but remains difficult to predict and treat. The literature pertaining to causative factors and treatment options is heterogeneous and inconclusive. Longer-term prospective studies combining biopsychosocial intervention in conjunction with existing curve correction techniques would be meaningful.
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Affiliation(s)
- Juhyung K An
- College of Medicine, SUNY Downstate
Health Sciences University, Brooklyn, NY, USA
| | - Daniel Berman
- Department of Orthopedic Surgery,
Montefiore Medical Center, Bronx, NY, USA
- Daniel Berman, Apt 18L, 353 East 83rd
Street, New York, NY 10028, USA.
| | - Jacob Schulz
- Department of Orthopedic Surgery,
Montefiore Medical Center, Bronx, NY, USA
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Lemans JVC, Wijdicks SPJ, Overweg G, Hekman EEG, Schlösser TPC, Castelein RM, Verkerke GJ, Kruyt MC. Three-dimensional correction of scoliosis by a double spring reduction system as a dynamic internal brace: a pre-clinical study in Göttingen minipigs. Spine J 2023; 23:599-608. [PMID: 36343914 DOI: 10.1016/j.spinee.2022.10.012] [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: 07/13/2022] [Revised: 10/07/2022] [Accepted: 10/26/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND CONTEXT Adolescent idiopathic scoliosis (AIS) is a major skeletal deformity that is characterized by a combination of apical rotation, lateral bending and apical lordosis. To provide full 3D correction, all these deformations should be addressed. We developed the Double Spring Reduction (DSR) system, a (growth-friendly) concept that continuously corrects the deformity through two different elements: A posterior convex Torsional Spring Implant (TSI) that provides a derotational torque at the apex, and a concave Spring Distraction System (SDS), which provides posterior, concave distraction to restore thoracic kyphosis. PURPOSE To determine whether the DSR components are able to correct an induced idiopathic-like scoliosis and to compare correction realized by the TSI alone to correction enforced by the complete DSR implant. STUDY DESIGN/SETTING Preclinical randomized animal cohort study. PATIENT SAMPLE Twelve growing Göttingen minipigs. OUTCOME MEASURES Coronal Cobb angle, T10-L3 lordosis/kyphosis, apical axial rotation, relative anterior lengthening. METHODS All mini-pigs received the TSI with a contralateral tether to induce an idiopathic-like scoliosis with apical rotation (mean Cobb: 20.4°; mean axial apical rotation: 13.1°, mean lordosis: 4.9°). After induction, the animals were divided into two groups: One group (N=6) was corrected by TSI only (TSI only-group), another group (N=6) was corrected by a combination of TSI and SDS (DSR-group). 3D spinal morphology on CT was compared between groups over time. After 2 months of correction, animals were euthanized. RESULTS Both intervention groups showed excellent apical derotation (TSI only-group: 15.0° to 5.4°; DSR-group: 11.2° to 3.5°). The TSI only-group showed coronal Cobb improvement from 22.5° to 6.0°, while the DSR-group overcorrected the 18.3° Cobb to -9.2°. Lordosis was converted to kyphosis in both groups (TSI only-group: -4.6° to 4.3°; DSR-group: -5.2° to 25.0°) which was significantly larger in the DSR-group (p<.001). CONCLUSIONS The TSI alone realized strong apical derotation and moderate correction in the coronal and sagittal plane. The addition of distraction on the posterior concavity resulted in more coronal correction and reversal of induced lordosis into physiological kyphosis. CLINICAL SIGNIFICANCE This study shows that dynamic spring forces could be a viable method to guide the spine towards healthy alignment, without fusing it or inhibiting its growth.
