Endoscopic Mechanical Spinal Hemiepiphysiodesis Modifies Spine Growth

Wall, Eric J.; Bylski-Austrow, Donita I.; Kolata, Ronald J.; Crawford, Alvin H.

doi:10.1097/01.brs.0000162278.68000.91

Cited by 80 publications

(34 citation statements)

References 26 publications

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“…Studies such as those by Beguiristáin et al and Zhang and Sucato [3,5] emphasised NCC asymmetry as a cause of structured scoliosis. However, other studies demonstrated the effects of EP on vertebral wedging which in turn develop scoliotic deformity [1,2]. The results from these studies prompted us to analyse the effectiveness of physiodesis of EP and/or NCC by direct electrocoagulation decreasing the possibilities of surgical complications due to the potential extrusion of the implants.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, Wall et al [1] implanted staples using thoracoscopy in seven mediothoracic vertebrae in immature pigs. Each assembly covered the intervertebral disc and the superior physeal cartilage of the lower vertebra, as well as the inferior physeal cartilage of the upper vertebra.…”

Section: Discussionmentioning

confidence: 99%

“…Spinal deformities have been experimentally induced by physeal stapling [1], theatering a flexible cable to the vertebral bodies [2] and by posterior transpedicular screws [3][4][5]. Most of these techniques involve the destruction of spinal structures adjacent to growth plates, which also might influence the development of the scoliotic curvature.…”

Section: Introductionmentioning

confidence: 99%

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Vertebral growth modulation by hemicircumferential electrocoagulation: an experimental study in pigs

Caballero¹,

Barrios

Burgos

et al. 2011

Eur Spine J

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Introduction This experimental study in pigs was aimed at evaluating spinal growth disorders after partial arrest of the vertebral epiphyseal plates (EP) and neurocentral cartilages (NCC). Unilateral and multisegmental single or combined lesions of the physeal structures were performed by electrocogulation throughout a video-assisted thoracoscopical approach. Materials and methods Thirty 4-week-old domestic pigs (mean weight 16 kg) were included in the experiments. The superior and inferior epiphyseal plates of T5 to T9 vertebra were damaged in ten animals by hemicircumferential electrocoagulation (group I). In other ten pigs (group II), right NCC at the same T5-T9 levels were damaged. Ten other animals underwent combined lesions of the ipsilateral hemiepiphyseal plates and NCC at the T5-T9 levels. A total of 26 animals could be evaluated after 12 weeks of followup using conventional X-rays, CT scans and histology. Results The pigs with hemicircumferential EP damage developed very slight concave non-structured scoliotic deformities without vertebral rotation.(mean 12°Cobb; range10-16°). Some of the damaged vertebra showed a marked wedgening with unilateral development alteration of the vertebral body, including the adjacent discs The animals with damage of the NCC developed mild scoliotic curves (mean 19°Cobb; range 16-24°) with convexity opposite to the damaged side and loss of physiological kyphosis. The injured segments showed an asymmetric growth with hypoplasia of the pedicle and costovertebral joints at the damaged side. The pigs undergoing combined EP and NCC lesions developed minimal non-structured curves, ranging from 10 to 12°Cobb. In these animals there was a lack of growth of a vertebral hemibody and disc hypoplasia at the damaged segments. Both damage of the NCC and the EP affect the height of the vertebral body. No spinal stenosis was found in any case. In most cases, the adjacent superior and inferior vertebral EP to damaged segments had a compensatory growth that maintained the straight spinal shape. Conclusions In summary, unilateral direct lesion of the EP by hemicircumferential thoracoscopic electrocoagulation modifies vertebral growth, but is not able to induce true scoliostic curves in pigs. Only animals with damaged NCC developed mild scoliotic curves of lordotic type. This work rediscovers and emphasizes the decisive role of the neurocentral cartilage in the ethiopatogeny of idiopathic scoliosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Vertebral growth modulation by hemicircumferential electrocoagulation: an experimental study in pigs

Caballero¹,

Barrios

Burgos

et al. 2011

Eur Spine J

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show abstract

“…Endoscopic spinal hemiepiphysiodesis, via custom spine staples, was performed in pig vertebrae and was shown to modify the spinal growth effectively. No staple back-out was reported [42]. Asymmetrical static loading rat tail was shown to create vertebral wedging [29].…”

