Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey.
Urla State Hospital, İzmir, Turkey.
Spine J. 2021 Nov;21(11):1793-1801. doi: 10.1016/j.spinee.2021.05.020. Epub 2021 May 23.
Vertebral body tethering (VBT), a flexible compression-based growth modulation technique, was claimed to prevent disc degeneration due to its less rigid nature compared to other growth-friendly techniques. Yet, the consequences of VBT surgery on discs and facet joints have not been precisely acknowledged.
The purpose of this study was to determine the changes in the intermediate and adjacent levels at least 2 years after surgery.
STUDY DESIGN/SETTING: Prospectively-followed consecutive patient cohort PATIENT SAMPLE: Adolescent idiopathic scoliosis patients who underwent thoracoscopic VBT between 2014 and 2017 were included.
Degeneration of the intervertebral discs using the Pfirrmann classification; Degeneration of facet joints using a scale of 0 to 3.
Demographic, perioperative, clinical, radiographic data were collected. Skeletal maturity and height gain were assessed in every follow-up. Overcorrection, tether breakage, mechanical and pulmonary complications as well as readmission and reoperations were recorded. MRIs taken before surgery and at a minimum of 2 years follow-up were evaluated for degeneration at the intermediate and adjacent segment intervertebral discs and facet joints by a blinded senior radiologist and compared.
Twenty-five patients with a mean of 38.6±10.6 months (24-62) of follow-up were included. The mean age at surgery was 12.2 (10-14), and the median Sanders stage was 3 (1-7). A mean of 7.7±1.1 (6-11) levels were tethered. The mean preoperative main thoracic curve magnitude of 46°±7.7° was corrected to 23.3°±5.9° postoperatively, which was subsequently modulated to 12° ±11.5° during the follow-up. At the time of the MRI (mean 29±9.5 (24-62) months), the median Sanders stages was 7 (5-8). A total of 217 levels of discs and bilateral facet joints were evaluated in the preoperative and follow-up MRI images. Analyses of disc and facet scores revealed no significant differences between patients. Deterioration of previously degenerated discs was noted in one patient (from grade 2 to 3), while previously healthy lower adjacent facet joints were degenerated (grade 2) in another patient.
Intermediate discs and facet joints were preserved after growth modulation with VBT surgery at a mean of 29 months of follow-up. Studies in larger cohorts with longer follow-up are warranted to have more in-depth analyses of the effects of relative stabilization and altered biomechanical loads.
与其他促进生长的技术相比，椎体牵拉术（VBT）是一种灵活的基于压缩的生长调节技术，因其性质较软，据称可以防止椎间盘退变。然而，VBT 手术后对椎间盘和小关节的影响尚未得到准确的认识。
本研究旨在确定手术后至少 2 年时中间和相邻节段的变化。
研究设计/设置：前瞻性连续患者队列
纳入 2014 年至 2017 年间接受胸腔镜下 VBT 的青少年特发性脊柱侧凸患者。
使用 Pfirrmann 分级评估椎间盘退变；使用 0 至 3 级评估小关节退变。
收集人口统计学、围手术期、临床、影像学数据。在每次随访中评估骨骼成熟度和身高增长。记录过矫、系绳断裂、机械和肺部并发症以及再入院和再次手术。由一名经验丰富的放射科医生对术前和至少 2 年随访时的 MRI 进行评估，评估中间和相邻节段椎间盘和小关节的退变情况，并进行比较。
共纳入 25 例患者，平均随访时间为 38.6±10.6 个月（24-62）。手术时的平均年龄为 12.2 岁（10-14 岁），中位数 Sanders 分期为 3 期（1-7 期）。平均有 7.7±1.1 个（6-11 个）节段被系绳。术前主胸弯的平均大小为 46°±7.7°，术后矫正至 23.3°±5.9°，随后在随访中调节至 12°±11.5°。在 MRI 检查时（平均 29±9.5 个月[24-62]），中位数 Sanders 分期为 7 期（5-8 期）。在术前和随访 MRI 图像中评估了总共 217 个椎间盘和双侧小关节的水平。分析椎间盘和小关节评分显示，患者之间无显著差异。一名患者的先前退变椎间盘恶化（从 2 级到 3 级），而另一名患者的先前健康的下相邻小关节退变（2 级）。
VBT 手术后平均 29 个月的随访中，中间椎间盘和小关节得到了保留。需要更大的队列和更长的随访时间来进行更深入的分析，以了解相对稳定和改变的生物力学负荷的影响。
