Anterior Vertebral Body Tethering for Skeletally Immature Patients with AIS: Indication for Spinal Fusion at Skeletal Maturity Is Not Obviated in 60% of Cases
Abstract
:1. Introduction
2. Materials and Methods
- Patients with AIS who failed previous brace therapy;
- Preoperative Cobb angle of the major curve ≤ 65°;
- Preoperative Cobb angle of thoracic kyphosis ≤ 40°;
- Lenke curve types 1, 3, and 5;
- Skeletal immaturity at the time of surgery, with at least 2 years of residual growth corresponding to Sanders Stadium ≤ 5.
- Preoperative: bone age, Cobb angle of the major curve, instrumented segment of the spine. The patients were divided into subgroups according to bone age: Sanders Stadium (SS): ≤2 vs. ≥3; Cobb angle, major curve: ≤50° vs. ≥51°; instrumented segment of the spine: at or above T12 vs. at or below L1.
- Postoperative: Cobb angle, rupture of the flexible tether. Tether breakage was anticipated if, on serial X-rays, the divergence between the screws placed at two adjacent segments of ≥5° Cobb increased.
2.1. Statistical Analysis
2.2. Surgical Technique
3. Results
3.1. Patient Demographics and Clinical and Radiological Characteristics
3.2. Radiological Results
3.3. Evaluation of Risk Factors with Influence on Outcome
3.3.1. Bone Age at Surgery
3.3.2. Preoperative Cobb Angle of the Major Curve
3.3.3. Location of the Instrumented Curve
3.3.4. Tether Rupture
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Danielsson, A.J. Natural history of adolescent idiopathic scoliosis: A tool for guidance in decision of surgery of curves above 50 degrees. J. Child. Orthop. 2013, 7, 37–41. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Nachemson, A. A long term follow-up study of non-treated scoliosis. Acta Orthop. Scand. 1968, 39, 466–476. [Google Scholar] [CrossRef]
- Weinstein, S.L.; Dolan, L.A.; Spratt, K.F.; Peterson, K.K.; Spoonamore, M.J.; Ponseti, I.V. Health and Function of Patients With Untreated Idiopathic Scoliosis: A 50-year natural history study. JAMA 2003, 289, 559–567. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Weinstein, S.L. The Natural History of Adolescent Idiopathic Scoliosis. J. Pediatr. Orthop. 2019, 39 (Suppl. S1), S44–S46. [Google Scholar] [CrossRef] [PubMed]
- Nilsonne, U.; Lundgren, K.D. Long-term prognosis in idiopathic scoliosis. Acta Orthop. Scand. 1968, 39, 456–465. [Google Scholar] [CrossRef] [Green Version]
- Bjure, J.; Nachemson, A. Non-Treated Scoliosis. Clin. Orthop. Relat. Res. 1973, 93, 44–52. [Google Scholar] [CrossRef]
- Weinstein, L.S.; Zavala, D.C.; Ponseti, I.V. Idiopathic scoliosis: Long-term follow-up and prognosis in untreated patients. J. Bone Jt. Surg. Am. 1981, 63, 702–712. [Google Scholar] [CrossRef] [Green Version]
- Weinstein, S.L.; Ponseti, I.V. Curve progression in idiopathic scoliosis. J. Bone Jt. Surg. Am. 1983, 65, 447–455. [Google Scholar] [CrossRef]
- Available online: www.srs.org/professionals/online-education-and-resources/conditions-and-treatments/adolescent-idiopathic-scoliosis#Treatment (accessed on 10 April 2023).
