Growth modulation response in vertebral body tethering depends primarily on magnitude of concave vertebral body growth.

Autor: Louer CR Jr; Department of Orthopedic Surgery, Vanderbilt University Medical Center, 2200 Childrens Way, Suite 4202, Nashville, TN, 37212, USA. Craig.louer@vumc.org., Upasani VV; Department of Orthopedics, Rady Children's Hospital, San Diego, CA, USA.; Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA, USA., Hurry JK; Division of Orthopaedic Surgery, IWK Health Centre, Halifax, NS, Canada., Nian H; 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., Farnsworth CL; Department of Orthopedics, Rady Children's Hospital, San Diego, CA, USA., Newton PO; Department of Orthopedics, Rady Children's Hospital, San Diego, CA, USA.; Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA, USA., Parent S; Department of Surgery, Faculty of Medicine, Universite´ de Montre´Al, Montre´Al, QC, Canada., El-Hawary R; Division of Orthopaedic Surgery, IWK Health Centre, Halifax, NS, Canada.
Jazyk: angličtina
Zdroj: Spine deformity [Spine Deform] 2024 Nov; Vol. 12 (6), pp. 1689-1698. Date of Electronic Publication: 2024 Jun 04.
DOI: 10.1007/s43390-024-00909-9
Abstrakt: 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.
(© 2024. The Author(s).)
Databáze: MEDLINE
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