Skip to main content
SpringerLink
Log in

Modulation of spinal shape with growth following implantation of a novel surgical implant

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

First, to determine whether scoliosis development could be limited or reversed by growth when a novel modular hinged implant was fixed to the convexity of a scoliosis created by contralateral rib and laminar tethering and unilateral rib resection in a sheep model. Second, to assess the effect and performance of the implant in normal non-tethered sheep.

Methods

At 5 weeks, 20 Scottish Blackface lambs underwent surgery to create a right sided scoliosis by (i) tethering the left lamina of T5–L1 and the left lower six ribs and (ii) resecting a segment of their right lower six ribs [1, 2]. Twelve weeks later, through an antero-lateral thoracotomy, a mobile bi-planar hinged implant was inserted onto the right side of the spine of eight animals (group 1). For comparison, 12 sheep were tethered only but had no implant insertion (group 2). In addition, seven had no tethering but were implanted (group 3) and normal growth patterns were observed in five that had no surgery (group 4). Curve progression was assessed by plain radiography and CT over a 1-year period.

Results

Before implant insertion the trial animals had a scoliosis of 35º ± 16º and a lordosis of 44º ± 20º (n = 8, mean ± SD). Surgery immediately reduced these values to 25º ± 14º, p < 0.01 and 35º ± 18º, p < 0.001, with scoliosis continuing to decrease during the next three months. Spinal flexibility was retained. In the un-tethered sheep, a scoliosis of 10º ± 6º was created on the opposite side to the implant (p < 0.05) with no significant change in alignment in the sagittal plane (1º ± 6º). The implant did not cause any adverse effect on growth or affect neurological function.

Conclusions

In the un-tethered animals the effect of the implant was to create a scoliotic deformity and in the tethered to improve deformity while maintaining spinal motion. We believe that the results are promising and that devices of similar construct may be of use in children with scoliosis, potentially changing current methods of clinical care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Burke JG, Vettorato E, Schöffmann G, Clutton RE, Drew TS, Gibson JNA (2015) Creation of an ovine model of progressive structural scoliosis using a unilateral laminar tether. Eur Sp J. doi:10.1007/s00586-014-3609-z

  2. Braun JT, Ogilivie JW, Akyuz E, Brodke DS, Bachus KN (2006) Creation of an experimental idiopathic-type scoliosis in an immature goat model using a flexible posterior asymmetric tether. Spine 31:1410–1414

    Article  PubMed  Google Scholar 

  3. Tis JE, Karlin LI, Akbarnia BA, Blakemore LC, Thompson GH, McCarthy RE, Tello CA, Mendelow MJ, Southern EP (2012) Growing spine committee of the scoliosis research society. J Pediatr Orthop 32(7):647–657

    Article  PubMed  Google Scholar 

  4. Cahill P, Marvil S, Cuddihy L, Schutt C, Idema J, Clements DH, Antonacci MD, Asghar J, Samdani AF, Betz RR (2010) Autofusion in the immature spine treated with growing rods. Spine 35:E1199–E1203

    Article  PubMed  Google Scholar 

  5. Sankar W, Skaggs D, Yazici M, Johnston CE, Shah SA, Javidan P, Kadakia RV, Day TF, Akbarnia BA (2011) Lengthening of dual growing rods and the law of diminishing returns. Spine 36:806–809

    Article  PubMed  Google Scholar 

  6. Singh V, Simpson J, Rawlinson J, Hallab N (2013) Growth guidance system for early onset scoliosis: comparison of experimental and retrieval wear. Spine 38:1546–1553

    Article  PubMed  Google Scholar 

  7. Shah SC, Birknes JK, Sagoo S, Thome S, Samdani AF (2009) Vertical expandable prosthetic titanium rib (VEPTR): indications, technique and management review. Surg Technol Int 18:223–229

    PubMed  Google Scholar 

  8. Braun JT, Akyuz E, Udall H, Ogilvie JW, Brodke DS, Bachus KN (2006) Three-dimensional analysis of two fusionless scoliosis treatments: a flexible ligament tether versus a rigid-shape memory alloy staple. Spine 31:262–268

    Article  PubMed  Google Scholar 

  9. Betz RR, Ranade A, Samdani AF, Chafetz R, D’Andrea LP, Gaughan JP, Asghar J, Grewal H, Mulcahey MJ (2010) Vertebral body stapling: a fusionless treatment option for a growing child with moderate idiopathic scoliosis. Spine 35(2):169–176

