Metaizeau Jean-Damien, Denis Delphy
Department of Paediatric Orthopaedic Surgery, Chu Dijon, 21000 Dijon, France.
Children (Basel). 2024 Jan 26;11(2):157. doi: 10.3390/children11020157.
Vertebral body tethering has been approved for adolescent scoliosis correction. The usual approach is anterior, which is relatively easy for the thoracic spine, but becomes much more challenging for the lumbar curves, with a higher rate of complications. The purpose of this study was to describe and evaluate the first results of a new posterior vertebral body tethering (PVBT) technique using pedicle screws through a posterolateral Wiltse approach. Twenty-two patients with 5C idiopathic scoliosis (Lenke classification) were included in this retrospective study, with a follow up of 2 years after surgery. The lumbar and thoracic curves were measured pre-operatively (POS), at first standing (FS) and at 2 years (2Y). Complications were also analysed. A significant improvement of 30.7° was observed for lumbar curve magnitude between POS and 2Y. Both the thoracic kyphosis and the lumbar lordosis remained stable. Thirteen complications were noted: three led to posterior arthrodesis, three needed a revision with a good outcome, and the seven others (overcorrections, screw breakage or pull-out) achieved a good result. PVBT seems an effective technique for the management of type 5 C adolescent idiopathic scoliosis. The complication rate seems high but is probably secondary to the learning curve of this new technic as it concerns only the first half of the patients.
椎体拴系术已被批准用于青少年脊柱侧弯的矫正。通常的方法是前路手术，这对于胸椎来说相对容易，但对于腰椎侧弯则更具挑战性，并发症发生率更高。本研究的目的是描述和评估一种新的经后外侧Wiltse入路使用椎弓根螺钉的后路椎体拴系（PVBT）技术的初步结果。本回顾性研究纳入了22例5C型特发性脊柱侧弯（Lenke分型）患者，术后随访2年。在术前（POS）、首次站立时（FS）和2年时（2Y）测量腰椎和胸椎的弯曲度。同时分析并发症情况。观察到腰椎弯曲度在POS和2Y之间有30.7°的显著改善。胸椎后凸和腰椎前凸均保持稳定。记录到13例并发症：3例导致后路融合，3例需要翻修且效果良好，另外7例（过度矫正、螺钉断裂或拔出）也取得了良好效果。PVBT似乎是治疗5C型青少年特发性脊柱侧弯的一种有效技术。并发症发生率似乎较高，但可能是由于这项新技术的学习曲线所致，因为仅涉及了前半部分患者。
