Dynamic Scoliosis Correction as Alternative Treatment for Patients with Adolescent Idiopathic Scoliosis: a Non-Fusion Surgical Technique

Trobisch, Per; Kobbe, Philipp; Baroncini, Alice

doi:10.1055/a-0983-1265

Cited by 16 publications

(16 citation statements)

References 15 publications

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“…The following radiologic parameters were measured before surgery, at the 1st standing X-ray and at the 1-year follow-up: Cobb angle, coronal balance (CB, the linear distance between C7 plumb line and the central sacral vertical line), pelvic incidence (PI), pelvic tilt (PT), thoracic kyphosis (TK), lumbar lordosis (LL) and sagittal vertical alignment (SVA). Curve type was determined according to our previously published classification [11]. This classification is based on the potential advantages and feasibility of VBT over fusion: lumbar curves are defined as type 1, double curves type 2, long thoracic curves with L2 being the first caudal that touches the central sacral vertical line (CSVL) are type 3, short thoracic curves with L1 or higher touching the CSVL are described as type 4 and rigid proximal thoracic curves as type 5.…”

Section: Methodsmentioning

confidence: 99%

Preliminary outcomes after vertebral body tethering (VBT) for lumbar curves and subanalysis of a 1- versus 2-tether construct

Trobisch¹,

Baroncini

2021

Eur Spine J

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Introduction Aim of this study was to analyze the rate of tether breakages after lumbar vertebral body tethering (VBT) and to study the effects and possible benefits of the use of a 2-tether construct. Tether breakage is a known mechanical complication after VBT. However, the literature only refers to thoracic VBT, and no data on the breakage rate or 2-tether construct after lumbar VBT are available. Materials and methods Patients who underwent lumbar VBT with lowest instrumented vertebra at L3 or L4 and had a 1-year follow-up were included. Radiologic data were obtained preoperatively, at the 1st standing X-ray and at the 1-year follow-up to study breakage rate, loss of correction and lumbar lordosis in 1-and 2-tether constructs. Results Data from 30 patients (mean age 14.7 ± 1.8) were available, 12 with double tether. Double tether did not decrease lumbar lordosis. The breakage rate was 24% in segments instrumented with a single tether and 16% in segments instrumented with a double tether (OR 1.6, p = 0.4). Lumbar loss of correction was 10° ± 6.8° in the entire cohort and 12.1° ± 5.4° in patients with a breakage (p = 0.2). Revision rate was 10%, due to tether breakage and loss of correction. Conclusion Breakage rate after lumbar VBT is high, but was improved with the use of a 2-tether construct. Despite tether breakage, loss of correction was limited and the revision rate low. The use of a double tether does not have a kyphotic effect on the lumbar spine.

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Section: Methodsmentioning

confidence: 99%

Preliminary outcomes after vertebral body tethering (VBT) for lumbar curves and subanalysis of a 1- versus 2-tether construct

Trobisch¹,

Baroncini

2021

Eur Spine J

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“…For patients requiring a bilateral correction, this was conducted in one stage with lumbar instrumentation performed first, as the authors feel instrumentation of the lumbar curve is mentally and physically more demanding. After suturing and dressing the wounds, patients were repositioned for thoracic instrumentation [2,3]. The screws were placed bicortically following anatomic landmarks and under antero-posterior fluoroscopic control.…”

Section: Surgical Proceduresmentioning

confidence: 99%

“…However, these patients were not included in this work. While research aimed to identify the ideal candidate for VBT is still ongoing, the authors developed a classification based on the benefits of VBT over fusion and on the magnitude and flexibility of the curve [2] (Table 1). This classification is employed for immature patients (Risser ≤ 4 and/or Sanders ≤ 7) with curves between 40° and 70°.…”

Section: Patient Recruitmentmentioning

confidence: 99%

“…This technique allows for curve correction while maintaining spine mobility, which is of particular relevance in the lumbar spine. VBT has been investigated with promising results [1][2][3][4][5][6][7][8], but further research is being conducted to define the role of VBT in the treatment of AIS and to identify the ideal candidate for this intervention. VBT was developed to employ the Hüter-Volkmann principle to modulate spine growth through a unilateral block of growth plates [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

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Learning curve for vertebral body tethering: analysis on 90 consecutive patients

