European Spine Journal

, Volume 26, Issue 6, pp 1748–1755 | Cite as

Growth modulation and remodeling by means of posterior tethering technique for correction of early-onset scoliosis with thoracolumbar kyphosis

  • Alaaeldin A. AhmadEmail author
  • Loai Aker
  • Yahia Hanbali
  • Aesha Sbaih
  • Zaher Nazzal
Original Article



The aim of this study is to evaluate the role of the non-fusion instrumented procedure with compression adjunct to lengthening by distraction in facilitating spinal modulation of the wedged peak vertebra, in patients with congenital thoracolumbar kyphosis/kyphoscoliosis according to the Hueter–Volkmann law. The authors seek to address the progressive modulation of the most wedged vertebra by analyzing the subjects’ pre-operative and latest follow-up sagittal radiograph.


Ongoing data collection of 14 peak wedged vertebra modulation during surgical management of 13 patients with Type I congenital thoracolumbar kyphosis (5 patients) or kyphoscoliosis (8 patients). Age at initial surgery averaged 58.6 months, with mean follow-up of 55.6 months (24–78). All were done with hybrid rib construct with clawing fashion through a single posterior approach with at least 4 lengthenings.


Two vertebral bodies were selected, the peaked deformed vertebrae within the instrumentation compression level (WICL) and the vertebrae nearest but outside the instrumentation compression process (OICL). Anterior vertebral body height (AVBH) and posterior vertebral body height (PVBH) were measured in both vertebral bodies. Regarding measured vertebrae (WICL), average preoperative AVBH/PVBH ratio significantly increased from 0.54 to 0.77 in the final follow-up. Regarding measured vertebrae (OICL), the average preoperative AVBH/PVBH ratio increased from 0.76 to 0.79 in the final follow-up. Modulation can be confirmed in the most deformed vertebrae (WICL) as the difference between the change in AVBH/PVBH ratio between vertebrae (OICL) and (WICL) was statistically significant (P < 0.001).


Through the compression model adjunct to lengthening through distraction implemented in the surgical management of early-onset scoliosis, wedging improves through vertebral modulation (WICL) in comparison with the (OICL). This calls for further studies on the impact of surgical correction of EOS on modulation of the vertebrae.


Posterior tethering technique Non-fusion technique Early-onset scoliosis Thoracolumbar kyphosis Vertebral modulation 


Compliance with ethical standards

All procedures done in this study were within approved ethical standards.

Informed consent was obtained from all participants involved in this study.

Conflict of interest

All authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Alaaeldin A. Ahmad
    • 1
    Email author
  • Loai Aker
    • 1
  • Yahia Hanbali
    • 1
  • Aesha Sbaih
    • 1
  • Zaher Nazzal
    • 1
  1. 1.Faculty of Medicine and Health SciencesAn-Najah National UniversityNablusPalestine

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