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Affiliation(s)
- Justin V C Lemans
- University Medical Center Utrecht, Department of Orthopaedic Surgery, PO Box 85500, 3553 GA, Utrecht, The Netherlands.
| | - Sebastiaan P J Wijdicks
- University Medical Center Utrecht, Department of Orthopaedic Surgery, PO Box 85500, 3553 GA, Utrecht, The Netherlands
| | - Gerrit Overweg
- University of Twente, Department of Biomechanical Engineering, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Edsko E G Hekman
- University of Twente, Department of Biomechanical Engineering, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Tom P C Schlösser
- University Medical Center Utrecht, Department of Orthopaedic Surgery, PO Box 85500, 3553 GA, Utrecht, The Netherlands
| | - René M Castelein
- University Medical Center Utrecht, Department of Orthopaedic Surgery, PO Box 85500, 3553 GA, Utrecht, The Netherlands
| | - Gijsbertus J Verkerke
- University of Twente, Department of Biomechanical Engineering, PO Box 217, 7500 AE, Enschede, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Moyo C Kruyt
- University Medical Center Utrecht, Department of Orthopaedic Surgery, PO Box 85500, 3553 GA, Utrecht, The Netherlands; University of Twente, Department of Developmental BioEngineering, PO Box 217, 7500 AE, Enschede, The Netherlands
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Trobisch P, Mahoney JM, Eichenlaub EK, Antonacci CL, Cuddihy L, Amin DB, Razo-Castaneda D, Orbach MR, McGuckin JP, Bucklen BS, Antonacci MD, Betz RR. An investigation of range of motion preservation in fusionless anterior double screw and cord constructs for scoliosis correction. 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; 32:1173-1186. [PMID: 36871254 DOI: 10.1007/s00586-023-07608-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 03/06/2023]
Abstract
PURPOSE To evaluate the motion-preserving properties of vertebral body tethering with varying cord/screw constructs and cord thicknesses in cadaveric thoracolumbar spines. METHODS In vitro flexibility tests were performed on six fresh-frozen human cadaveric spines (T1-L5) (2 M, 4F) with a median age of 63 (59-to-80). An ± 8 Nm load was applied to determine range of motion (ROM) in flexion-extension (FE), lateral bending (LB), and axial rotation (AR) in the thoracic and lumbar spine. Specimens were tested with screws (T5-L4) and without cords. Single (4.0 mm and 5.0 mm) and double (4.0 mm) cord constructs were sequentially tensioned to 100 N and tested: (1) Single 4.0 mm and (2) 5.0 mm cords (T5-T12); (3) Double 4.0 mm cords (T5-12); (4) Single 4.0 mm and (5) 5.0 mm cord (T12-L4); (6) Double 4.0 mm cords (T12-L4). RESULTS In the thoracic spine (T5-T12), 4.0-5.0 mm single-cord constructs showed slight reductions in FE and 27-33% reductions in LB compared to intact, while double-cord constructs showed reductions of 24% and 40%, respectively. In the lumbar spine (T12-L4), double-cord constructs had greater reductions in FE (24%), LB (74%), and AR (25%) compared to intact, while single-cord constructs exhibited reductions of 2-4%, 68-69%, and 19-20%, respectively. CONCLUSIONS The present biomechanical study found similar motion for 4.0-5.0 mm single-cord constructs and the least motion for double-cord constructs in the thoracic and lumbar spine suggesting that larger diameter 5.0 mm cords may be a more promising motion-preserving option, due to their increased durability compared to smaller cords. Future clinical studies are necessary to determine the impact of these findings on patient outcomes.
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Affiliation(s)
| | - Jonathan M Mahoney
- Musculoskeletal Education and Research Center, A Division of Globus Medical Inc., 2560 General Armistead Ave., Audubon, PA, 19403, USA
| | - Emily K Eichenlaub
- Musculoskeletal Education and Research Center, A Division of Globus Medical Inc., 2560 General Armistead Ave., Audubon, PA, 19403, USA
| | | | - Laury Cuddihy
- Institute for Spine and Scoliosis, Lawrenceville, NJ, USA
| | - Dhara B Amin
- Musculoskeletal Education and Research Center, A Division of Globus Medical Inc., 2560 General Armistead Ave., Audubon, PA, 19403, USA
| | - Dominic Razo-Castaneda
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA , USA
| | - Mattan R Orbach
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA , USA
| | - Joshua P McGuckin
- Musculoskeletal Education and Research Center, A Division of Globus Medical Inc., 2560 General Armistead Ave., Audubon, PA, 19403, USA.
