Does preoperative and intraoperative imaging for anterior vertebral body tethering predict postoperative correction?

Abstract

Purpose

Anterior vertebral body tethering (AVBT) is an emerging approach for idiopathic scoliosis. However, overcorrection and under-correction are common causes of revision surgery, and intraoperative tensioning of the cord is one key component to achieve appropriate curve correction. We sought to determine whether preoperative flexibility radiographs or intraoperative radiographs would predict correction at first erect imaging for scoliosis patients undergoing anterior vertebral body tethering (AVBT).

Methods

Single-center retrospective review. Fifty-one patients with a diagnosis of idiopathic scoliosis underwent anterior body tethering. Preoperative flexibility films and intraoperative radiographs were compared to first erect standing radiographs to determine if there was a correlation in Cobb angle.

Results

Preoperative major Cobb angle measured 52° ± 9°. Major Cobb angle on bending films was 24° ± 8°. Intraoperative imaging showed correction to a mean of 17° ± 8°. Postoperative first erect standing radiographs showed correction to a mean of 26° ± 10°. The mean difference in major Cobb angle between intraoperative radiograph and a first erect radiograph was 10° ± 4°, whereas the mean difference from preoperative bending radiograph at first erect was 2° ± 7°. Thus, correction on preoperative flexibility films correlated with the first erect radiograph.

Conclusion

Preoperative bending radiographs provide a reasonable estimate of postoperative correction for patients undergoing AVBT with tensioning of the cord. Surgeons should expect the major Cobb angle to increase on first erect radiographs compared to intraoperative radiographs. These findings may guide patient selection and assist surgeons in achieving appropriate correction intraoperatively.

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References

  1. 1.

    O’Leary PT, Sturm PF, Hammerberg KW, Lubicky JP, Mardjetko SM (2011) Convex hemiepiphysiodesis: the limits of vertebral stapling. Spine Phila Pa 1976 36(19):1579–1583

    Article  Google Scholar 

  2. 2.

    Theologis AA, Cahill P, Auriemma M et al (2013) Vertebral body stapling in children younger than 10 years with idiopathic scoliosis with curve magnitude of 30 degrees to 39 degrees. Spine Phila Pa 1976 38P:E1583–E1588

    Article  Google Scholar 

  3. 3.

    Crawford CH III, Lenke LG (2010) Growth modulation by means of anterior tethering resulting in progressive correction of juvenile idiopathic scoliosis: a case report. J Bone Jt Surg Am 92:202–209

    Article  Google Scholar 

  4. 4.

    Samdani AF, Ames RJ, Kimball JS, Pahys JM, Grewal H, Pelletier GJ, Betz RR (2014) Anterior vertebral body tethering for idiopathic scoliosis: two-year results. Spine Phila Pa 1976 39(20):1688–1693

    Article  Google Scholar 

  5. 5.

    Boudissa M, Eid A, Bourgeois E, Griffet J, Courvoisier A (2017) Early outcomes of spinal growth tethering for idiopathic scoliosis with a novel device: a prospective study with 2 years of follow-up. Childs Nerv Syst 33(5):813–818

    CAS  Article  Google Scholar 

  6. 6.

    Courvoisier A, Eid A, Bourgeois E, Griffet J (2015) Growth tethering devices for idiopathic scoliosis. Expert Rev Med Devices 12(4):449–456

    CAS  Article  Google Scholar 

  7. 7.

    Samdani AF, Ames RJ, Kimball JS, Pahys JM, Grewal H, Pelletier GJ, Betz RR (2015) Anterior vertebral body tethering for immature adolescent idiopathic scoliosis: one-year results on the first 32 patients. Eur Spine J 24(7):1533–1539

    Article  Google Scholar 

  8. 8.

    Newton PO, Kluck DG, Saito W, Yaszay B, Bartley CE, Bastrom TP (2018) Anterior spinal growth tethering for skeletally immature patients with scoliosis: a retrospective look two to four years postoperatively. J Bone Jt Surg Am 100(19):1691–1697

    Article  Google Scholar 

  9. 9.

    Newton PO, Bartley CE, Bastrom TP, Kluck DG, Saito W, Yaszay B (2020) Anterior spinal growth modulation in skeletally immature patients with idiopathic scoliosis: a comparison with posterior spinal fusion at 2 to 5 years Postoperatively. J Bone Jt Surg Am 102(9):769–777. https://doi.org/10.2106/JBJS.19.01176 (PubMed PMID: 32379117)

    Article  Google Scholar 

  10. 10.

