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Analysis of three-dimensional spine growth for vertebral body tethering patients at 2 and 5 years post operatively

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Abstract

Purpose

Scoliosis can be treated with vertebral body tethering (VBT) as a motion-sparing procedure. However, the knowledge of how growth is affected by a tether spanning multiple levels is unclear in the literature. Three-dimensional true spine length (3D-TSL) is a validated assessment technique that accounts for the shape of the spine in both the coronal and sagittal planes. This study aimed to assess if 3D-TSL increases over a five-year period after VBT implantation in thoracic curves for idiopathic scoliosis.

Methods

Prospectively collected radiographic data from an international pediatric spine registry was analyzed. Complete radiographic data over three visits (post-operative, 2 years, and 5 years) was available for 53 patients who underwent VBT.

Results

The mean age at instrumentation of this cohort was 12.2 (9–15) years. The average number of vertebrae instrumented was 7.3 (SD 0.7). Maximum Cobb angles were 50° pre-op, which improved to 26° post-op (p < 0.001) and was maintained at 5 years (30°; p = 0.543). Instrumented Cobb angle was 22° at 5 years (p < 0.001 vs 5-year maximum Cobb angle). An accentuation was seen in global kyphosis from 29° pre-operative to 41° at 5 years (p < 0.05). The global spine length (T1-S1 3D-TSL) started at 40.6 cm; measured 42.8 cm at 2 years; and 44.0 cm at the final visit (all p < 0.05). At 5 years, patients reached an average T1-S1 length that is comparable to a normal population at maturity. Immediate mean post-operative instrumented 3D-TSL (top of UIV–top of LIV) was 13.8 cm two-year length was 14.3 cm; and five-year length was 14.6 cm (all p < 0.05). The mean growth of 0.09 cm per instrumented level at 2 years was approximately 50% of normal thoracic growth. Patients who grew more than 0.5 cm at 2 years had a significantly lower BMI (17.0 vs 19.0, p < 0.05) and smaller pre-operative scoliosis (48° vs 53°, p < 0.05). Other subgroup analyses were not significant for age, skeletal maturity, Cobb angles or number of spanned vertebras as contributing factors.

Conclusions

This series demonstrates that 3D-TSL increased significantly over the thoracic instrumented levels after VBT surgery for idiopathic scoliosis. This represented approximately 50% of expected normal thoracic growth over 2 years.

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Data availability

Registry data is available to member institutions. Measurements and analysis done at the IWK Health Centre are on a password-protected server. Access may be arranged through an application to the REB.

Code availability

Statistical analysis was conducted using Excel version 16.63.1 (Microsoft Corporation, Redmond, Washington, USA) and SPSS version 28.0.1.1 (IBM Corp, Armonk, NY, USA).

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Orthopaedic Clinic, IWK Health Centre, 5850 University Avenue, PO Box 9700, Halifax, NS, B3K 6R8, Canada

    Mathieu Boulet, Jennifer Hurry & Ron El-Hawary

  2. Cedars Sinai Spine Center, Department of Orthopaedics, Los Angeles, CA, USA

    David Skaggs & Ron El-Hawary

  3. Department of Spine Surgery, Shriners Hospital for Children Portland, Portland, OR, USA

    Michelle Cameron Welborn & Ron El-Hawary

  4. Children’s Hospital Los Angeles, Children’s Orthopaedic Center, Los Angeles, CA, USA

    Lindsay Andras & Ron El-Hawary

  5. Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA

    Craig Louer & Ron El-Hawary

  6. Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA

    A. Noelle Larson & Ron El-Hawary

  7. Department of Orthopaedic Surgery, BC Children’s Hospital, Vancouver, BC, Canada

    Firoz Miyanji & Ron El-Hawary

  8. Department of Orthopaedic Surgery, CHU Sainte-Justine, Montreal, QC, Canada

    Stefan Parent & Ron El-Hawary

  9. Pediatric Spine Study Group, Pediatric Spine Foundation, Valley Forge, PA, USA

    Ron El-Hawary

  10. Faculty of Medicine, Dalhousie University, Halifax, NS, Canada

    Ron El-Hawary

Authors
  1. Mathieu Boulet
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  2. Jennifer Hurry
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  8. Firoz Miyanji
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  9. Stefan Parent
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  10. Ron El-Hawary
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Contributions

Design or the acquisition, analysis, or interpretation of data: Mathieu Boulet, Jennifer Hurry, David Skaggs, Michelle Welborn, Lindsay Andras, Craig Louer, A. Noelle Larson, Firoz Miyanji, Stefan Parent, Pediatric Spine Study Group, Ron El-Hawary.

