JOR spine · 2025
Effect of Vertebral Body Tether Tensioning on Vertebral Body Growth Modulation.
СтатьяНазвание и аннотация: Перевод в очереди
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Jackson Taylor J, Louer Craig, El-Hawary Ron, Hurry Jennifer, Nian Hui, Farnsworth Christine, Bartley Carrie E, Bryan Tracey P, Kelly Michael P, Newton Peter O, Parent Stefan, Pediatric Spine Study Group, Upasani Vidyadhar V
Аннотация
BACKGROUND: The relationship between tether tension and spinal growth modulation following vertebral body tethering (VBT) has not been studied in growing children.
AIMS: This study aims to explore the relationship between vertebral body growth modulation under varying tether tension.
MATERIALS AND METHODS: A retrospective, multicenter pediatric registry was queried for idiopathic scoliosis patients treated with right-sided VBT, with recorded intraoperative tension (using an ordinal scale of 0-3), and 3D reconstructions from biplanar radiographs at the first erect (FE) and 2-year post-operative visits. Custom MATLAB code was used to calculate vertebral height (mm) on the untethered and tethered sides from T5-T12. Generalized linear mixed models were used to analyze the effect of tension on vertebral body growth.
RESULTS: Fifty-two subjects (47 female) were included with a mean age of 12.5 ± 1 years. Patients were skeletally immature (triradiate cartilage open in 23 patients) with Proximal Femoral Maturity Index scores of 2 (nine patients), 3 (21 patients), 4 (20 patients), and 5 (two patients). A total of 330 vertebral bodies were analyzed. Mean height change of the vertebral bodies from FE to 2 years was 1.6 + 1.9 mm (untethered) and 1.2 + 1.8 mm (tethered). On the tethered side, greater tension resulted in less height change, with the greatest differential growth observed between maximal tension and no tension (0.8 mm vs. 0.2 mm, p = 0.02). Greater tension resulted in less vertebral body growth and greater differential growth. Future studies should quantify forces applied during VBT surgery, as well as the forces maintained in the post-operative period with spinal motion.
CONCLUSION: Intraoperative intervertebral tensioning significantly affects vertebral body growth over 2 years.
AIMS: This study aims to explore the relationship between vertebral body growth modulation under varying tether tension.
MATERIALS AND METHODS: A retrospective, multicenter pediatric registry was queried for idiopathic scoliosis patients treated with right-sided VBT, with recorded intraoperative tension (using an ordinal scale of 0-3), and 3D reconstructions from biplanar radiographs at the first erect (FE) and 2-year post-operative visits. Custom MATLAB code was used to calculate vertebral height (mm) on the untethered and tethered sides from T5-T12. Generalized linear mixed models were used to analyze the effect of tension on vertebral body growth.
RESULTS: Fifty-two subjects (47 female) were included with a mean age of 12.5 ± 1 years. Patients were skeletally immature (triradiate cartilage open in 23 patients) with Proximal Femoral Maturity Index scores of 2 (nine patients), 3 (21 patients), 4 (20 patients), and 5 (two patients). A total of 330 vertebral bodies were analyzed. Mean height change of the vertebral bodies from FE to 2 years was 1.6 + 1.9 mm (untethered) and 1.2 + 1.8 mm (tethered). On the tethered side, greater tension resulted in less height change, with the greatest differential growth observed between maximal tension and no tension (0.8 mm vs. 0.2 mm, p = 0.02). Greater tension resulted in less vertebral body growth and greater differential growth. Future studies should quantify forces applied during VBT surgery, as well as the forces maintained in the post-operative period with spinal motion.
CONCLUSION: Intraoperative intervertebral tensioning significantly affects vertebral body growth over 2 years.