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.
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Winter RB, Moe JH, Wang JF (1973) Congenital kyphosis. Its natural history and treatment as observed in a study of one hundred and thirty patients. J Bone Joint Surg Am 55(2):223–256
Smith JT, Gollogly S, Dunn HK (2005) Simultaneous anterior-posterior approach through a costotransversectomy for the treatment of congenital kyphosis and acquired kyphoscoliotic deformities. J Bone Joint Surg Am 87(10):2281–2289. doi:10.2106/jbjs.d.01795
Basu PS, Elsebaie H, Noordeen MH (2002) Congenital spinal deformity: a comprehensive assessment at presentation. Spine 27(20):2255–2259. doi:10.1097/01.brs.0000029425.58936.ba
Winter RB (1973) Congenital spine deformity. Natural history and treatment. Isr J Med Sci 9(6):719–727
Mayfield JK, Winter RB, Bradford DS, Moe JH (1980) Congenital kyphosis due to defects of anterior segmentation. J Bone Joint Surg Am 62(8):1291–1301
Atici Y, Sokucu S, Uzumcugil O, Albayrak A, Erdogan S, Kaygusuz MA (2013) The results of closing wedge osteotomy with posterior instrumented fusion for the surgical treatment of congenital kyphosis. Eur Spine J 22(6):1368–1374. doi:10.1007/s00586-013-2755-z
McMaster MJ, Singh H (1999) Natural history of congenital kyphosis and kyphoscoliosis. A study of one hundred and twelve patients. J Bone Joint Surg Am 81(10):1367–1383
Akyuz E, Braun JT, Brown NA, Bachus KN (2006) Static versus dynamic loading in the mechanical modulation of vertebral growth. Spine 31(25):E952–E958. doi:10.1097/01.brs.0000248810.77151.22
Betz RR, D’Andrea LP, Mulcahey MJ, Chafetz RS (2005) Vertebral body stapling procedure for the treatment of scoliosis in the growing child. Clin Orthop Relat Res 434:55–60
Braun JT, Akyuz E, Udall H, Ogilvie JW, Brodke DS, Bachus KN (2006) Three-dimensional analysis of 2 fusionless scoliosis treatments: a flexible ligament tether versus a rigid-shape memory alloy staple. Spine 31(3):262–268. doi:10.1097/01.brs.0000197569.13266.fe
Wall EJ, Bylski-Austrow DI, Kolata RJ, Crawford AH (2005) Endoscopic mechanical spinal hemiepiphysiodesis modifies spine growth. Spine 30(10):1148–1153
Goh S, Price RI, Leedman PJ, Singer KP (2000) A comparison of three methods for measuring thoracic kyphosis: implications for clinical studies. Rheumatology (Oxford, England) 39(3):310–315
Manns RA, Haddaway MJ, McCall IW, Cassar Pullicino V, Davie MWJ (1996) The relative contribution of disc and vertebral morphometry to the angle of kyphosis in asymptomatic subjects. Clin Radiol 51(4):258–262. doi:10.1016/S0009-9260(96)80342-4
Goh S, Price RI, Leedman PJ, Singer KP (1999) The relative influence of vertebral body and intervertebral disc shape on thoracic kyphosis. Clin Biomech (Bristol, Avon) 14(7):439–448
Harrington PR (1962) Treatment of scoliosis. Correction and internal fixation by spine instrumentation. J Bone Joint Surg Am 44-A:591–610
Moe JH (1980) Modern concepts of treatment of spinal deformities in children and adults. Clin Orthop Relat Res 150:137–153
Braun JT, Hoffman M, Akyuz E, Ogilvie JW, Brodke DS, Bachus KN (2006) Mechanical modulation of vertebral growth in the fusionless treatment of progressive scoliosis in an experimental model. Spine 31(12):1314–1320. doi:10.1097/01.brs.0000218662.78165.b1
Braun JT, Hines JL, Akyuz E, Vallera C, Ogilvie JW (2006) Relative versus absolute modulation of growth in the fusionless treatment of experimental scoliosis. Spine 31(16):1776–1782. doi:10.1097/01.brs.0000227263.43060.50
Braun JT, Akyuz E, Ogilvie JW (2005) The use of animal models in fusionless scoliosis investigations. Spine 30(17 Suppl):S35–S45
Stokes IA, Spence H, Aronsson DD, Kilmer N (1996) Mechanical modulation of vertebral body growth. Implications for scoliosis progression. Spine 21(10):1162–1167
Mente PL, Stokes IA, Spence H, Aronsson DD (1997) Progression of vertebral wedging in an asymmetrically loaded rat tail model. Spine 22(12):1292–1296
Wessels M, Hekman EE, Kruyt MC, Castelein RM, Homminga JJ, Verkerke GJ (2016) Spinal shape modulation in a porcine model by a highly flexible and extendable non-fusion implant system. Eur Spine J 25(9):2975–2983. doi:10.1007/s00586-016-4570-9
Wessell NM, Martus JE, Halanski MA, Snyder B, Truong W (2016) What’s new in pediatric spine growth modulation and implant technology for early-onset scoliosis? J Pediatr Orthop. doi:10.1097/bpo.0000000000000830
Olgun ZD, Ahmadiadli H, Alanay A, Yazici M (2012) Vertebral body growth during growing rod instrumentation: growth preservation or stimulation? J Pediatr Orthop 32(2):184–189. doi:10.1097/BPO.0b013e3182471915
Sarwark J, Aubin CE (2007) Growth considerations of the immature spine. J Bone Joint Surg Am 89(Suppl 1):8–13. doi:10.2106/jbjs.f.00314
El-Hawary R, Samdani A, Wade J, Smith M, Heflin JA, Klatt JW, Vitale MG, Smith JT (2015) Rib-based distraction surgery maintains total spine growth. J Pediatr Orthop. doi:10.1097/bpo.0000000000000567
Enercan M, Kahraman S, Erturer E, Ozturk C, Hamzaoglu A (2014) Apical and intermediate anchors without fusion improve Cobb angle and thoracic kyphosis in early-onset scoliosis. Clin Orthop Relat Res 472(12):3902–3908. doi:10.1007/s11999-014-3815-3
Jain V, Lykissas M, Trobisch P, Wall EJ, Newton PO, Sturm PF, Cahill PJ, Bylski-Austrow DI (2014) Surgical aspects of spinal growth modulation in scoliosis correction. Instr Course Lect 63:335–344
Xue X, Shen J, Zhang J, Li S, Wang Y, Qiu G (2014) X-ray assessment of the effect of pedicle screw on vertebra and spinal canal growth in children before the age of 7 years. Eur Spine J 23(3):520–529. doi:10.1007/s00586-013-3035-7
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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Ahmad, A.A., Aker, L., Hanbali, Y. et al. Growth modulation and remodeling by means of posterior tethering technique for correction of early-onset scoliosis with thoracolumbar kyphosis. Eur Spine J 26, 1748–1755 (2017). https://doi.org/10.1007/s00586-016-4910-9
- Posterior tethering technique
- Non-fusion technique
- Early-onset scoliosis
- Thoracolumbar kyphosis
- Vertebral modulation