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Biomechanical modeling and assessment of lumbar vertebral body tethering configurations

  • Biomechanics
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Abstract

Purpose

Vertebral body tethering (VBT) is a fusionless spinal growth modulation technique, which shows promise for pediatric idiopathic scoliosis (IS) curve correction. This technique, mainly used for thoracic curves, is increasingly being used to treat lumbar curves in order to preserve spine flexibility. It remains necessary to adequately define the cord tension to be applied during the operation and the instrumented levels to biomechanically predict correction over time for the lumbar spine.

Methods

Twelve pediatric patients with lumbar IS, treated with lumbar-only or lumbar and thoracic VBT, were selected for this study. Three independent variables were tested alternately using a patient-specific finite element model (FEM), which includes an algorithm modeling vertebra growth and spine curve changes due to growth modulation for 24 months post-operatively according to the Hueter-Volkmann principle. Parameters included cable tensioning (150N/250N), upper instrumented level (actual UIV, UIV-1) and lower instrumented level (actual LIV, LIV + 1). Each FEM was personalized using 3D radiographic reconstruction and flexibility supine radiographs.

Result

An increase in cord tension (from 150 to 250N) had significant effects on main thoracic and thoraco-lumbar/lumbar Cobb angles, as well as on lumbar lordosis, after surgery (supplementary average correction of 3° and 8°, and increase of 1.4°, respectively) and after 24 months (4°, 10° and 1.1°) (p < 0.05). Adding a level to the actual UIV or LIV did not improve correction.

Conclusion

This parametric study showed that cord tension is the most important biomechanical parameter on the simulated immediate and 2-year increase in lumbar curve correction. Our preliminary model suggests that it is not advantageous to add additional instrumented levels.

Level of evidence

This computational study uses a retrospective validation cohort (level of evidence 3).

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Data availability

The numerical data supporting the results of this study are available from the corresponding author upon reasonable request.

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Funding

The engineering analysis and simulation portion within this project were separately funded by the Natural Sciences and Engineering Research Council of Canada (Industrial Research Chair program with Medtronic of Canada) (grant number PCIPJ-346145). This work is also related to a SRS research grant (SRS-ZimVie Satandard Investigator Grant).

Author information

Authors and Affiliations

  1. Department of Mechanical Engineering, Polytechnique Montréal, Downtown Station, P.O. Box 6079, Montreal, QC, H3C 3A7, Canada

    Sophie Martin, Nikita Cobetto & Carl-Eric Aubin

  2. Research Center, Sainte-Justine University Hospital Center, 3175 Côte-Sainte-Catherine Road, Montreal, QC, H3T 1C5, Canada

    Nikita Cobetto & Carl-Eric Aubin

  3. Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA

    A. Noelle Larson

Authors
  1. Sophie Martin
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  2. Nikita Cobetto
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  3. A. Noelle Larson
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  4. Carl-Eric Aubin
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Contributions

NC: model development, simulations, analyses, interpretation of data for the work, drafting work, final approbation, agree to be accountable. SM: simulations, analyses, interpretation of the data for the work, drafting work, final approbation, agree to be accountable. NL: recruitment of cases, clinical interpretation of the data for the work, revising, final approbation, agree to be accountable. CÉA: design, supervising the study, interpretation of the data for the work, comprehensive review, final approbation, agree to be accountable.

Corresponding author

Correspondence to Carl-Eric Aubin.

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Conflict of interest

Sophie Martin and Nikita Cobetto declare that they have no competing interests that are directly or indirectly related to the work submitted for publication. Dr. Larson states that she has a personal financial relationship with a commercial interest indirectly related to the work submitted for publication (consultant with all funding directed to peds ortho research at Mayo Clinic from Medtronic, Orthopediatrics, Stryker, DePuy, Zimmer). Dr Aubin declares that he has a personal financial relationship with a commercial interest indirectly related to the work submitted for publication as peer-review grant from the Natural Sciences & Engineering Research Council of Canada (industrial research chair program with Medtronic of Canada and research contracts with Medtronic apart from this topic). However, these relationships/affiliations will not bias or otherwise influence their involvement in the proposed research.

Research involving human participants

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional ethical research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all participants included in the study and their parents.

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Martin, S., Cobetto, N., Larson, A.N. et al. Biomechanical modeling and assessment of lumbar vertebral body tethering configurations. Spine Deform 11, 1041–1048 (2023). https://doi.org/10.1007/s43390-023-00697-8

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  • DOI: https://doi.org/10.1007/s43390-023-00697-8

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