Section: Experimental Research On Spinal Growth Modulationmentioning

confidence: 99%

Growth modulation in the management of growing spine deformities

Akel

Yazıcı

2009

Journal of Children's Orthopaedics

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The Hueter-Volkmann law explains the physiological response of the growth plate under mechanical loading. This law mainly explains the pathological mechanism for growing long-bone deformities. Vertebral endplates also show a similar response under mechanical loading. Experimental studies have provided information about spinal growth modulation and, now, it is possible to explain the mechanism of the curvature progression. Convex growth arrest is shown to successfully treat deformities of the growing spine and unnecessary growth arrest of the whole spine is prevented. Both anterior and posterior parts of the convexity should be addressed to achieve a satisfactory improvement in the deformity, albeit epiphysiodesis effect cannot be stipulated at all times. Anterior vertebral body stapling without fusion yielded better results with new shape memory alloys and techniques. This method can be used with minimally invasive techniques and has the potential advantage of producing reversible physeal arrest. Instrumented posterior hemiepiphysiodesis seems to be as effective as classical combined anterior and posterior arthrodesis, where it is less invasive and morbid. Convex hemiepiphysiodesis with concave-side distraction through growing rod techniques provide a better control of the curve immediately after surgery. This method has the advantages of posterior instrumented hemiepiphysiodesis, but necessitates additional surgeries. Concave-side rib shortening and/ or convex-side lengthening is an experimental method with an indirect effect on spinal growth. To conclude, whatever the cause of the spinal deformity, growth modulation can be used to manage the growing spine deformities with no or shorter segment fusions.

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“…These minimally invasive approaches maintain a certain spinal flexibility depending on the rigidity of the implant. Wall et al [18] introduced a rigid 2-prong vertebral staple that fixes two adjacent vertebral bodies, while slowing down growth on one side of the spine. These were tested on a pig model and showed the ability to induce significant spinal curvature (reverse problem).…”

Section: Introductionmentioning

confidence: 99%

A novel fusionless vertebral physeal device inducing spinal growth modulation for the correction of spinal deformities

et al. 2008

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Current fusionless scoliosis surgical techniques span the intervertebral disc. This alters the spine stiffness, disc pressure equilibrium and possibly may lead to disc degeneration. A new fusionless physeal device was developed that locally modulates vertebral growth by compressing the physeal ring, while maintaining maximum segmental spinal mobility without spanning the intervertebral disc. This study's objective was to test the feasibility of the device on a small animal model by inducing a scoliotic deformity (inverse approach) while analyzing the growth modifications. This study was conducted on caudal vertebrae of 21 rats (26-day-old) divided into 3 groups: (1) ''experimental'' (n = 11) with 4 instrumented vertebrae, (2) sham (n = 5) and (3) control (n = 5). Radiographs were taken at regular intervals during the 7-week experimental period. Tissues were embedded in methyl metacrylate (MMA), prepared by the cutting/grinding method, and then stained (Toluidine blue). The discs physiological alterations were qualitatively assessed and classified by inspection of the histological sections. A mean maximum Cobb angle of 308 (±68) and a mean maximum vertebral wedge angle of 108 (±38) were obtained between the 23rd and 35th day postoperative in the subgroup that underwent a long-term response from the device. The sham group underwent no growth alterations when compared to the control group. Descriptive histological analyses of the operated segments showed that 69% had no alterations to the intervertebral disc. This study presents experimental evidence that the device induces a significant and controlled wedging of the vertebrae while maintaining regular flexibility. In most discs, there were no visible morphological alterations induced. Further analysis of the discs and testing of this device on a larger animal is recommended with the long-term objective of developing an early treatment of progressive idiopathic scoliosis.

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Endoscopic Mechanical Spinal Hemiepiphysiodesis Modifies Spine Growth

Abstract: Spinal hemiepiphysiodesis using an anatomically based implant and minimally invasive procedures repeatedly induced spine curvature in a normal porcine model. These techniques may slow, and perhaps even correct, early progressive spine deformity without long rod instrumentation or fusion.

Cited by 80 publications

References 26 publications

Vertebral growth modulation by hemicircumferential electrocoagulation: an experimental study in pigs

Vertebral growth modulation by hemicircumferential electrocoagulation: an experimental study in pigs

Growth modulation in the management of growing spine deformities

A novel fusionless vertebral physeal device inducing spinal growth modulation for the correction of spinal deformities

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