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A preliminary assessment of intervertebral disc health and pathoanatomy changes observed two years following anterior vertebral body tethering

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Abstract

Purpose

Vertebral body tethering (VBT) has been reported as a safe and effective non-fusion surgical technique for the treatment of adolescent idiopathic scoliosis, but the postoperative health of the bone and soft tissues of the spine following instrumentation remains unknown. We aimed to evaluate pathoanatomy and degenerative changes of the spine in adolescent idiopathic scoliosis patients both prior to and two years following VBT.

Methods

We prospectively enrolled nine patients who underwent VBT for the treatment of progressive adolescent idiopathic scoliosis. All patients received preoperative and two-year postoperative magnetic resonance imaging of their spine; images were assessed for pathoanatomy (e.g. nucleus pulposus positioning and muscle atrophy) and degenerative changes (e.g. Schmorl nodes, endplate oedema, disc degeneration, and osteoarthritis) at each vertebral level between T1 and S1.

Results

Four patients (44%) exhibited a shift of the nucleus pulposus from an eccentric position at baseline towards midline at three or more levels, most of which were in the tethered region. Tethering did not affect preexisting fatty atrophy of multifidus. No patients exhibited postoperative Schmorl nodes, endplate oedema, or disc degeneration in either the tethered or untethered regions. Four patients (44%) presented with mild facet osteoarthritis in the lower lumbar spine, which did not change postoperatively. One patient developed moderate facet osteoarthritis at L5-S1.

Conclusions

These preliminary data indicate that VBT may not result in significant degenerative changes in either the intervertebral discs or the posterior facets two years following instrumentation.

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References

  1. Nohara A, Kawakami N, Seki K et al (2015) The effects of spinal fusion on lumbar disc degeneration in patients with adolescent idiopathic scoliosis: a minimum 10-year follow-up. Spine Deform 3:462–468

    Article  Google Scholar 

  2. Nohara A, Kawakami N, Tsuji T et al (2018) Intervertebral disc degeneration during postoperative follow-up more than 10 years after corrective surgery in idiopathic scoliosis: comparison between patients with and without surgery. Spine 43:255–261

    Article  Google Scholar 

  3. Baroncini A, Trobisch PD, Migliorini F (2020) Learning curve for vertebral body tethering: analysis on 90 consecutive patients. Spine Deform 9:141–147

    Article  Google Scholar 

  4. Hoernschemeyer D, Boeyer M, Robertson M et al (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 102:1169–1176

    Article  Google Scholar 

  5. Newton P, Kluck D, Saito W et al (2018) Anterior spinal growth tethering for skeletally immature patients with scoliosis: a retrospective look two to four years postoperatively. J Bone Jt Surg Am 100:1691–1697

    Article  Google Scholar 

  6. Samdani A, Ames R, Kimball J et al (2014) Anterior vertebral body tethering for idiopathic scoliosis: two-year results. Spine 39:1688–1693

    Article  Google Scholar 

  7. Parent S, Shen J (2020) Anterior vertebral body growth-modulation tethering in idiopathic scoliosis: surgical technique. J Am Acad Orthop Surg 28:693–699

    Article  Google Scholar 

  8. Newton P, Fricka K, Lee S et al (2002) Asymmetrical flexible tethering of spine growth in an immature bovine model. Spine 27:689–693

    Article  Google Scholar 

  9. Newton P, Farnsworth C, Faro F et al (2008) Spinal growth modulation with an anterolateral flexible tether in an immature bovine model: disc health and motion preservation. Spine 33:724–733

    Article  Google Scholar 

  10. Upasani V, Farnsworth C, Chambers R et al (2011) Intervertebral disc health preservation after six months of spinal growth modulation. J Bone Jt Surg Am 93:1408–1416

    Article  Google Scholar 

  11. Rahme R, Moussa R (2008) The modic vertebral endplate and marrow changes: pathologic significance and relation to low back pain and segmental instability of the lumbar spine. AJNR Am H Neuroradiol 29:838–842

    Article  CAS  Google Scholar 

  12. Kellgren J, Lawrence J (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502

    Article  CAS  Google Scholar 

  13. Fujiwara A, Tamai K, An HS et al (2000) The relationship between disc degeneration, facet joint osteoarthritis, and stability of the degenerative lumbar spine. J Spinal Disord 13:444–450. https://doi.org/10.1097/00002517-200010000-00013

    Article  CAS  PubMed  Google Scholar 

  14. Newton P, Bartley C, Bastrom T et al (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 102:769–777

    Article  Google Scholar 

  15. Hueter C (1862) Anatomische studien an den extremitätengelenken neugeborener und erwachsener. Virchows Arch 25:572–599

    Article  Google Scholar 

  16. Schlösser T, Brink R, Castelein R (2017) The etiologic relevance of 3-D pathoanatomy of adolescent idiopathic scoliosis. Coluna/Columna 16:302–307

    Article  Google Scholar 

  17. Chan Y, Cheng J, Guo X et al (1999) MRI evaluation of multifidus muscles in adolescent idiopathic scoliosis. Pediatr Radiol 29:360–363