- Asher, M.A.; Burton, D.C. Adolescent idiopathic scoliosis: Natural history and long term treatment effects. Scoliosis 2006, 1, 2. [Google Scholar] [CrossRef] [Green Version]
- Helenius, L.; Diarbakerli, E.; Grauers, A.; Lastikka, M.; Oksanen, H.; Pajulo, O.; Löyttyniemi, E.; Manner, T.; Gerdhem, P.; Helenius, I. Back Pain and Quality of Life after Surgical Treatment for Adolescent Idiopathic Scoliosis at 5-Year Follow-up: Comparison with Healthy Controls and Patients with Untreated Idiopathic Scoliosis. J. Bone Jt. Surg. Am. 2019, 101, 1460–1466. [Google Scholar] [CrossRef]
- Marks, C.M.; Bastrom, T.P.; Petcharaporn, M.; Shah, S.A.; Betz, R.R.; Samdani, A.; Lonner, B.; Miyanji, F.; Newton, P.O. The Effect of Time and Fusion Length on Motion of the Unfused Lumbar Segments in Adolescent Idiopathic Scoliosis. Spine Deform. 2015, 3, 549–553. [Google Scholar] [CrossRef] [PubMed]
- Parsch, D.; Gaertner, V.; Brocai, D.R.; Carstens, C. The effect of spinal fusion on the long-term outcome of idiopathic scoliosis. A case–control study. J. Bone Jt. Surg. Am. 2001, 83, 1133–1136. [Google Scholar] [CrossRef]
- Crawford, H.C., 3rd; Lenke, L.G. Growth modulation by means of anterior tethering resulting in progressive correction of juvenile idiopathic scoliosis: A case report. J. Bone Jt. Surg. Am. 2010, 92, 202–209. [Google Scholar] [CrossRef] [PubMed]
- Samdani, F.A.; Ames, R.J.; Kimball, J.S.; Pahys, J.M.; Grewal, H.; Pelletier, G.J.; Betz, R.R. Anterior vertebral body tethering for idiopathic scoliosis: Two-year results. Spine 2014, 39, 1688–1693. [Google Scholar] [CrossRef] [PubMed]
- Newton, O.P.; Kluck, D.G.; Saito, W.; Yaszay, B.; Bartley, C.E.; Bastrom, T.P. Anterior Spinal Growth Tethering for Skeletally Immature Patients with Scoliosis: A Retrospective Look Two to Four Years Postoperatively. J. Bone Jt. Surg. Am. 2018, 100, 1691–1697. [Google Scholar] [CrossRef]
- Miyanji, F.; Pawelek, J.; Nasto, L.A.; Rushton, P.; Simmonds, A.; Parent, S. Safety and efficacy of anterior vertebral body tethering in the treatment of idiopathic scoliosis. Bone Jt. J. 2020, 102, 1703–1708. [Google Scholar] [CrossRef]
- Rushton, P.P.R.; Nasto, L.; Parent, S.; Turgeon, I.; Aldebeyan, S.; Miyanji, F. Anterior Vertebral Body Tethering for Treatment of Idiopathic Scoliosis in the Skeletally Immature: Results of 112 Cases. Spine 2021, 46, 1461–1467. [Google Scholar] [CrossRef]
- Shaw, K.A.; Welborn, M.C.; Matsumoto, H.; Parent, S.; Sachwani, N.; El-Hawary, R.; Skaggs, D.; Newton, P.O.; Blakemore, L.; Vitale, M.; et al. To tether or fuse? Significant equipoise remains in treatment recommendations for idiopathic scoliosis. Spine Deform. 2022, 10, 763–773. [Google Scholar] [CrossRef]
- Lenke, L.G.; Betz, R.R.; Harms, J.; Bridwell, K.H.; Clements, D.H.; Lowe, T.G.; Blanke, K. Adolescent idiopathic scoliosis: A new classification to determine extent of spinal arthrodesis. J. Bone Jt. Surg. Am. 2001, 83, 1169–1181. [Google Scholar] [CrossRef]