Corresponding author

Correspondence to Ron El-Hawary.

Ethics declarations

Conflict of interest

Mathieu Boulet has nothing to disclose. Jennifer Hurry reports a fellowship from Depuy Synthes. David Skaggs reports personal fees or stocks from Globus Medical, Orthobullets, Top Doctors, ZimmerBiomet, and Zipline Medical; IP or publishing royalties from Globus Medical, Medtronic, ZimmerBiomet and Wolters Kluwer Health; grant from Nuvasive; board or committee member for Pediatric Spine Foundation, Pediatric Spine Study Group, and the Scoliosis Research Society; and editorial or governing board of OrthoBullets, Orthopedics Today, and the Journal of Children’s Orthopaedics, outside the submitted work. Michelle Cameron Welborn reports personal fees from AstraZeneca Rare Disease, DePuy, A Johnson & Johnson Company, Nuvasive, Orthopediatrics, Stryker, and Synthes; research support from the Pediatric Orthopaedic Society of North America, Shriners Hospital for Children, and ZimVie; board or committee member of the Pediatric Orthopaedic Society of North America, Pediatric Spine Study Group, and the Scoliosis Research Society; and editorial or governing board of the Journal of Pediatric Orthopedics, Spine Journal, and the Journal of Spine Deformity, outside the submitted work. Lindsay Andras reports personal fees or stocks from Eli Lilly, Medtronic, Nuvasive, Orthobullets, and Zimmer Biomet; board or committee member for the Pediatric Orthopaedic Society of North America and the Scoliosis Research Society; and editorial or governing board of Journal of Pediatric Orthopedics, outside the submitted work. Craig Louer reports personal fees from DePuy, A Johnson & Johnson Company, royalties from National Scoliosis Clinics, Inc., research grants from Pediatric Orthopaedic Society of North America and NuVasive, outside the submitted work. A. Noelle Larson reports grants from DePuy, A Johnson & Johnson Company, Globus Medical, Medtronic, Orthopediatrics, and Zimmer; and board or committee member of the Scoliosis Research Society, outside the submitted work. Firoz Miyanji reports personal fees from DePuy, A Johnson & Johnson Company, Stryker, Zimmer and OrthoPediatrics; board or committee member of the Pediatric Orthopaedic Society of North America; and grant from DePuy, outside the submitted work. Stefan Parent reports personal fees from EOS-imaging, Spinologics, and DePuy, a Johnson & Johnson Company; Academic Research chair in spine deformities of the CHU Sainte-Justine (DePuy), grants from EOS-imaging, DePuy and the Setting Scoliosis Straight Foundation; board or committee member with the Canadian Spine Society, Pediatric Orthopaedic Society of North America, and the Scoliosis Research Society; and IP royalties from Rodin 4D, outside the submitted work. Pediatric Spine Study Group reports grants from DePuy Synthes Spine, grants from Medtronic, grants from NuVasive, grants from Globus Medical Inc., grants from OrthoPediatrics, grants from Zimmer Biomet, grants from Pediatric Spine Foundation, grants from Stryker, outside the submitted work. Ron El-Hawary reports personal fees from Depuy Synthes Spine, personal fees from Medtronic Spine, grants from Depuy Synthes Spine, grants from Medtronic Spine, personal fees from Orthopediatrics, other from Pediatric Spine Foundation, other from Scoliosis Research Society, outside the submitted work.

Ethical approval

This work is a sub-study of the Pediatric Spine Study Group Registry which was approved by the Research Ethics Board at the IWK Health Centre (#1002256) in accordance with the ethical standards outlined in the Tri-Council Policy Statement and the 1964 Declaration of Helsinki and its later amendments.

Consent to participate

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

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Not applicable.

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Boulet, M., Hurry, J., Skaggs, D. et al. Analysis of three-dimensional spine growth for vertebral body tethering patients at 2 and 5 years post operatively. Spine Deform (2024). https://doi.org/10.1007/s43390-024-00857-4

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