Does vertebral body tethering cause disc and facet joint degeneration? A preliminary MRI study with minimum two years follow-up

Yücekul, Altuğ; Akpunarli, Burcu; Durbas, Atahan; Zulemyan, Tais; Havlucu, Irem; Ergene, Gokhan; Şenay, Şahin; Dikmen, Pınar Yalınay; Balci, Sule Turgut; Karaarslan, Ercan; Yavuz, Yasemin; Yılgör, Çağlar; Alanay, Ahmet

doi:10.1016/j.spinee.2021.05.020

Cited by 24 publications

(18 citation statements)

References 38 publications

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“…We did not identify a statistically significant association with the curve magnitude, age, sex, or skeletal maturity and the degree of disk degeneration seen on MRI. This is in contrast to a report of patients treated with VBT who were noted to have no change in Pfirrman disk rating at a mean of 2.4 years following surgery 15. These patients were Sanders 1 to 7 in contrast to our cohort which was primarily Sanders 3 and 4 at the time of surgery.…”

Section: Discussioncontrasting

confidence: 99%

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Intervertebral Disk Health Following Vertebral Body Tethering for Adolescent Idiopathic Scoliosis: A Preliminary Study

Jackson

Milbrandt

Mathew

et al. 2022

Journal of Pediatric Orthopaedics

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Background: Interest in vertebral body tethering (VBT) as an alternative to posterior spinal fusion for adolescent idiopathic scoliosis (AIS) continues to grow. The purpose of this study was to prospectively assess intervertebral disk health on magnetic resonance imaging (MRI) at 1 year following VBT in AIS patients. Methods: AIS patients were enrolled in a prospective surgeon-sponsored Food and Drug Administration (FDA) Investigational Device Exemption (IDE) Study and underwent MRI at 1-year following VBT. All spanned disks and the untethered disks immediately adjacent to the upper instrumented vertebra and lowest instrumented vertebra levels were evaluated according to Pfirrmann grading criteria. Associations between patient factors and preoperative and postoperative disk health and patient-reported outcomes were evaluated. Results: Twenty-two patients were enrolled with a postoperative MRI (25 curves, 188 disks), and 7 patients (7 curves) had both preoperative and postoperative MRIs (67 disks). The mean age was 12.7 years. Most were Risser 0 (65%) and either Sanders Skeletal Maturity Score 3 (35%) or 4 (53%). In the 7 patients with preoperative and postoperative MRI, the mean Pfirrmann grade of the disks spanned by the tether was 1.88 preoperatively and 2.31 postoperatively (P=0.0075). No statistically significant differences in preoperative versus postoperative Pfirrmann grade were identified in the disks adjacent to the upper or lower instrumented vertebrae. No association was found between patient-reported outcomes and Pfirrmann grade. Conclusion: At 1 year postoperatively, increased degenerative changes in disks spanned by the tether was identifiable on MRI without evidence of adjacent segment disk disease. These changes were not associated with patient-reported outcomes. Level of Evidence: Level III.

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Section: Discussioncontrasting

confidence: 99%

“…This grading system has well-reported interobserver and intraobserver reliability 19. While there have been no studies to validate the Pfirrmann scoring system in pediatric patients specifically, it has been used to evaluate degenerative changes in pediatric patients in prior studies 15,20…”

Section: Methodsmentioning

confidence: 99%

Intervertebral Disk Health Following Vertebral Body Tethering for Adolescent Idiopathic Scoliosis: A Preliminary Study

Jackson

Milbrandt

Mathew

et al. 2022

Journal of Pediatric Orthopaedics

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“…This fusion-less technique maintains spine mobility [1], and patients showed a quick return to daily life activities and sports [2]. Furthermore, it allows for a good correction on the sagittal plane [3] and it may prevent adjacent segment degeneration [4,5], a common downfall of spine fusion. VBT can be employed both in its growth-modulating form for skeletally immature patients (VBT-growth modulation, VBT-GM) and as a tissue remodelling technique in patients who are approaching or have reached skeletal maturity (VBT-anterior scoliosis correction, VBT-ASC) [6][7][8].…”

