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Pre-operative parameters influencing vertebral body tethering outcomes: patient’s characteristics play an important role in determining the outcomes at a minimum of 2 years post-op

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Abstract

Purpose

The aim of this study is to determine preoperative predictors of good radiographic outcomes in VBT patients at a minimum 2-year follow-up.

Methods

From a single-center dataset, we reviewed patients who underwent VBT from January 2014 to November 2018. Data analysis included age, gender, Risser grade and biometric data. Radiographically, maximum Cobb angle, C-DAR and apical vertebral and disc wedging were measured preop and at a minimum 2-year follow-up. Patients were divided into two cohorts following two different outcome measures: (1) vertebral growth modulation, those patients that growth modulated or corrected ≥ 5° and those who did not; and (2) Maximum Cobb angle at 2 years, < and ≥ 40°. Student T and Chi2 tests were used for comparison and a multiple linear correlation test was implemented between statistically significant variables.

Results

79 patients were recruited. 26 patients (33%) did growth modulate their spine at 2-year follow-up. These patients were significantly younger, and more skeletally immature with less height (147 cm vs 155 cm; p < 0.0001), weight (38 kg vs. 45 kg; p = 0.0009) and BMI (17 vs 18.8; p = 0.0229) as those who did not. Multiple linear regression model with these variables resulted in a moderate correlation (r2 = 0.234). 67 patients (85%) finished at a 2-year follow-up with a maximum Cobb angle < 40°. These patients were also younger and skeletally immature. We found significant differences in outcome 2 regarding the average preoperative maximum Cobb angle (48.5° ± 9.5 vs. 59.1° ± 10), average C-DAR (7 ± 1.5 vs. 8.5 ± 2.1), average apical vertebral wedging (6.5° vs. 8.3°), average vertebral/disc wedging ratio (1.5 vs. 2.4) and the average immediate postoperative Cobb angle (25° vs. 38°). These variables predicted a 36% of the variation in final Cobb angle measurement at a 2-year follow-up (r2 = 0.362).

Conclusion

Curve severity determined by a preoperative C-DAR, preoperative Cobb angles and immediate postoperative Cobb angle are significantly related to curves < 40° at a minimum 2-year follow-up, while the potential to growth modulate the spine is more dependent on skeletal maturity, lower body weight and lower BMI. These patients’ characteristics should be considered preoperatively.

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Data availability

Measurements and analysis done at the CHU Sainte-Justine are on a password protected server. Access may be arranged through application to the REB.

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Funding

Bourse de jumelage de fonds du CHU Sainte-Justine.

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Authors and Affiliations

  1. Université de Montréal, Montréal, QC, Canada

    Matias Pereira-Duarte, Jean-Marc Mac-Thiong, Hubert Labelle & Stefan Parent

  2. Research Center, Sainte-Justine University Hospital Center, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada

    Matias Pereira-Duarte, Marjolaine Roy-Beaudry, Isabelle Turgeon, Julie Joncas, Jean-Marc Mac-Thiong, Hubert Labelle, Soraya Barchi & Stefan Parent

Authors
  1. Matias Pereira-Duarte
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  2. Marjolaine Roy-Beaudry
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  3. Isabelle Turgeon
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  4. Julie Joncas
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  5. Jean-Marc Mac-Thiong
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  6. Hubert Labelle
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  7. Soraya Barchi
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  8. Stefan Parent
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Contributions

Design of the work: J-MM-T, HL, SP. Data acquisition: MP-D, MR-B, IT, JJ, SB. Analysis interpretation of data: MP-D, MR-B, HL, SB, SP. Drafting the work: MP-D, SB, SP. Critical revisión, final approval, agree to be accountable for all aspects of the work: MP-D, MR-B, IT, JJ, J-MM-T, HL, SB, SP. Supervision: SB.

Corresponding author

Correspondence to Stefan Parent.

Ethics declarations

Conflict of interest

MPD, MRB, IT, JJ, and SB declare that they have no conflict of interest. JMMT has received a peer-reviewed grant from the Natural Sciences and Engineering Research Council of Canada (industrial research chair program with Medtronic of Canada) related to the work, and other funds not related to the work (i.e. Discovery grant from the Natural Sciences and Engineering Research Council of Canada, grant from the Canada First Research Excellence Funds, and development contracts with Medtronic Spine and Biologics through the university Polytechnique Montreal); HL is he is Co-founder of the company Spinologics Inc, SP has received outside the submitted work: royalties from EOS imaging, he is Co-founder of the company Spinologics Inc., he received consultancy fees from K2M, Medtronic and DePuy Synthes Spine, he received grants from DePuy Synthes Spine, Canadian Institutes of Health Research, Pediatric Orthopaedic Society of North America, Scoliosis Research Society, Medtronic, EOS imaging, Canadian Foundation for Innovation, Setting Scoliosis Straight Foundation, Natural Sciences and Engineering Council of Canada, Fonds de recherche Québec—Santé, grants and Orthopaedic Research and Education Foundation, he received fellowship support from DePuy Synthes and Medtronic, he is the holder of the Academic Chair in Pediatric Spinal Deformities of CHU Ste-Justine, he is member of speaker bureau of Orthopaediatrics.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the ethics Committee of the CHU Sainte-Justine.

Consent to participate

All research participants or their legal guardians provided written consent to be a part of the database and have the data collected be used in ongoing research on scoliosis.

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Pereira-Duarte, M., Roy-Beaudry, M., Turgeon, I. et al. Pre-operative parameters influencing vertebral body tethering outcomes: patient’s characteristics play an important role in determining the outcomes at a minimum of 2 years post-op. Spine Deform 11, 1389–1397 (2023). https://doi.org/10.1007/s43390-023-00739-1

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