Jackson Taylor J, Louer Craig, El-Hawary Ron, Hurry Jennifer, Nian Hui, Farnsworth Christine, Bartley Carrie E, Bryan Tracey P, Kelly Michael P, Newton Peter O, Parent Stefan, Upasani Vidyadhar V
Division of Orthopedics & Scoliosis Rady Children's Hospital San Diego California USA.
Department of Orthopedics Vanderbilt University Medical Center Nashville Tennessee USA.
JOR Spine. 2025 Jul 24;8(3):e70098. doi: 10.1002/jsp2.70098. eCollection 2025 Sep.
The relationship between tether tension and spinal growth modulation following vertebral body tethering (VBT) has not been studied in growing children.
This study aims to explore the relationship between vertebral body growth modulation under varying tether tension.
A retrospective, multicenter pediatric registry was queried for idiopathic scoliosis patients treated with right-sided VBT, with recorded intraoperative tension (using an ordinal scale of 0-3), and 3D reconstructions from biplanar radiographs at the first erect (FE) and 2-year post-operative visits. Custom MATLAB code was used to calculate vertebral height (mm) on the untethered and tethered sides from T5-T12. Generalized linear mixed models were used to analyze the effect of tension on vertebral body growth.
Fifty-two subjects (47 female) were included with a mean age of 12.5 ± 1 years. Patients were skeletally immature (triradiate cartilage open in 23 patients) with Proximal Femoral Maturity Index scores of 2 (nine patients), 3 (21 patients), 4 (20 patients), and 5 (two patients). A total of 330 vertebral bodies were analyzed. Mean height change of the vertebral bodies from FE to 2 years was 1.6 + 1.9 mm (untethered) and 1.2 + 1.8 mm (tethered). On the tethered side, greater tension resulted in less height change, with the greatest differential growth observed between maximal tension and no tension (0.8 mm vs. 0.2 mm, = 0.02). Greater tension resulted in less vertebral body growth and greater differential growth. Future studies should quantify forces applied during VBT surgery, as well as the forces maintained in the post-operative period with spinal motion.
Intraoperative intervertebral tensioning significantly affects vertebral body growth over 2 years.
椎体拴系术（VBT）后拴系张力与脊柱生长调节之间的关系在儿童生长过程中尚未得到研究。
本研究旨在探讨不同拴系张力下椎体生长调节之间的关系。
对一个回顾性多中心儿科登记处进行查询，以获取接受右侧VBT治疗的特发性脊柱侧凸患者，记录术中张力（使用0 - 3的有序量表），以及首次直立（FE）和术后2年双平面X线片的三维重建图像。使用自定义MATLAB代码计算T5 - T12未拴系侧和拴系侧的椎体高度（mm）。采用广义线性混合模型分析张力对椎体生长的影响。
纳入52名受试者（47名女性），平均年龄12.5 ± 1岁。患者骨骼未成熟（23例患者的三辐射软骨开放），股骨近端成熟指数评分为2（9例患者）、3（21例患者）、4（20例患者）和5（2例患者）。共分析了330个椎体。椎体从FE到2年的平均高度变化为1.6 + 1.9 mm（未拴系侧）和1.2 + 1.8 mm（拴系侧）。在拴系侧，更大的张力导致高度变化更小，最大张力与无张力之间观察到最大的差异生长（0.8 mm对0.2 mm，P = 0.02）。更大的张力导致椎体生长更少和差异生长更大。未来的研究应量化VBT手术期间施加的力，以及术后脊柱运动时维持的力。
术中椎间张力在2年内显著影响椎体生长。
