Growth modulation in the management of growing spine deformities

Abstract

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.

Utility of an allograft tendon for scoliosis correction via the costo‐transverse foreman

“…Recently, there has been an increasing interest in convex tethering procedure in treating AIS as a fusionless treatment . Indeed, several studies have described the feasibility and efficacy of such techniques . However, all these tethering procedures are based on an anterior approach placed through the chest cavity, compromising lung function and increasing surgical risk .…”

“…The current standard of care for skeletally immature patients with progressive scoliosis measuring greater than or equal to 25° is a spinal orthosis, and those with greater than 45° are indicated for surgical fusion . However, surgical fusion sacrifices growth potential limits spinal flexibility, and increases the risk of degenerative spinal changes in the long‐term .…”

Convex Short Segment Instrumentation and Hemi-Chevron Osteotomies for Putti Type 1 Thoracic Hemivertebrae

“…[11][12][13][16][17][18][19] Several studies have documented an epiphysiodesis effect in the majority of patients with control of deformity, whereas the correction effect is observed less frequently. In congenital spinal deformities the growth potential is asymmetric, due either to formation or segmentation defects.…”

Surgical epiphysiodesis indications and techniques: update

“…Other indications have included upper limb deformities [2], excessive predicted height in boys (>205 cm) [3] and fixed knee flexion deformity of more than 108 [4,5]. Growth modulation of the spine is also gaining interest in surgical management of scoliosis in children [6]; tethering of the convexity by bridging the vertebral endplates produces a gradual decrease in the curve magnitude by allowing the concave side to grow. This technique is intended to compensate for the excessive growth on one side of the spine.…”