Section: Introductionmentioning

confidence: 97%

The timing of tether breakage influences clinical results after VBT

et al. 2022

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Introduction Tether breakage is a frequent mechanical complications after vertebral body tethering (VBT), but not all patients with a breakage show loss of correction. The reason of this clinical finding has not yet been clarified. We hypothesized that the integrity of the tether is relevant only in the early stages after VBT, when it drives growth modulation and tissue remodelling. After these mechanisms have taken place, the tether loses its function and a breakage will not alter the new shape of the spine. Thus, tether breakage would have a greater clinical relevance when occurring shortly after surgery. Methods All consecutive patients who underwent VBT and had a min. 2-year follow-up were included. The difference in curve magnitude between the 1st standing x-ray and the last follow-up was calculated (ΔCobb). For each curve, the presence and timing of tether breakage were recorded. The curves were grouped according to if and when the breakage was observed (no breakage, breakage at 0–6 months, 6–12 months, > 12 months). The ΔCobb was compared among these groups with the analysis of variance (ANOVA). Results Data from 152 curves were available: 68 with no breakage, 12 with a breakage at 0–6 months, 37 at 6–12 months and 35 > 12 months. The ANOVA found significant difference in the ΔCobb among the groups (Sum of square 2553.59; degree of freedom 3; mean of square 851.1; Fisher test 13.8; P < 0.0001). Patients with no breakage or breakage at > 12 months had similar ΔCobb (mean 4.8° and 7.8°, respectively, P = 0.3), smaller than the 0–6 or 6–12 groups (15.8° and 13.8°, respectively). Conclusion Tether breakage leads to a consistent loss of correction when occurring within the first 12 months, while it has limited clinical relevance when occurring later on.

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“…External bracing is applied in less severe cases, while posterior spinal fusion is the gold standard for advanced curves, although it has associated morbidity and can lead to reduced mobility [ 4 , 5 , 6 ]. Degenerative disc disease can be documented at long term follow-up after spinal fusion, mainly at the lumbar level, although literature is not conclusive at this regard [ 7 ]. Other promising surgical treatments for IS have also been described in the literature, including traditional growing rods or magnetically controlled growing rods, which can be lengthened using external remote controller on an outpatient basis, developed in the last decade but still burdened by high complication and failure rates [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Video-Assisted Thoracoscopy for Vertebral Body Tethering of Juvenile and Adolescent Idiopathic Scoliosis: Tips and Tricks of Surgical Multidisciplinary Management

et al. 2022

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VATS (video assisted thoracoscopic surgery) is routinely and successfully performed in minor and major complex thoracic procedures. This technique has been recently introduced for the treatment of severe forms of idiopathic scoliosis (IS) with the aim to repair the deformity, reduce morbidity and to prevent its progression in patients with skeletal immaturity. This study aims to present VATS in anterior vertebral body tethering (AVBT) approach to support the pediatric orthopedic surgeons during vertebral body fixation. Surgical and anesthesiologic tips and tricks are reported to assure a safe procedure. The study includes preadolescents with IS and a grade of scoliosis >40° that had a high probability of deterioration due to remaining growth (December 2018 to April 2021). Skeletal immaturity of enrolled patients was assessed by Sanders classification and Risser sign. Patients had a Risser score between 0 and 1 and a Sanders score >2 and <5. AVBT technique using VATS was performed by a senior pediatric surgeon assisting the pediatric orthopedic surgeon. Twenty-three patients have been submitted to VATS AVBT in the period of study (age range 9–14 years). The patients had a classified deformity Lenke 1A or B convex right and all types of curves were treated. In all patients, the vertebrae submitted to tethering surgery ranged from D5 to D12; mean curve correction was 43%. Three postoperative complications occurred: one late postoperative bleeding requiring a chest tube positioning on 12th postoperative day; one screw dislodged and needed to be removed; one child showed worsening of the scoliosis and needed a posterior arthrodesis. Initial results of VATS AVBT in growing patients with spinal deformities are encouraging. An appropriate selection of patients and a pediatric dedicated multidisciplinary surgical approach decrease intraoperative complications, time of operation and postoperative sequelae and guarantee an optimal outcome.

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Does vertebral body tethering cause disc and facet joint degeneration? A preliminary MRI study with minimum two years follow-up

Cited by 24 publications

References 38 publications

Intervertebral Disk Health Following Vertebral Body Tethering for Adolescent Idiopathic Scoliosis: A Preliminary Study

Intervertebral Disk Health Following Vertebral Body Tethering for Adolescent Idiopathic Scoliosis: A Preliminary Study

The timing of tether breakage influences clinical results after VBT

Video-Assisted Thoracoscopy for Vertebral Body Tethering of Juvenile and Adolescent Idiopathic Scoliosis: Tips and Tricks of Surgical Multidisciplinary Management

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