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Differential vertebral body growth is maintained after vertebral body tethering surgery for idiopathic scoliosis: 4-year follow-up on 888 peri-apical vertebrae and 592 intervertebral discs

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Abstract

Purpose

To radiographically evaluate if vertebral body tethering (VBT) can maintain differential peri-apical vertebral growth at medium-term follow-up of 4 years.

Methods

A prospective, international, multicenter database was queried to identify idiopathic scoliosis patients treated with thoracic VBT. Concave vs. convex vertebral body height, vertebral wedging, and disc wedging of the 3 peri-apical vertebrae were measured by two independent observers at 5 timepoints (pre-operative to 4-year follow-up).

Results

65 skeletally immature patients (60 female, mean 12.8 years old, 21 with open triradiate cartilages) met inclusion criteria. Mean pre-operative maximum scoliosis of 50 ± 8° decreased significantly post-operatively to 27 ± 9° (p < 0.001), which remained stable at 4-year follow-up 30 ± 17° (p = 0.38 vs. post-operative). Mean instrumented scoliosis was 21 ± 14° at 4-year follow-up, which was significantly different than 4-year maximum scoliosis (p < 0.001). Mean pre-operative kyphosis of 30 ± 12° did not significantly change post-operatively (p = 1.0) and remained stable at 4-year follow-up (35 ± 18°; p = 0.05).

Mean individual convex vertebral height increased from 17.7 ± 1.9 mm to 19.8 ± 1.5 mm (p < 0.001), while mean individual concave height increased from 14.8 ± 1.9 mm to 17.6 ± 1.6 mm (p < 0.001). Summing the peri-apical heights, the difference in height from pre-operative to 4-year follow-up was greater on the concave (8.3 ± 4.7 mm) than on the convex side (6.2 ± 4.7 mm) (p < 0.001). Mean individual vertebral wedging decreased from 6 ± 2° at pre-operative to 4 ± 2° at 4-year follow-up (p < 0.001). Mean total vertebral and disc wedging started at 29 ± 7° pre-operatively, decreased to 16 ± 6° at post-operative (p < 0.001), then further decreased to 14 ± 8° at 4-year follow-up (p < 0.001). Patients with open triradiate cartilages at the time of surgery had a larger height change over the 4 years compared to those with closed triradiate cartilages (p < 0.001).

Conclusion

Patients with idiopathic scoliosis treated with VBT demonstrated differential vertebral growth which was maintained at minimum 4-year follow-up. This effect was more pronounced in patients whose triradiate cartilages were open at the time of surgery.

Level of Evidence

III.

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Data availability

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

Code availability

Statistical analysis was conducted using Excel version 2002 (Microsoft Corporation, Redmond, Washington, USA) and SPSS version 27.0 (IBM Corp, Armonk, NY, USA).

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Acknowledgements

The authors acknowledge the contribution of the Pediatric Spine Study Group.

Funding

Funding was received for this study from the Dalhousie Medical Research Foundation W. Alan Curry Studentship and Dalhousie Faculty of Medicine Gladys Osman Estate.

Author information

Authors and Affiliations

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

    Gregory Photopoulos & Ron El-Hawary

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

    Gregory Photopoulos, Jennifer Hurry, Ankita Bansal & Ron El-Hawary

  3. Orthopaedics Research Department, BC Children’s Hospital, Vancouver, BC, Canada

    Firoz Miyanji

  4. Department of Orthopaedics, CHU Sainte-Justine, Montreal, QC, Canada

    Stefan Parent

  5. Department of Surgery, University of Montreal, Montreal, QC, Canada

    Stefan Parent

  6. Department of Orthopaedic Surgery, Children’s Healthcare of Atlanta, Atlanta, GA, USA

    Joshua Murphy

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Consortia

Pediatric Spine Study Group

Contributions

Design or the acquisition, analysis, or interpretation of data, Drafted the work or revised it critically, Approved, Accountable: Gregory Photopoulos, Jennifer Hurry, Ankita Bansal, Firoz Miyanji, Stefan Parent, Joshua Murphy, Pediatric Spine Study Group, Ron El-Hawary.

Corresponding author

Correspondence to Ron El-Hawary.

Ethics declarations

Conflict of interest

  1. 1.

    Gregory Photopoulos—received two studentships from Dalhousie University during the conduct of the study.

  2. 2.

    Jennifer Hurry—reports a fellowship from Depuy Synthes Spine outside the submitted work.

  3. 3.

    Ankita Bansal—nothing to disclose.

  4. 4.

    Firoz Miyanji—DePuy, A Johnson & Johnson Company: paid consultant; research support. OrthoPediatrics: paid consultant. Pediatric Orthopaedic Society of North America: board or committee member. Stryker: paid consultant. Zimmer: IP royalties; paid consultant. All disclosures are outside the submitted work.

  5. 5.

    Stefan Parent—EOS-imaging: paid consultant, research grant, Royalties. K2M: paid consultant. DePuy Synthes Spine: paid consultant, research grant, fellowship support. Spinologics/Spino-Modulation: stock/shareholder, employee. Academic Research chair in spine deformities of the CHU Sainte-Justine (DePuy): endowment. Pediatric Orthopaedic Society of North America: research grant. Scoliosis Research Society: research grant. Canadian Foundation for Innovation: research grant. Setting Scoliosis Straight Foundation: research grant. Natural Sciences and Engineering Council of Canada: research grant. Fonds de recherche Québec—Santé: research grant, committee member. Orthopaedic Research and Education Foundation: research grant. Medtronic: research grant. OrthoPediatrics: speaker’s bureau. All disclosures are outside the submitted work.

  6. 6.

    Joshua Murphy—reports personal fees from Depuy Synthes Spine, personal fees from OrthoPediatrics, personal fees from Alphatec Spine, outside the submitted work.

  7. 7.

    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. All disclosures are outside the submitted work.

  8. 8.

    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. All disclosures are 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.

Consent for publication

Not applicable.

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Photopoulos, G., Hurry, J., Bansal, A. et al. Differential vertebral body growth is maintained after vertebral body tethering surgery for idiopathic scoliosis: 4-year follow-up on 888 peri-apical vertebrae and 592 intervertebral discs. Spine Deform (2024). https://doi.org/10.1007/s43390-024-00874-3

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