    Hoernschemeyer DG, Boeyer ME, Robertson ME, Loftis CM, Worley JR, Tweedy NM, Gupta SU, Duren DL, Holzhauser CM, Ramachandran VM (2020) Anterior vertebral body tethering for adolescent scoliosis with growth remaining: a retrospective review of 2- to 5-year postoperative results. J Bone Jt Surg Am 102(13):1169–1176

    Google Scholar 

  11. 11.

    Alanay A, Yucekul A, Abul K, Ergene G, Senay S, Ay B, Cebeci BO, Dikmen PY, Zulemyan T, Yavuz Y, Yilgor C (2020) Thoracoscopic vertebral body tethering for adolescent idiopathic scoliosis: follow-up curve behavior according to sanders skeletal maturity staging. Spine (Phila Pa 1976) (published online ahead of print, 2020 Aug 1)

  12. 12.

    Lenke LG, Betz RR, Harms J, Bridwell KH, Clements DH, Lowe TG, Blanke K (2001) Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Jt Surg Am 83(8):1169–1181

    CAS  Article  Google Scholar 

  13. 13.

    He C, Wong MS (2018) Spinal flexibility assessment on the patients with adolescent idiopathic scoliosis: a literature review. Spine Phila Pa 1976 43(4):E250–E258

    Article  Google Scholar 

  14. 14.

    Cheung K, Luk K (1997) Prediction of correction of scoliosis with use of the fulcrum bending radiograph. J Bone Jt Surg Am 79:1144–1150

    CAS  Article  Google Scholar 

  15. 15.

    Cobetto N, Aubin CE, Parent S (2018) Surgical planning and follow-up of anterior vertebral body growth modulation in pediatric idiopathic scoliosis using a patient-specific finite element model integrating growth modulation. Spine Deform 6(4):344–350

    Article  Google Scholar 

  16. 16.

    Cobetto N, Parent S, Aubin CE (2018) 3D correction over 2years with anterior vertebral body growth modulation: A finite element analysis of screw positioning, cable tensioning and postoperative functional activities. Clin Biomech Bristol Avon 51:26–33

    Article  Google Scholar 

  17. 17.

    Cobetto N, Aubin CE, Parent S (2018) Contribution of lateral decubitus positioning and cable tensioning on immediate correction in anterior vertebral body growth modulation. Spine Deform 6(5):507–513

    Article  Google Scholar 

  18. 18.

    Carman DL, Browne RH, Birch JG (1990) Measurement of scoliosis and kyphosis radiographs Intraobserver and interobserver variation. J Bone Jt Surg Am 72(3):328–333

    CAS  Article  Google Scholar 

  19. 19.

    Morrissy RT, Goldsmith GS, Hall EC, Kehl D, Cowie GH (1990) Measurement of the Cobb angle on radiographs of patients who have scoliosis. Evaluation of intrinsic error. J Bone Jt Surg Am. 72(3):320–327

    CAS  Article  Google Scholar 

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Funding

Funding for this study was obtained from Orthopedic Research and Education Foundation, Pediatric Orthopedic Society of North America, and Mayo CCaTS-CBD Pilot Award for Team Science.

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Authors

Contributions

SEM, TAM, AFB, DDP, ANL: Substantial contributions to the conception or design of the work, or the acquisition, analysis, or interpretation of data. SEM, TAM, AFB, DDP, ANL: Drafting the work or critically revising it for important intellectual content. SEM, TAM, AFB, DDP, ANL: Final Approval of the version to be published. SEM, TAM, AFB, DDP, ANL: Responsible for content and accuracy of the entire manuscript. SEM, TAM, AFB, DDP, ANL: The order and inclusion should be decided by consensus among the authors and acknowledged in writing.

Corresponding author

Correspondence to A. Noelle Larson.

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Conflict of interest

Outside of the study, Dr. Milbrandt reports consulting activities with Orthopediatrics, Medtronic, Zimmer and stock ownership in Viking Scientific. Dr. Larson reports consulting activities with Orthopediatrics, Medtronic, Zimmer, and Globus. Drs. Mathew, Potter, and Buyuk have no conflicts to report.

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IRB approval was obtained for all aspects of this study.

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Buyuk, A.F., Milbrandt, T., Mathew, S. et al. Does preoperative and intraoperative imaging for anterior vertebral body tethering predict postoperative correction?. Spine Deform (2021). https://doi.org/10.1007/s43390-020-00267-2

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Keywords

  • Spinal growth modulation
  • Flexibility
  • Curve correction
  • Scoliosis
  • Vertebral body tethering
  • Anterior spinal instrumentation