| | - Brandon S Bucklen
- Musculoskeletal Education and Research Center, A Division of Globus Medical Inc., 2560 General Armistead Ave., Audubon, PA, 19403, USA
| | | | - Randal R Betz
- Institute for Spine and Scoliosis, Lawrenceville, NJ, USA
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Baroncini A, Courvoisier A. The different applications of Vertebral Body Tethering - Narrative review and clinical experience. J Orthop 2023; 37:86-92. [PMID: 36974090 PMCID: PMC10039119 DOI: 10.1016/j.jor.2023.02.012] [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: 12/29/2022] [Revised: 02/02/2023] [Accepted: 02/21/2023] [Indexed: 03/29/2023] Open
Abstract
Background Vertebral body tethering (VBT) has been originally developed as a growth modulation technique for the surgical management of skeletally immature patients with adolescent idiopathic scoliosis (AIS). Given the positive results obtained in this setting, the use of VBT is gradually expanding to other patient categories, such as those with no or limited remaining growth or with non-idiopathic scoliosis. Aim of this manuscript is to offer an overview over the current applications of VBT, along with imaging and comments derived from the clinical experience. The work was based on a literature search conducted in January 2023 on Pubmed, Scopus and Web of Science databases. Following keywords were used for the search: vertebral body tethering, adolescent idiopathic scoliosis, early onset scoliosis, neuromuscular scoliosis, syndromic scoliosis. Results Three patient categories in which VBT has been applied have been highlighted: VBT for growth modulation in AIS, VBT as anterior scoliosis correction in AIS and VBT for non-idiopathic curves or early-onset scoliosis. Conclusion While growth modulation in AIS still represents the most widespread use of VBT, the use of this technique has yielded positive results in different settings as well, such as scoliosis correction in AIS or temporary or definitive curve management in non-AIS curves. While long-term results are lacking, patient selection seems to play a central role to reduce the complication rate and ensure predictable and stable results.
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Affiliation(s)
- A. Baroncini
- Department of Orthopaedics, RWTH Aachen University Clinic, Aachen, Germany
| | - A. Courvoisier
- Grenoble Alpes Scoliosis Center, Grenoble Alpes University Hospital, Grenoble, France
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Perioperative Outcomes of Open Anterior Vertebral Body Tethering and Instrumented Posterior Spinal Fusion for Skeletally Immature Patients With Idiopathic Scoliosis. J Pediatr Orthop 2023; 43:143-150. [PMID: 36746139 DOI: 10.1097/bpo.0000000000002320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Correcting adolescent idiopathic scoliosis (AIS) without fusion can be achieved with anterior vertebral body tethering (AVBT). However, little is known about the perioperative outcomes, pain control, and clinical outcomes in patients undergoing AVBT compared with instrumented posterior spinal fusion (IPSF). METHODS In this retrospective cohort study, we compared pediatric patients with AIS who underwent either AVBT or IPSF. Inclusion criteria were based on the AVBT group, which included primary thoracic idiopathic scoliosis, Risser ≤1, curve magnitude 40 to 70 degrees, age 9 to 15, no prior spine surgery, index surgery between 2014 and 2019, and minimum 2-year follow-up. Patient demographics, perioperative metrics, pain visual analog scale scores, opiate morphine equivalent usage, cost data, and radiographic outcomes were compared. RESULTS We identified 23 patients who underwent AVBT and 24 matched patients in the IPSF group based on inclusion criteria. Patients undergoing AVBT and PSF were similar in age (12±1 y vs. 13±1 y, P =0.132) and average follow-up time (3.8±1.6 y vs. 3.3±1.4 y, P =0.210). There were 23 female patients (87%) in the AVBT group and 24 female (92%) patients in the IPSF group. Intraoperatively, estimated blood loss (498±290 vs. 120±47 mL, P <0.001) and procedure duration (419±95 vs. 331±83 min, P =0.001) was significantly greater in the IPSF group compared with AVBT. Length of stay was lower in the AVBT group compared with PSF (4±1 vs. 5±2 d, P =0.04). PSF patients had significantly greater total postoperative opiate morphine equivalent use compared with AVBT (2.2±1.9 vs. 5.6±3.4 mg/kg, P <0.001). Overall direct costs following PSF and AVBT were similar ($47,655+$12,028 vs. $50,891±$24,531, P =0.58). Preoperative radiographic parameters were similar between both the groups, with a major thoracic curve at 51±10 degrees for AVBT and 54±9 degrees for IPSF ( P =0.214). At the most recent follow-up, IPSF patients had greater curve reduction to a mean major thoracic curve of 11±7 degrees (79%) compared with 19±10 degrees (63%) in AVBT patients ( P =0.002). Nine patients (39%) required revision surgery following AVBT compared with 4 patients(17%) following IPSF ( P =0.09). CONCLUSIONS In a select cohort of patients, AVBT offers decreased surgical time, blood loss, length of stay, and postoperative opiate usage compared with IPSF. Although IPSF resulted in greater deformity correction at 2-year follow-up, the majority of patients who underwent AVBT had ≤35 major curves and avoided fusion. There is optimism for AVBT as a treatment option for select AIS patients, but long-term complications are still being understood, and the risk for revision surgeries remains high. LEVEL OF EVIDENCE Level III.