    Article  PubMed  Google Scholar 

  10. Akbarnia BA (2007) Management themes in early onset scoliosis. J Bone Joint Surg 89-A(SUPPL I):42–54

    Article  Google Scholar 

  11. Lenke LG, Dobbs MB (2007) Management of juvenile idiopathic scoliosis. J Bone Joint Surg 89-A(SUPPL I):54–63

    Google Scholar 

  12. Thompson GH, Lenke LG, Akbarnia BA, McCarthy RE, Campbell RM (2007) Early onset scoliosis: future directions. J Bone Joint Surg 89-A(SUPPL I):163–166

    Article  Google Scholar 

  13. Block AJ, Wexler J, McDonnell EJ (1970) Cardiopulmonary failure of the hunchback. A possible therapeutic approach. JAMA 212:1520–1522

    Article  CAS  PubMed  Google Scholar 

  14. Stokes IA, Aronsson DD, Dimock AN, Cortright V, Beck S (2006) Endochondral growth in growth plates of three species at two anatomical locations modulated by mechanical compression and tension. J Orthop Res 24:1327–1334

    Article  PubMed Central  PubMed  Google Scholar 

  15. Lam GC, Hill DL, Le LH, Raso JV, Lou EH (2008) Vertebral rotation measurement: a summary and comparison of common radiographic and CT methods. Scoliosis 3:16

    Article  PubMed Central  PubMed  Google Scholar 

  16. Aaro S, Dahlborn M (1981) Estimation of vertebral rotation and the spinal and rib cage deformity in scoliosis by coumputer tomography. Spine 6(5):460–467

    Article  CAS  PubMed  Google Scholar 

  17. Newton P, Fricka K, Lee SS, Farnsworth CL, Cox TG, Mahar AT (2002) Asymetrical flexible tethering of spine growth in an immature bovine model. Spine 27:689–693

    Article  PubMed  Google Scholar 

  18. Newton P, Faro FD, Farnsworth CL, Shapiro GS, Mohamad F, Parent S, Fricka K (2005) Multilevel spinal growth modulation with an anterolateral flexible tether in an immature bovine model. Spine 30:2608–2613

    Article  PubMed  Google Scholar 

  19. Driscoll M, Aubin C, Moreau A, Wakula Y, Sarwark JF, Parent S (2012) Spinal growth modulation using a novel intravertebral epiphyseal device in an immature porcine model. Eur Spine J 21:138–144

    Article  PubMed Central  PubMed  Google Scholar 

  20. Braun JT, Akyuz E, Ogilvie JW, Bachus KN (2005) The efficacy and integrity of shape memory alloy staples and bone anchors with ligament tethers in the fusionless treatment of experimental scoliosis. J Bone Joint Surg 87-A:2038–2051

    Article  Google Scholar 

  21. Dannawi Z, Altaf F, Harshavardhana NS, El Sebaie H, Noordeen H (2013) Early results of a remotely-operated magnetic growth rod in early-onset scoliosis. Bone Joint J 95-B(1):75–80

    Article  CAS  PubMed  Google Scholar 

  22. Rohlmann A, Richter M, Zander T, Klöckner C, Bergmann G (2006) Effect of different surgical strategies on screw forces after correction of scoliosis with a VDS implant. Eur Spine J 15:457–464

    Article  PubMed Central  PubMed  Google Scholar 

  23. Driscoll M, Aubin CE, Moreau A, Wakula Y, Amini S, Parent S (2013) Novel Hemi-staple for the fusionless correction of pediatric scoliosis: influence on intervertebral discs and growth plates in a porcine model. J Spinal Disord Tech. [Epub ahead of print]

Download references

Acknowledgments

Grant funding was received from The Medical Research Council, UK. Special thanks are due to Joan Docherty and staff of the University of Edinburgh for ensuring welfare of the animals and laboratory assistance.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. The Galway Clinic, Doughiska, Galway, Ireland

    John G. Burke

  2. The Roslin Institute, The University of Edinburgh, Edinburgh, EH25 9RG, Scotland, UK

    Enzo Vettorato, Gudrun Schöffmann & R. Eddie Clutton

  3. University of Veterinary Medicine, 1210, Vienna, Austria

    Gudrun Schöffmann

  4. Ninewells Hospital and Medical School, The University of Dundee, Dundee, DD1 9SY, Scotland, UK

    Tim S. Drew

  5. The Royal Infirmary and University of Edinburgh, Edinburgh, EH16 4SU, Scotland, UK

    J. N. Alastair Gibson

Authors
  1. John G. Burke
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Enzo Vettorato
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gudrun Schöffmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. Eddie Clutton
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tim S. Drew
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. N. Alastair Gibson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. N. Alastair Gibson.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Burke, J.G., Vettorato, E., Schöffmann, G. et al. Modulation of spinal shape with growth following implantation of a novel surgical implant. Eur Spine J 24, 1522–1532 (2015). https://doi.org/10.1007/s00586-014-3610-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-014-3610-6

Keywords

Search

Navigation