- Sanders, J.O.; Khoury, J.G.; Kishan, S.; Browne, R.H.; Mooney, J.F.; Arnold, K.D.; McConnell, S.J.; Bauman, J.A.; Finegold, D.N. Predicting scoliosis progression from skeletal maturity: A simplified classification during adolescence. J. Bone Jt. Surg. Am. 2008, 90, 540–553. [Google Scholar] [CrossRef]
- Cheung, P.W.H.; Canavese, F.; Chan, C.Y.W.; Wong, J.S.H.; Shigematsu, H.; Luk, K.D.P.; Cheung, J.P. The Utility of a Novel Proximal Femur Maturity Index for Staging Skeletal Growth in Patients with Idiopathic Scoliosis. J. Bone Jt. Surg. Am. 2022, 104, 630–640. [Google Scholar] [CrossRef] [PubMed]
- Hoernschemeyer, D.G.; Boeyer, M.E.; Robertson, M.E.; Loftis, C.M.; Worley, J.R.; Tweedy, N.M.; Gupta, S.U.; Duren, D.L.; Holzhauser, C.M.; Ramachandran, V.M. Anterior Vertebral Body Tethering for Adolescent Scoliosis with Growth Remaining: A Retrospective Review of 2 to 5-Year Postoperative Results. J. Bone Jt. Surg. Am. 2020, 102, 1169–1176. [Google Scholar] [CrossRef] [PubMed]
- Newton, O.P.; Upasani, V.V.; Farnsworth, C.L.; Oka, R.; Chambers, R.C.; Dwek, J.; Kim, J.R.; Perry, A.; Mahar, A.T. Spinal growth modulation with use of a tether in an immature porcine model. J. Bone Jt. Surg. Am. 2008, 90, 2695–2706. [Google Scholar] [CrossRef]
- Baker, C.E.; Kiebzak, G.M.; Neal, K.M. Anterior vertebral body tethering shows mixed results at 2-year follow-up. Spine Deform. 2021, 9, 481–489. [Google Scholar] [CrossRef] [PubMed]
- Wong, K.H.; Ruiz, J.N.M.; Newton, P.O.; Liu, K.P.G. Non-Fusion Surgical Correction of Thoracic Idiopathic Scoliosis Using a Novel, Braided Vertebral Body Tethering Device: Minimum Follow-up of 4 Years. JBJS Open Access 2019, 4, e0026. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Newton, P.O.; Takahashi, Y.; Yang, Y.; Yaszay, B.; Bartley, C.E.; Bastrom, T.P.; Munar, C. Anterior vertebral body tethering for thoracic idiopathic scoliosis leads to asymmetric growth of the periapical vertebrae. Spine Deform. 2022, 10, 553–561. [Google Scholar] [CrossRef]
- McDonald, T.C.; Shah, S.A.; Hargiss, J.B.; Varghese, J.; Boeyer, M.E.; Pompliano, M.; Neal, K.; Lonner, B.S.; Larson, A.N.; Yaszay, B.; et al. When successful, anterior vertebral body tethering (VBT) induces differential segmental growth of vertebrae: An in vivo study of 51 patients and 764 vertebrae. Spine Deform. 2022, 10, 791–797. [Google Scholar] [CrossRef]
- Alanay, A.; Yucekul, A.; Abul, K.; Ergene, G.; Senay, S.; Ay, B.; Cebeci, B.O.; Dikmen, P.Y.; Zulemyan, T.; Yavuz, Y.; et al. Thoracoscopic Vertebral Body Tethering for Adolescent Idiopathic Scoliosis: Follow-up Curve Behavior According to Sanders Skeletal Maturity Staging. Spine 2020, 45, E1483–E1492. [Google Scholar] [CrossRef]
- Newton, P. Spinal growth tethering: Indications and limits. Ann. Transl. Med. 2020, 8, 27. [Google Scholar] [CrossRef]
- Trobisch, P.D.; Baroncini, A. Preliminary outcomes after vertebral body tethering (VBT) for lumbar curves and subanalysis of a 1- versus 2-tether construct. Eur. Spine J. 2021, 30, 3570–3576. [Google Scholar] [CrossRef]
- Newton, O.P.; Bartley, C.E.; Bastrom, T.P.; Kluck, D.G.; Saito, W.; Yaszay, B. Anterior Spinal Growth Modulation in Skeletally Immature Patients with Idiopathic Scoliosis: A Comparison with Posterior Spinal Fusion at 2 to 5 Years Postoperatively. J. Bone Jt. Surg. Am. 2020, 102, 769–777. [Google Scholar] [CrossRef] [PubMed]