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Haber L, Starring H, Newcomb N, Larson AN, Desai B, Roybal J, Fant W, Milbrandt T, Boeyer M, Marks M, Newton P, Samdani A, Miyanji F, Hoernschemeyer D. Drain options after vertebral body tethering. Spine Deform 2023; 11:367-372. [PMID: 36219390 DOI: 10.1007/s43390-022-00595-5] [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: 06/27/2022] [Accepted: 09/17/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE Since the introduction of vertebral body tethering (VBT) for adolescent idiopathic scoliosis (AIS), a variety of post-operative chest drainage systems have been utilized. Most surgeons use formal chest tubes with a Pleur-evac, while others use smaller bulb suction drains (e.g., Blake drain). In addition, some centers utilize pleural closure. This multicenter study evaluates whether drain type or pleural closure impact perioperative and 90 day complication rates. METHODS A retrospective review was conducted from three institutions with established VBT programs. All preoperative, perioperative and 90 day postoperative data were analyzed to determine differences in outcomes between three cohorts: standard chest tube (SCT), standard chest tube with pleural closure (SCTPC) and 10 French Bulb drain (BD). RESULTS 104 patients were identified for the study. 57 SCT, 25 SCTPC and 22 BD. All data are listed in order: SCT, SCTPC, BD. Length of stay (3.7, 4.3, 3.0 days) was less in the BD group (p = 0.009); post-operative drainage (460, 761, 485 cc) was less in the SCT and BD groups (p < 0.001); intra-operative estimated blood loss (EBL) 146, 382, 64 cc was less in the BD group (p < 0.001). No significant difference in number of days (3.2, 3.2, and 2.8 days) drainage was in place, groups (p = 0.311). Complication profile was similar with 2 chest tube reinsertions in the SCT and one hemothorax that resolved spontaneously in BD group. CONCLUSIONS In this series of 104 patients, SCT, SCTPC and BD all had a similar safety profile. All three methods were safe and effective in managing post-operative chest drainage after thoracic VBT. In the series, BD group had significantly shorter LOS than both groups that used chest tubes. LEVEL OF EVIDENCE Level III, Retrospective cohort study.
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Affiliation(s)
- Lawrence Haber
- Department of Orthopaedic Surgery, Ochsner Clinic Foundation, 1415 Jefferson Hwy, New Orleans, LA, 70121, USA
| | - Hunter Starring
- Department of Orthopaedic Surgery, Ochsner Clinic Foundation, 1415 Jefferson Hwy, New Orleans, LA, 70121, USA.
