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When successful, anterior vertebral body tethering (VBT) induces differential segmental growth of vertebrae: an in vivo study of 51 patients and 764 vertebrae

Abstract

Purpose

This study aimed to determine (1) does vertebral body tethering (VBT) produce differential growth modulation in individual vertebrae in patients with idiopathic scoliosis, (2) does VBT change disc shape, and (3) does VBT affect total spine length?

Methods

Patients with idiopathic scoliosis treated with VBT of the main thoracic curve and minimum 2-year follow-up were included. Vertebrae and discs were categorized as uninstrumented proximal thoracic, instrumented main thoracic, or uninstrumented thoracolumbar–lumbar. The left- and right-sided heights of each vertebra and disc were measured on subsequent radiographs to assess for differential growth. T1–T12 thoracic and T1–S1 thoracolumbar growth velocities were compared with standardized reference data.

Results

Fifty-one patients (764 vertebrae and 807 discs) were analyzed. The average major curve magnitude improved from 46° ± 11° to 17° ± 11° at 2-year follow-up. Differential growth was observed in MT vertebrae, in which the left/concave side grew 2.0 ± 2.2 mm compared with 1.5 ± 2.3 mm on the right/convex (tethered) side (p < 0.001). Differential height changes were observed for all discs, but were most pronounced in instrumented MT discs, in which the right/convex sides decreased by an average of 1.2 mm each, compared with no significant height change on the left/concave side. Total spinal growth velocities were not significantly different from standard reference data.

Conclusion

Vertebral body tethering limits convex spinal growth as designed while permitting concave growth. Curve correction results from differential vertebral growth and decreased convex disc height. Overall spinal growth continues at the expected rate.

Level of evidence

Level IV case series.

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Availability of data and materials

Data are available upon reasonable request.

Code availability

Not applicable.

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Acknowledgements

The authors would like to thank Stefan Parent (Sainte-Justine University Hospital, Montreal, QC and Department of Surgery, Université de Montréal, Montréal, QC) and Firoz Miyanji (BC Children’s Hospital, Vancouver, BC) for their valuable insight and assistance with the design and analysis of our data for this study.

Funding

The authors received study support from Setting Scoliosis Straight Foundation for the submitted work.

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Authors and Affiliations

Authors

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Contributions

1a. Conception or design of the work OR: TCM, SAS, MEB, KN, BSL, ANL, BY, PON, DGH. 1b. Acquisition, analysis, or interpretation of data for the work OR: TCM, JBH, JV, MEB, MP, ANL, PON, DGH, Harms. 1c. Creation of new software used in the work: none. 2a. Drafting the work OR: TCM. 2b. Revising the work critically for important intellectual content: TCM, SAS, JBH, JV, MEB, MP, KN, BSL, ANL, BY, PON, DGH, Harms. 3. Final approval of the version to be published: TCM, SAS, JBH, JV, MEB, MP, KN, BSL, ANL, BY, PON, DGH, Harms. 4. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: TCM, SAS, JBH, JV, MEB, MP, KN, BSL, ANL, BY, PON, DGH, Harms.

Corresponding author

Correspondence to Suken A. Shah.

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Conflict of interest

Authors TCM, JBH, JV, MEB, and MP have no relevant financial or non-financial interests to disclose. Author SAS reports grants from the Setting Scoliosis Straight Foundation, during the conduct of the study and personal fees from DePuy Synthes Spine, outside the submitted work. Author KN reports personal fees from OrthoPediatrics, outside the submitted work. Author BSL reports grants from Grant from DePuy Synthes to Setting Scoliosis Straight Foundation in Support of Harms Study Group, personal fees and non-financial support from Depuy Synthes, personal fees from Zimmer Biomet, personal fees and non-financial support from ApiFix, other from Spine Search, other from Paradigm Spine, other from SRS Spine Deformity Journal, outside the submitted work. Author ANL reports other from Depuy, Globus, Orthopediatrics, Medtronic, outside the submitted work. Author BY reports grants from Setting Scoliosis Straight, during the conduct of the study and grants and personal fees from Stryker, grants and personal fees from Depuy Synthes, personal fees from Nuvasive, personal fees from Medtronic, personal fees from Biogen, personal fees from Orthopediatrics, personal fees from Globus, outside the submitted work. Author PON reports grants from Setting Scoliosis Straight Foundation, during the conduct of the study; grants and other from Setting Scoliosis Straight Foundation, other from Rady Children's Specialists of San Diego; grants, personal fees and non-financial support from DePuy Synthes Spine; grants and other from Scoliosis Research Society; grants from EOS imaging; personal fees from Thieme Publishing, grants from NuVasive; other from Electrocore; other from International Pediatric Orthopedic Think Tank; grants, non-financial support and other from Orthopediatrics; grants, personal fees, and non-financial support from Stryker K2M; grants and non-financial support from Alphatech; grants from Mazor Robotics; personal fees from Pacira; personal fees from Globus Medical; personal fees from Medtronic, outside the submitted work. In addition, Dr. Newton has a patent “Anchoring Systems and Methods for Correcting Spinal Deformities” (8540754) with royalties paid to DePuy Synthes Spine, a patent “Low Profile Spinal Tethering Systems” (8123749) licensed to DePuy Spine, Inc., a patent “Posterior Spinal Fixation” licensed to Stryker/K2M, and a patent “Posterior Cervical Fixation” with royalties paid to Stryker/K2M. Author DGH has a patent regarding tethering pending. Author HNFSG reports grants from Setting Scoliosis Straight Foundation, during the conduct of the study: SSSF receives funding from DePuy Synthes Spine, EOS imaging, K2M, Medtronic, NuVasive, Zimmer Biomet and the FDA in support of Harms Non-Fusion Study Group research; grants and other from Setting Scoliosis Straight Foundation: SSSF received educational grants from Orthopediatrics, Mazor Robotics, Stryker, Ellipse, Globus & SpineGuard, to support Setting Scoliosis Straight educational activities.

Ethical approval

Approval was obtained from the Nemours Institutional Review Board. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

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McDonald, T.C., Shah, S.A., Hargiss, J.B. et al. When successful, anterior vertebral body tethering (VBT) induces differential segmental growth of vertebrae: an in vivo study of 51 patients and 764 vertebrae. Spine Deform 10, 791–797 (2022). https://doi.org/10.1007/s43390-022-00471-2

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Keywords

  • Anterior vertebral body tethering (AVBT)
  • Growth modulation
  • Adolescent idiopathic scoliosis (AIS)
  • Differential growth