- Baroncini, A.; Trobisch, P.; Eschweiler, J.; Migliorini, F. Analysis of the risk factors for early tether breakage following vertebral body tethering in adolescent idiopathic scoliosis. Eur. Spine J. 2022, 31, 2348–2354. [Google Scholar] [CrossRef] [PubMed]
- Baroncini, A.; Migliorini, F.; Eschweiler, J.; Hildebrand, F.; Trobisch, P. The timing of tether breakage influences clinical results after VBT. Eur. Spine J. 2022, 31, 2362–2367. [Google Scholar] [CrossRef]
- Trobisch, P.; Baroncini, A.; Berrer, A.; Da Paz, S. Difference between radiographically suspected and intraoperatively confirmed tether breakages after vertebral body tethering for idiopathic scoliosis. Eur. Spine J. 2022, 31, 1045–1050. [Google Scholar] [CrossRef] [PubMed]
- Faldini, C.; Manzetti, M.; Neri, S.; Barile, F.; Viroli, G.; Geraci, G.; Ursini, F.; Ruffilli, A. Epigenetic and Genetic Factors Related to Curve Progression in Adolescent Idiopathic Scoliosis: A Systematic Scoping Review of the Current Literature. Int. J. Mol. Sci. 2022, 23, 5914. [Google Scholar] [CrossRef]
Cohort Demographics (n = 20) | ||||
---|---|---|---|---|
Gender | Male n = 5 (25%) | Female n = 15 (75%) | ||
Age | At surgery 13.4 ± 1.1 | At the latest follow-up 15.9 ± 1 | ||
Lenke curve type | 1 | 3 | 5 | |
Nr. Patients | 6 (30%) | 1 (5%) | 13 (65%) | |
Sanders Stadium at the time of surgery | 1 | 2 | 3 | 5 |
No. of patients | 2 (10%) | 5 (25%) | 7 (35%) | 6 (30%) |
Cobb° | p Value | |||||
---|---|---|---|---|---|---|
Preoperative | First Erect | Last f/u | Preop. vs. First Erect | First Erect vs. Last f/u | Preop. vs. Last f/u | |
Major curve (coronal) | 46.6 ± 9° | 17.7 ± 10.4° | 33.8 ± 18.7° | <0.001 | <0.001 | >0.05 |
Minor curve (coronal) | 36.5 ± 12.3° | 29.4 ± 14.4° | 36.2 ± 23.5° | >0.05 | >0.05 | >0.05 |
Thoracic kyphosis | 29.8 ± 7.9° | 29.5 ± 9.9° | >0.05 | |||
Lumbar lordosis | 50.5 ± 5.3° | 48.7 ± 7.2° | >0.05 |
Major Curve Cobb° | Preoperative | First Erect Postoperative | Follow-Up (Mo) | p-Value First Erect Postoperative vs. Last f/u | |||
---|---|---|---|---|---|---|---|
6 | 12 | 18 | Last f/u | ||||
Sanders ≤ 2 | 41.3 ± 9.4° | 14.2 ± 6.5 | 15.5 ± 11.3 | 12.1 ± 17.3 | 18.6 ± 9.7 | 13.5 ± 13.8 | p = 0.474 |
Sanders ≥ 3 | 49.3 ± 7.3° | 19.5 ± 11.7 | 23.8 ± 12.2 | 30.2 ± 11.1 | 36.6 ± 12.0 | 43.8 ± 10.8 | p < 0.001 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Mladenov, K.V.; Pinnschmidt, H.O.; 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. https://doi.org/10.3390/jcm12123933
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. Journal of Clinical Medicine. 2023; 12(12):3933. https://doi.org/10.3390/jcm12123933
Chicago/Turabian StyleMladenov, Kiril V., Hans O. Pinnschmidt, and Ralf Stücker. 2023. "Anterior Vertebral Body Tethering for Skeletally Immature Patients with AIS: Indication for Spinal Fusion at Skeletal Maturity Is Not Obviated in 60% of Cases" Journal of Clinical Medicine 12, no. 12: 3933. https://doi.org/10.3390/jcm12123933