    Article  CAS  Google Scholar 

  18. Mannion A, Meier M, Grob D, Müntener M (1998) Paraspinal muscle fibre type alterations associated with scoliosis: an old problem revisited with new evidence. Eur Spine J 7:289–293

    Article  CAS  Google Scholar 

  19. Yeung K, Man G, Shi L et al (2019) Magnetic resonance imaging-based morphological change of paraspinal muscles in girls with adolescent idiopathic scoliosis. Spine 44:1356–1363

    Article  Google Scholar 

  20. Périé D, Sales De Gauzy J, Curnier D, Hobatho M (2001) Intervertebral disc modeling using a MRI method: migration of the nucleus zone within scoliotic intervertebral discs. J Magn Reson Imaging 19:1245–1248

    Article  Google Scholar 

  21. Stokes I (2007) Analysis and simulation of progressive adolescent scoliosis by biomechanical growth modulation. Eur Spine J 16:1621–1628

    Article  Google Scholar 

  22. Stokes I, Spence H, Aronsson D, Kilmer N (1996) Mechanical modulation of vertebral body growth: implications for scoliosis progression. Spine 21:1162–1167

    Article  CAS  Google Scholar 

  23. Newton P, Farnsworth C, Upasani V et al (2011) Effects of intraoperative tensioning of an anterolateral spinal tether on spinal growth modulation in a porcine model. Spine 36:109–117

    Article  Google Scholar 

  24. Marks M, Newton P, Petcharaporn M et al (2012) Postoperative segmental motion of the unfused spine distal to the fusion in 100 patients with adolescent idiopathic scoliosis. Spine 37:826–832

    Article  Google Scholar 

  25. Foltz M, O’Leary R, Reader D et al (2020) Quantifying the effect of posterior spinal instrumentation on the MRI signal of adjacent intervertebral discs. Spine Deform 8:845–851

    Article  Google Scholar 

  26. Bisson DG, Lama P, Abduljabbar F et al (2018) Facet joint degeneration in adolescent idiopathic scoliosis. JOR SPINE 1:e1016. https://doi.org/10.1002/jsp2.1016

    Article  Google Scholar 

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Funding

This work was supported by research funds from the Scoliosis Research Society (Exploratory Grant #00032812 to DGH).

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Authors and Affiliations

  1. University of Missouri Women’s and Children’s Hospital, Columbia, MO, USA

    Daniel G. Hoernschemeyer & Nicole M. Tweedy

  2. Department of Orthopaedic Surgery, University of Missouri, 204 N Keene St. Suite #102, Columbia, MO, 65201, USA

    Daniel G. Hoernschemeyer, Melanie E. Boeyer, Nicole M. Tweedy & John R. Worley

  3. Missouri Orthopaedic Institute, Columbia, MO, USA

    Daniel G. Hoernschemeyer & Melanie E. Boeyer

  4. Department of Radiology, University of Missouri, Columbia, MO, USA

    Julia R. Crim

Authors
  1. Daniel G. Hoernschemeyer
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  2. Melanie E. Boeyer
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  3. Nicole M. Tweedy
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  4. John R. Worley
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  5. Julia R. Crim
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Contributions

Hoernschemeyer: conceptualization, investigation, funding acquisition, methodology, project administration, resources, supervision, writing–original draft, and writing–review and editing; Boeyer: data curation, formal analysis, investigation, methodology, validation, visualization, writing–original draft, and writing–review and editing; Tweedy: data curation, investigation, methodology, writing–review and editing; Worley: conceptualization, data curation, funding acquisition, methodology, writing–review and editing; and Crim: investigation, formal analysis, investigation, methodology, validation, visualization, writing–original draft, and writing–review and editing.

Corresponding author

Correspondence to Daniel G. Hoernschemeyer.

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Conflict of interest

Hoernschemeyer: (1) Biomarin–paid presenter or speaker, research funds, (2) Orthopaediatrics–IP royalties, paid consultant, stock or stock options, and (3) Zimmer Biomet–paid presenter or speakerer, research funds; Boeyer: Zimmer Biomet–research funds; Tweedy, Worley, and Crim have no relevant financial or non-financial interests to disclose.

Consent to participate

Written informed assent and consent was obtained from all participants enrolled in this study as outlined by the University of Missouri’s Institutional Review Board.

Consent for publication

All participants consented to the submission of these data to a peer-reviewed journal.

Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

Ethical approval

The procedures outlined were approved by the University of Missouri’s Institutional Review Board (Project Number: 2012351).

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Cite this article

Hoernschemeyer, D.G., Boeyer, M.E., Tweedy, N.M. et al. A preliminary assessment of intervertebral disc health and pathoanatomy changes observed two years following anterior vertebral body tethering. Eur Spine J 30, 3442–3449 (2021). https://doi.org/10.1007/s00586-021-06972-4

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  • DOI: https://doi.org/10.1007/s00586-021-06972-4

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