Departments of Orthopedic Surgery.
Radiology, Mayo Clinic, Rochester, MN.
J Pediatr Orthop. 2022 Aug 1;42(7):347-353. doi: 10.1097/BPO.0000000000002172. Epub 2022 May 10.
Interest in vertebral body tethering (VBT) as an alternative to posterior spinal fusion for adolescent idiopathic scoliosis (AIS) continues to grow. The purpose of this study was to prospectively assess intervertebral disk health on magnetic resonance imaging (MRI) at 1 year following VBT in AIS patients.
AIS patients were enrolled in a prospective surgeon-sponsored Food and Drug Administration (FDA) Investigational Device Exemption (IDE) Study and underwent MRI at 1-year following VBT. All spanned disks and the untethered disks immediately adjacent to the upper instrumented vertebra and lowest instrumented vertebra levels were evaluated according to Pfirrmann grading criteria. Associations between patient factors and preoperative and postoperative disk health and patient-reported outcomes were evaluated.
Twenty-two patients were enrolled with a postoperative MRI (25 curves, 188 disks), and 7 patients (7 curves) had both preoperative and postoperative MRIs (67 disks). The mean age was 12.7 years. Most were Risser 0 (65%) and either Sanders Skeletal Maturity Score 3 (35%) or 4 (53%). In the 7 patients with preoperative and postoperative MRI, the mean Pfirrmann grade of the disks spanned by the tether was 1.88 preoperatively and 2.31 postoperatively ( P =0.0075). No statistically significant differences in preoperative versus postoperative Pfirrmann grade were identified in the disks adjacent to the upper or lower instrumented vertebrae. No association was found between patient-reported outcomes and Pfirrmann grade.
At 1 year postoperatively, increased degenerative changes in disks spanned by the tether was identifiable on MRI without evidence of adjacent segment disk disease. These changes were not associated with patient-reported outcomes.
Level III.
椎体束缚（VBT）作为青少年特发性脊柱侧凸（AIS）后路融合术的替代方法，其应用受到越来越多的关注。本研究旨在前瞻性评估 AIS 患者 VBT 治疗 1 年后磁共振成像（MRI）上椎间盘的健康状况。
AIS 患者参与了一项前瞻性的由外科医生发起的食品和药物管理局（FDA）调查器械豁免（IDE）研究，并在 VBT 治疗后 1 年进行 MRI 检查。所有跨越的椎间盘以及最靠近上固定椎和最下固定椎水平的未束缚椎间盘，均按照 Pfirrmann 分级标准进行评估。评估了患者因素与术前和术后椎间盘健康以及患者报告的结果之间的相关性。
22 例患者纳入术后 MRI 检查（25 个曲线，188 个椎间盘），7 例患者（7 个曲线）同时进行了术前和术后 MRI 检查（67 个椎间盘）。患者平均年龄为 12.7 岁，其中 Risser 分级 0 级（65%）， Sanders 骨骼成熟度评分 3 级（35%）或 4 级（53%）。在 7 例有术前和术后 MRI 的患者中，束缚的椎间盘的平均 Pfirrmann 分级术前为 1.88 级，术后为 2.31 级（P=0.0075）。在上固定椎和下固定椎相邻的椎间盘，术前与术后 Pfirrmann 分级之间没有显著差异。患者报告的结果与 Pfirrmann 分级之间也没有发现关联。
术后 1 年，MRI 上可识别到束缚的椎间盘退行性改变，而无相邻节段椎间盘疾病的证据。这些变化与患者报告的结果无关。
III 级。
