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Prediction of post-operative adding-on or compensatory lumbar curve correction after anterior vertebral body tethering

  • Biomechanics
  • Published:
Spine Deformity Aims and scope Submit manuscript

Abstract

Purpose

Anterior Vertebral Body Tethering (AVBT), a fusionless surgical technique based on growth modulation, aims to correct pediatric scoliosis over time. However, medium-term curvature changes of the non-instrumented distal lumbar curve remains difficult to predict. The objective was to biomechanically analyze the level below the LIV to evaluate whether adding-on or compensatory lumbar curve after AVBT can be predicted by intervertebral disc (ID) wedging and force asymmetry.

Methods

33 retrospective scoliotic cases instrumented with AVBT were used to computationally simulate their surgery and 2-year post-operative growth modulation using a finite element model. The cohort was divided into two subgroups according to the lumbar curvature evolution over 2 years: (1) correction > 10° (C); (2) maintaining ± 10° (M). The lumbar Cobb angle and residual ID wedging angle under LIV were measured. Simulated pressures and moments at the superior endplate of LIV + 1 were post-processed. These parameters were correlated at 2 years postoperatively.

Findings

On average, the LIV + 1 simulated moment was 538 Nmm for subgroup C, 155 Nmm for subgroup M with lumbar Cobb angle > 20° and 34 Nmm for angle < 20° whereas the ID angle was 1° for C and 0° for M.

Interpretation

On average, a positive moment on the LIV + 1 superior growth plate led to correction of the lumbar curvature, whereas a null moment kept it stable, and a parallel immediate postoperative ID under LIV contributed to its correction or preservation. Nevertheless, the significant interindividual variability suggested that other parameters are involved in the distal non-instrumented curvature evolution.

Level of evidence

IV

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Acknowledgements

The data for this study came from an institutional database of cases operated on by Dr. Stefan Parent MD, PhD. whom we would like to thank for his contribution to the studies that preceded the current one.

Funding

This research was undertaken thanks, in part, to funding from the Canada First Research Excellence Fund through the TransMedTech Institute and the Natural Sciences and Engineering Research Council of Canada (Industrial Research Chair program with Medtronic of Canada).

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Authors and Affiliations

  1. Department of Mechanical Engineering, Polytechnique Montréal, Downtown Station, P.O. Box 6079, Montreal, QC, H3C 3A7, Canada

    Charlotte Raballand, Nikita Cobetto & Carl-Eric Aubin

  2. Research Center, Sainte-Justine University Hospital Center, 3175 Côte-Sainte-Catherine Road, Montreal, QC, H3T 1C5, Canada

    Nikita Cobetto & Carl-Eric Aubin

  3. Department of Orthopedic Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA

    A. Noelle Larson

Authors
  1. Charlotte Raballand
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  2. Nikita Cobetto
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  3. A. Noelle Larson
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  4. Carl-Eric Aubin
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Contributions

CR: design, acquisition, analysis, interpretation of data for the work, drafting, final approbation, agree to be accountable. NC: analysis, interpretation of the data for the work, revising, final approbation, agree to be accountable. NL: interpretation of the data for the work, revising, final approbation, agree to be accountable. CEA: interpretation of the data for the work, drafting and revising, final approbation, agree to be accountable.

Corresponding author

Correspondence to Carl-Eric Aubin.

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Conflict of interest

Natural Sciences and Engineering Research Council of Canada (industrial research chair program with Medtronic of Canada). Outside of the current work: contracts with Medtronic.

Ethical approval

Approval was obtained from both the ethics committee of Polytechnique Montreal and the Sainte-Justine University Hospital Center. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

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Raballand, C., Cobetto, N., Larson, A. et al. Prediction of post-operative adding-on or compensatory lumbar curve correction after anterior vertebral body tethering. Spine Deform 11, 27–33 (2023). https://doi.org/10.1007/s43390-022-00558-w

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  • DOI: https://doi.org/10.1007/s43390-022-00558-w

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