| | - Nicholas Newcomb
- University of Queensland-Ochsner Clinical School, New Orleans, LA, USA
| | - A Noelle Larson
- Department of Pediatric Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Bhumit Desai
- Department of Orthopaedic Surgery, Ochsner Clinic Foundation, 1415 Jefferson Hwy, New Orleans, LA, 70121, USA
| | - Jessica Roybal
- Department of Pediatric Surgery, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Whitney Fant
- Department of Orthopaedic Surgery, Ochsner Clinic Foundation, 1415 Jefferson Hwy, New Orleans, LA, 70121, USA
| | - Todd Milbrandt
- Department of Pediatric Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Melanie Boeyer
- Department of Orthopaedic Surgery, University of Missouri-Columbia, Columbia, MO, USA
| | | | - Peter Newton
- Division Orthopedics and Scoliosis, Rady Children's Hospital, San Diego, CA, USA
| | - Amer Samdani
- Department of Pediatric Orthopedic Surgery, Shriners Children's Philadelphia, Philadelphia, PA, USA
| | - Firoz Miyanji
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Dan Hoernschemeyer
- Department of Orthopaedic Surgery, University of Missouri-Columbia, Columbia, MO, USA
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Operative differences for posterior spinal fusion after vertebral body tethering: Are we fusing more levels in the end? 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; 32:625-633. [PMID: 36542164 DOI: 10.1007/s00586-022-07450-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 09/09/2022] [Accepted: 11/04/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Little is known about the perioperative characteristics associated with a posterior spinal fusion (PSF) in adolescent idiopathic scoliosis patients previously treated with vertebral body tethering (VBT). We aimed to determine if operative time, estimated blood loss, postoperative length of stay, instrumentation type, and implant density differed in patients that received a PSF (i.e., PSF-Only) or a PSF following a failed VBT (i.e., PSF-VBT). METHODS We retrospectively assessed matched cohort data (PSF-VBT = 22; PSF-Only = 22) from two multi-center registries. We obtained: (1) operative time, (2) estimated blood loss, (3) postoperative length of stay, (4) instrumentation type, and (5) implant density. Theoretical fusion levels prior to the index procedure were obtained for PSF-VBT and compared to the actual levels fused. RESULTS We observed no difference in operative time, estimated blood loss, or postoperative length of stay. Instrumentation type was all-screw in PSF-Only and varied in PSF-VBT with nearly 25% of patients exhibiting a hybrid construct. There was no added benefit to removing anterior instrumentation prior to fusion; however, implant density was higher in PSF-Only (1.9 ± 0.2) than when compared to PSF-VBT (1.7 ± 0.3). An additional two levels were fused in 50% of PSF-VBT patients, most of which were added to the distal end of the construct. CONCLUSIONS We found that operative time, estimated blood loss, and postoperative length of stay were similar in both cohorts; however, the length of the fusion construct in PSF-VBT is likely to be two levels longer when a failed VBT is converted to a PSF.
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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: 2] [Impact Index Per Article: 2.0] [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 for non-idiopathic scoliosis: initial results from a multicenter retrospective study. Spine Deform 2023; 11:139-144. [PMID: 36070136 DOI: 10.1007/s43390-022-00575-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 08/20/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Vertebral body tethering (VBT) has been described for patients with idiopathic scoliosis. Results of the technique for non-idiopathic scoliosis have not yet been reported. METHODS An international multicenter registry was retrospectively queried for non-idiopathic scoliosis patients who underwent VBT with minimum 2-year follow-up. Success at 2 years was defined as Cobb angle < 35 degrees and no fusion surgery. RESULTS Of the 251 patients treated with VBT, 20 had non-idiopathic scoliosis and minimum 2-year follow-up. Mean age at surgery was 12.4 years (range 10 to 17 years). Mean major Cobb angle at enrollment was 56 degrees. Of those, 18 patients had a major thoracic curve and two had a major lumbar curve. Of the 20 patients, nine met criteria for success (45%). Eight of the 20 patients had poor outcomes (four fusions, four with curve > 50 degrees). Success was associated with smaller preoperative Cobb angle (50 vs. 62 degrees, p = 0.01) and smaller Cobb angle on initial postop imaging (28 degrees vs. 46 degrees, p = 0.0007). All patients with Cobb angle < 35 degrees on 1st postop imaging had a successful result, with the exception of one patient who overcorrected and required fusion. Syndromic vs. neuromuscular patients had a higher likelihood of success (5 of 7, 71%, 2 of 10, 20%, p = 0.03). CONCLUSION Selected non-idiopathic scoliosis can be successfully treated with VBT, but failure rates are high and were associated with large curves, inadequate intraoperative correction and neuromuscular diagnosis. Achieving a Cobb angle less than 35 degrees on 1st standing radiograph was associated with a successful outcome which was achieved in 45% of patients. LEVEL OF EVIDENCE Level IV (retrospective review study).
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