Spontaneous Lumbar Curve Correction Following Vertebral Body Tethering of Main Thoracic Curves
| Autor: | Anthony A, Catanzano, Peter O, Newton, Tracey P, Bastrom, Carrie E, Bartley, Stefan, Parent, Firoz, Miyanji, Daniel G, Hoernschemeyer, Ahmet, Alanay, Laurel, Blakemore, Kevin, Neal, Baron, Lonner, Lawrence, Haber, Suken A, Shah, Burt, Yaszay |
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| Rok vydání: | 2022 |
| Předmět: | |
| Zdroj: | Journal of Bone and Joint Surgery. 104:1629-1638 |
| ISSN: | 1535-1386 0021-9355 |
| Popis: | Growth modulation through anterior vertebral body tethering (AVBT) has emerged as a fusionless option for the treatment of progressive scoliosis. When tethering the main thoracic curve, the compensatory thoracolumbar/lumbar curve must correct indirectly as a result. The present study evaluated the response of these lumbar curves following AVBT of the main thoracic curves.Patients who underwent thoracic AVBT and who had a minimum follow-up of 2 years were included. Magnitudes of the thoracic and lumbar curves were recorded preoperatively and at the first-erect and 2-year postoperative visits. Lumbar curves were further stratified according to their lumbar modifier (A, B, or C). Analysis of variance (ANOVA) and repeated-measures ANOVA were performed to compare correction rates, and the Pearson coefficient was utilized to determine the correlation between the tethered thoracic curve and uninstrumented lumbar curve magnitudes.A total of 218 patients were included. Thoracic curve correction was 40% at the first-erect visit and 43% at 2 years (p = 0.012). Lumbar correction was 30%, 26%, and 18% at the first-erect visit (p0.001 for all compared with preoperatively) and minimally changed at 31%, 26%, and 24% at 2 years for lumbar modifiers A, B, and C, respectively. A total of 118 patients (54%) showed thoracic curve improvement between the first-erect and 2-year visits. In a subgroup analysis, these patients had a correction in lumbar curve magnitude from preoperatively to the first-erect visit of 30%, 22%, and 16% for lumbar modifiers A, B, C, respectively, that increased to 42%, 34%, and 31% at 2 years, with strong correlation to thoracic correction at 2-year follow-up (r = 0.557, p0.001).Although there was immediate lumbar correction following AVBT of a main thoracic curve, further improvement following initial correction was only observed among patients with growth modulation of the thoracic curve. Considering all patients, the uninstrumented lumbar curve corrected 30% at 2 years and the instrumented thoracic curve corrected 40%. As indications for AVBT are refined, these data will provide insight into the response of the uninstrumented lumbar curve.Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence. |
| Databáze: | OpenAIRE |
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