Baroncini

Trobisch²,

Migliorini

2020

Spine Deform

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Study design Retrospective study. Objectives Vertebral body tethering (VBT) is raising interest for the treatment of adolescent idiopathic scoliosis (AIS), but many scoliosis surgeons have not been trained in anterior surgical approaches. We analyzed data of our first patients to define the learning curve for VBT. Summary of background data VBT has shown encouraging results in the treatment of growing AIS patients, but there is a paucity of data and long-term results are not yet available. To our best knowledge, there is no published data regarding the learning curve for VBT. Methods A retrospective analysis was performed, of all consecutive patients who underwent VBT at our Institution. Outcomes of interest were intubation time, surgical duration and estimated blood loss per screw and hospitalization length. For the statistical analysis, we referred to a linear model regression diagnostic and we used the Pearson product-moment correlation (r) for pairwise correlation. The final effect ranked between + 1 and − 1. Results Data of 90 patients were analyzed, age 14.6 ± 1.8 years. On average, 9.4 ± 2.6 levels were instrumented. Per screw, mean intubation time was 33.1 ± 7.6 min (r = − 0.57; p > 0.0001), mean surgical duration 21.3 ± 5.7 min (r = − 0.55; p > 0.0001), mean estimated blood loss 21.3 ± 18.2 ml (r = − 0.66; p > 0.0001). Mean hospitalization length was 8.3 ± 3.1 days (r = − 0.32; p = 0.002). No intraoperative complications were reported. Conclusion VBT has a rapid learning curve: the estimated blood loss per screw is expected to decrease by 60%, intubation time and surgical duration by over 50%, and hospitalization length by 32% for each treated patient. Level of evidence III.

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“…In 2019, the Food and Drug Administration (FDA) has approved the first device for US patients, whereas another device has already received CE approval (European approval) in 2017. Several basic sciences as well as clinical studies have confirmed safety and efficacy, including a prospective Humanitarian Device Exemption (HDE) study that was controlled by the FDA [1][2][3][4][5][6][7][8][9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Motion preservation surgery for scoliosis with a vertebral body tethering system: a biomechanical study

et al. 2021

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Purpose There is a paucity of studies on new vertebral body tethering (VBT) surgical constructs especially regarding their potentially motion-preserving ability. This study analyses their effects on the ROM of the spine. Methods Human spines (T10-L3) were tested under pure moment in four different conditions: (1) native, (2) instrumented with one tether continuously connected in all vertebrae from T10 to L3, (3) additional instrumented with a second tether continuously connected in all vertebrae from T11 to L3, and (4) instrumented with one tether and one titanium rod (hybrid) attached to T12, L1 and L2. The instrumentation was inserted in the left lateral side. The intersegmental ROM was evaluated using a magnetic tracking system, and the medians were analysed. Please check and confirm the author names and initials are correct. Also, kindly confirm the details in the metadata are correct. The mentioned information is correct Results Compared to the native spine, the instrumented spine presented a reduction of less than 13% in global ROM considering flexion–extension and axial rotation. For left lateral bending, the median global ROM of the native spine (100%) significantly reduced to 74.6%, 66.4%, and 68.1% after testing one tether, two tethers and the hybrid construction, respectively. In these cases, the L1-L2 ROM was reduced to 68.3%, 58.5%, and 38.3%, respectively. In right lateral bending, the normalized global ROM of the spine with one tether, two tethers and the hybrid construction was 58.9%, 54.0%, and 56.6%, respectively. Considering the same order, the normalized L1-L2 ROM was 64.3%, 49.9%, and 35.3%, respectively. Conclusion The investigated VBT techniques preserved global ROM of the spine in flexion–extension and axial rotation while reduced the ROM in lateral bending.

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Dynamic Scoliosis Correction as Alternative Treatment for Patients with Adolescent Idiopathic Scoliosis: a Non-Fusion Surgical Technique

Cited by 16 publications

References 15 publications

Preliminary outcomes after vertebral body tethering (VBT) for lumbar curves and subanalysis of a 1- versus 2-tether construct

Preliminary outcomes after vertebral body tethering (VBT) for lumbar curves and subanalysis of a 1- versus 2-tether construct

Learning curve for vertebral body tethering: analysis on 90 consecutive patients

Motion preservation surgery for scoliosis with a vertebral body tethering system: a biomechanical study

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