Photopoulos Gregory, Hurry Jennifer, Bansal Ankita, Miyanji Firoz, Parent Stefan, Murphy Joshua, El-Hawary Ron
Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
Division of Orthopedic Surgery, IWK Health Centre, Orthopaedic Clinic, IWK Health Centre, 5850 University Avenue, PO Box 9700, Halifax, NS, B3K 6R8, Canada.
Spine Deform. 2024 Sep;12(5):1369-1379. doi: 10.1007/s43390-024-00874-3. Epub 2024 Apr 18.
To radiographically evaluate if vertebral body tethering (VBT) can maintain differential peri-apical vertebral growth at medium-term follow-up of 4 years.
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).
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).
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.
III.
通过影像学评估椎体牵张术（VBT）在4年中期随访中能否维持椎体顶周差异生长。
查询一个前瞻性、国际性、多中心数据库，以确定接受胸椎VBT治疗的特发性脊柱侧凸患者。由两名独立观察者在5个时间点（术前至4年随访）测量3个顶周椎体的凹侧与凸侧椎体高度、椎体楔形变和椎间盘楔形变。
65例骨骼未成熟患者（60例女性，平均年龄12.8岁，21例三骨骺软骨未闭合）符合纳入标准。术前平均最大脊柱侧凸角度为50±8°，术后显著降至27±9°（p<0.001），在4年随访时保持稳定，为30±17°（与术后相比，p=0.38）。4年随访时平均内固定脊柱侧凸角度为21±14°，与4年最大脊柱侧凸角度有显著差异（p<0.001）。术前平均后凸角度为30±12°，术后无显著变化（p=1.0），在4年随访时保持稳定（35±18°；p=0.05）。平均单个凸侧椎体高度从17.7±1.9mm增加到19.8±1.5mm（p<0.001），而平均单个凹侧高度从14.8±1.9mm增加到17.6±1.6mm（p<0.001）。将顶周高度相加，术前至4年随访时凹侧的高度差（8.3±4.7mm）大于凸侧（6.2±4.7mm）（p<0.001）。平均单个椎体楔形变从术前的6±2°降至4年随访时的4±2°（p<0.001）。平均椎体和椎间盘总楔形变术前起始于29±7°，术后降至16±6°（p<0.001），然后在4年随访时进一步降至14±8°（p<0.001）。手术时三骨骺软骨未闭合的患者在4年中的高度变化比三骨骺软骨已闭合的患者更大（p<0.001）。
接受VBT治疗的特发性脊柱侧凸患者表现出椎体差异生长，且在至少4年的随访中得以维持。这种效应在手术时三骨骺软骨未闭合的患者中更为明显。
III级。
