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Spontaneous Lumbar Curve Correction Following Vertebral Body Tethering of Main Thoracic Curves
The Journal of Bone & Joint Surgery ( IF 5.3 ) Pub Date : 2022-09-21 , DOI: 10.2106/jbjs.21.01500
Anthony A Catanzano 1 , Peter O Newton 1 , Tracey P Bastrom 1 , Carrie E Bartley 1 , Stefan Parent 2, 3 , Firoz Miyanji 4 , Daniel G Hoernschemeyer 5 , Ahmet Alanay 6 , Laurel Blakemore 7 , Kevin Neal 8 , Baron Lonner 9 , Lawrence Haber 10 , Suken A Shah 11 , Burt Yaszay 12 ,
Affiliation  

Background: 

Growth modulation through anterior vertebral body tethering (AVBT) has emerged as a fusionless option for the treatment of progressive scoliosis. When tethering the main thoracic curve, the compensatory thoracolumbar/lumbar curve must correct indirectly as a result. The present study evaluated the response of these lumbar curves following AVBT of the main thoracic curves.

Methods: 

Patients who underwent thoracic AVBT and who had a minimum follow-up of 2 years were included. