Skip to main content
SpringerLink
Log in

Three-dimensional vertebral shape changes confirm growth modulation after anterior vertebral body tethering for idiopathic scoliosis

  • Case Series
  • Published:
Spine Deformity Aims and scope Submit manuscript

Abstract

Purpose

To evaluate three-dimensional (3D) vertebra and disk shape changes over 2 years following anterior vertebral body tether (AVBT) placement in patients with idiopathic scoliosis (IS).

Methods

Patients with right thoracic IS treated with AVBT were retrospectively evaluated. 3D reconstructions were created from biplanar radiographs. Vertebral body and disk height (anterior, posterior, left and right) and shape (wedging angle) were recorded over the three apical segments in the local vertebral reference planes. Changes in height and wedging were measured through 2 years postoperatively. Change in patient height was correlated with changes in the spine dimensions.

Results

Forty-nine patients (Risser 0–3, Sanders 2–4) were included. The mean age was 12.2 ± 1.4 years (range 8–14). The mean coronal curve was 51 ± 10° preoperatively, 31 ± 9° at first postoperative time point and 27 ± 11° at 2-year follow-up (p < 0.001). The mean patient height increased 8 cm by 2 years (p < 0.001). The left side of the spine (vertebra + disc) grew in height by 2.2 mm/level versus 0.7 mm/level on the right side (p < 0.001). This differential growth was composed of 0.5 mm/vertebral level and 1.0 mm/disk level. Evaluation of the change in disk heights showed significantly decreased height anteriorly (− 0.4 mm), posteriorly (− 0.3 mm) and on the right (− 0.5 mm) from FE to 2 years. Coronal wedging reduced 2.3°/level with 1.1°/vertebral level change and 1.2°/disk level. There was no differential growth in the sagittal plane (anterior/posterior height). Patient height change moderately correlated with 3D measures of vertebra + disk shape changes.

Conclusions

Three-dimensional analysis confirms AVBT in skeletally immature patients results in asymmetric growth of the apical spine segments. The left (untethered) side length increased more than 3 × than the right (tethered) side length with differential effects observed within the vertebral bodies and disks, each correlating with overall patient height change.

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

Similar content being viewed by others

References

  1. Stokes IA, Spence H, Aronsson DD et al (1996) Mechanical modulation of vertebral body growth. Implic Scoliosis Progress Spine (Phila Pa 1976) 21:1162–1167

    Article  CAS  Google Scholar 

  2. Mehlman CT, Araghi A, Roy DR (1997) Hyphenated history: the Hueter-Volkmann law. Am J Orthop (Belle Mead NJ) 26:798–800

    CAS  PubMed  Google Scholar 

  3. Akel I, Yazici M (2009) Growth modulation in the management of growing spine deformities. J Child Orthop 3:1–9

    Article  PubMed  Google Scholar 

  4. Baker CE, Milbrandt TA, Larson AN (2021) Anterior vertebral body tethering for adolescent idiopathic scoliosis: early results and future directions. Orthop Clin North Am 52:137–147

    Article  PubMed  Google Scholar 

  5. Parent S, Shen J (2020) Anterior vertebral body growth-modulation tethering in idiopathic scoliosis: surgical technique. J Am Acad Orthop Surg 28:693–699

    Article  PubMed  Google Scholar 

  6. Moal B, Schwab F, Demakakos J et al (2013) The impact of a corrective tether on a scoliosis porcine model: a detailed 3D analysis with a 20 weeks follow-up. Eur Spine J 22:1800–1809

    Article  PubMed  PubMed Central  Google Scholar 

  7. Braun JT, Akyuz E, Ogilvie JW et al (2005) The use of animal models in fusionless scoliosis investigations. Spine (Phila Pa 1976) 30:S35-45

    Article  PubMed  Google Scholar 

  8. Upasani VV, Farnsworth CL, Chambers RC et al (2011) Intervertebral disc health preservation after six months of spinal growth modulation. J Bone Jt Surg Am 93:1408–1416

    Article  Google Scholar 

  9. Carreau JH, Farnsworth CL, Glaser DA et al (2012) The modulation of spinal growth with nitinol intervertebral stapling in an established swine model. J Child Orthop 6:241–253

    Article  PubMed  PubMed Central  Google Scholar 

  10. Liu J, Li Z, Shen J et al (2015) Spinal growth modulation with posterior unilateral elastic tether in immature swine model. Spine J 15:138–145

    Article  PubMed  Google Scholar 

  11. Newton PO, Farnsworth CL, Faro FD et al (2008) Spinal growth modulation with an anterolateral flexible tether in an immature bovine model: disc health and motion preservation. Spine (Phila Pa 1976) 33:724–733

    Article  PubMed  Google Scholar 

  12. Newton PO, Farnsworth CL, Upasani VV et al (2011) Effects of intraoperative tensioning of an anterolateral spinal tether on spinal growth modulation in a porcine model. Spine (Phila Pa 1976) 36:109–117

    Article  PubMed  Google Scholar 

  13. Newton PO, Faro FD, Farnsworth CL et al (2005) Multilevel spinal growth modulation with an anterolateral flexible tether in an immature bovine model. Spine (Phila Pa 1976) 30:2608–2613

    Article  PubMed  Google Scholar 

  14. Newton PO, Fricka KB, Lee SS et al (2002) Asymmetrical flexible tethering of spine growth in an immature bovine model. Spine (Phila Pa 1976) 27:689–693

    Article  PubMed  Google Scholar 

  15. Newton PO, Glaser DA, Doan JD et al (2013) 3D Visualization of vertebral growth plates and disc: the effects of growth modulation. Spine Deform 1:313–320

    Article  PubMed  Google Scholar 

  16. Newton PO, Upasani VV, Farnsworth CL et al (2008) Spinal growth modulation with use of a tether in an immature porcine model. J Bone Jt Surg Am 90:2695–2706

    Article  Google Scholar 

  17. Rushton PRP, Nasto L, Parent S et al (2021) Anterior vertebral body tethering for treatment of idiopathic scoliosis in the skeletally immature: results of 112 cases. Spine (Phila Pa 1976) 46:1461–1467

    Article  PubMed  Google Scholar 

  18. Miyanji F, Pawelek J, Nasto LA et al (2020) Safety and efficacy of anterior vertebral body tethering in the treatment of idiopathic scoliosis. Bone Jt J 102-B:1703–1708

    Article  Google Scholar 

  19. Hoernschemeyer DG, Boeyer ME, Robertson ME et al (2020) Anterior vertebral body tethering for adolescent scoliosis with growth remaining: a retrospective review of 2 to 5-year postoperative results. J Bone Jt Surg Am 102:1169–1176

    Article  Google Scholar 

  20. Samdani AF, Pahys JM, Ames RJ et al (2021) Prospective follow-up report on anterior vertebral body tethering for idiopathic scoliosis: interim results from an FDA IDE study. J Bone Jt Surg Am 103:1611–1619

    Article  Google Scholar 

  21. Baroncini A, Trobisch PD, Birkenmaier C et al (2021) Radiographic results after vertebral body tethering. Z Orthop Unfall 160(387):392

    Google Scholar 

  22. Alanay A, Yucekul A, Abul K et al (2020) Thoracoscopic vertebral body tethering for adolescent idiopathic scoliosis: follow-up curve behavior according to sanders skeletal maturity Staging. Spine (Phila Pa 1976) 45:E1483–E1492

    Article  PubMed  Google Scholar 

  23. Baker CE, Kiebzak GM, Neal KM (2021) Anterior vertebral body tethering shows mixed results at 2-year follow-up. Spine Deform 9:481–489

    Article  PubMed  Google Scholar 

  24. Pehlivanoglu T, Oltulu I, Ofluoglu E et al (2020) Thoracoscopic vertebral Body tethering for adolescent idiopathic scoliosis: a minimum of 2 Years’ results of 21 patients. J Pediatr Orthop 40:575–580

    Article  PubMed  Google Scholar 

  25. Newton PO, Bartley CE, Bastrom TP et al (2020) Anterior spinal growth modulation in skeletally immature patients with idiopathic scoliosis: a comparison with posterior spinal fusion at 2 to 5 years postoperatively. J Bone Jt Surg Am 102:769–777

    Article  Google Scholar 

  26. Hoernschemeyer DG, Boeyer ME, Tweedy NM et al (2021) A preliminary assessment of intervertebral disc health and pathoanatomy changes observed two years following anterior vertebral body tethering. Eur Spine J 30:3442–3449

    Article  PubMed  Google Scholar 

  27. Newton PO, Kluck DG, Saito W et al (2018) Anterior spinal growth tethering for skeletally immature patients with scoliosis: a retrospective look two to four years postoperatively. J Bone Jt Surg Am 100:1691–1697

    Article  Google Scholar 

  28. Samdani AF, Ames RJ, Kimball JS et al (2014) 1976 Anterior vertebral body tethering for idiopathic scoliosis: two-year results. Spine (Phila Pa 1976) 39:1688–1693

    Article  PubMed  Google Scholar 

  29. Newton PO, Takahashi Y, Yang Y et al (2022) Anterior vertebral body tethering for thoracic idiopathic scoliosis leads to asymmetric growth of the periapical vertebrae. Spine Deform 10:553–561

    Article  PubMed  Google Scholar 

  30. Newton PO, Fujimori T, Doan J et al (2015) Defining the “three-dimensional sagittal plane” in thoracic adolescent idiopathic scoliosis. J Bone Jt Surg Am 97:1694–1701

    Article  Google Scholar 

  31. Farivar D, Parent S, Miyanji F et al (2023) Concave and convex growth do not differ over tethered vertebral segments, even with open tri-radiate cartilage. Spine Deformity 11(4):881–886

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors thank J.D. Bomar and Byron Beasley for their work on the manuscript’s figures. This study was supported in part by grants to the Setting Scoliosis Straight Foundation in support of Harms Study Group research from DePuy Synthes Spine, EOS imaging, Stryker Spine, Medtronic, NuVasive, Zimmer Biomet and the Food and Drug Administration.

Funding

This work was supported in part by grants to the author’s institution from the Setting Scoliosis Straight Foundation.

Author information

Authors and Affiliations

  1. Department of Orthopedics, University of Utah, Salt Lake City, UT, USA

    Joshua N. Speirs

  2. Department of Orthopaedics, CHU Sainte-Justine, Montreal, QC, Canada

    Stefan Parent

  3. Department of Surgery, University of Montreal, Montréal, QC, Canada

    Stefan Parent

  4. Division of Orthopedics and Scoliosis, Rady Children’s Hospital, 3020 Children’s Way, San Diego, CA, 92123, USA

    Michael Kelly, Vidyadhar V. Upasani, Tracey P. Bryan & Peter O. Newton

  5. Department of Orthopaedics, University of California, San Diego, CA, USA

    Michael Kelly, Vidyadhar V. Upasani & Peter O. Newton

  6. Setting Scoliosis Straight Foundation, San Diego, CA, USA

    Maty Petcharaporn

Authors
  1. Joshua N. Speirs
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stefan Parent
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael Kelly
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vidyadhar V. Upasani
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Maty Petcharaporn
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tracey P. Bryan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Peter O. Newton
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conception or design of the work; or acquisition, analysis or interpretation of data for the work: Joshua N. Speirs, MD X, Stefan Parent MD, PhD X, Vidyadhar V. Upasani, MD X, Maty Petcharaporn, BS X, Tracey P. Bryan, MA X, Peter O. Newton, MD X. Drafting or critically revising the work: Joshua N. Speirs X, Stefan Parent MD, PhD X, Vidyadhar V. Upasani, MD X, Maty Petcharaporn, BS X, Tracey P. Bryan, MA X, Peter O. Newton, MD X. Final approval of the version to be published: Joshua N. Speirs, MD X, Stefan Parent MD, PhD X, Vidyadhar V. Upasani, MD X, Maty Petcharaporn, BS X, Tracey P. Bryan, MA X, Peter O. Newton, MD X. Agree to be accountable for all aspects of the work: Joshua N. Speirs, MD X, Stefan Parent MD, PhD X, Vidyadhar V. Upasani, MD X, Maty Petcharaporn, BS X, Tracey P. Bryan, MA X, Peter O. Newton, MD X.

Corresponding author

Correspondence to Peter O. Newton.

Ethics declarations

Conflict of interest

Joshua N. Speirs, MD. No conflicts. Stefan Parent MD, PhD. Funding for this work was supported in part by grants to the author’s institution from the Setting Scoliosis Straight Foundation. Disclosures outside of the submitted work include, Canadian Spine Society: board or committee member, DePuy, A Johnson & Johnson Company: paid consultant; paid presenter or speaker; research support, fellowship support, EOS-Imaging: IP royalties; paid consultant, research support, Pediatric Orthopaedic Society of North America: board or committee member, Rodin 4D: IP royalties, Scoliosis Research Society: board or committee member, Setting Scoliosis Straight Foundation: research support, Spinologics Employee; stock or stock options, Orthopaediatrics: speaker’s bureau, fellowship support. Michael Kelly, MD, MSc. Funding for this work was supported in part by grants to the author’s institution from the Setting Scoliosis Straight Foundation. Disclosures outside of the submitted work include, AO Spine: payment to support attendance at meetings and/or travel; board or committee member, Cervical Spine Research Society: board or committee member. San Diego Spine Foundation: grants, Scoliosis Research Society: grants; board of directors, Spine: editorial or governing board, John and Marcella Fox Research Fund: grant paid to institution. Vidyadhar V. Upasani, MD. Funding for this work was supported in part by grants to the author’s institution from the Setting Scoliosis Straight Foundation. Disclosures outside of the submitted work include, Daedalus Medical Solutions: patents (planned, issued or pending), employee, DePuy Synthes Spine: paid consultant, Imagen: stock or stock options, Indius: unpaid consultant, Orthofix, Inc: royalties or licenses; paid consultant, OrthoPediatrics: IP royalties; paid consultant; research support, Pacira: paid consultant, Pediatric Orthopedic Society of North America: board or committee member (unpaid), Scoliosis Research Society: board or committee member (unpaid), Spine Journal: editorial or governing board (unpaid), Stryker Spine: paid consultant, Wolters Kluwer Health: publishing royalties, financial or material support, ZimVie: research support. Maty Petcharaporn, BS. Employee of Setting Scoliosis Straight Foundation. Tracey P. Bryan, MA. Funding for this work was supported in part by grants to the author’s institution from the Setting Scoliosis Straight Foundation. Disclosures outside of the submitted work include: no conflicts. Peter O. Newton MD. Funding for this work was supported in part by grants to the author’s institution from the Setting Scoliosis Straight Foundation. Disclosures outside of the submitted work include: Alphatech: grant paid to institution, Cubist: consulting fees, participation on a Data Safety Monitoring Board, DePuy Synthese Spine: grant paid to institution/research support, royalties or licenses paid, consulting fees, speakers bureau, payment for development of educational programs, patents, anchoring systems and methods for correcting spinal deformities (8540754); low profile spinal, tethering systems (8123749); screw placement guide (79811117); compressor for use in, minimally invasive surgery (7189244), Electrocore: stock or stock options, EOS Imaging: grant paid to institution, Globus Medica: consulting fees, International Pediatric Orthopedic Think Tank: board membership (unpaid), Mazor Robotics: grant paid to institution, Mirus: consulting fees, NuVasive: grant paid to institution, Orthopediatrics: grant paid to institution, Pacira: consulting fees, Scoliosis Research Society: grant paid to institution, board membership, Stryker/K2M: grant paid to institution, royalties or licenses, consulting fees, patent: Posterior spinal fixation, Rady Children’s Specialists of San Diego: board membership (unpaid), Setting Scoliosis Straight Foundation: grants paid to institution, board membership (unpaid), Thieme Publishing: royalties or licenses, John and Marcella Fox Research Fund: grant paid to institution.

Ethical approval

IRB approval was obtained for this study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Speirs, J.N., Parent, S., Kelly, M. et al. Three-dimensional vertebral shape changes confirm growth modulation after anterior vertebral body tethering for idiopathic scoliosis. Spine Deform (2024). https://doi.org/10.1007/s43390-024-00856-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s43390-024-00856-5

Keywords

Search

Navigation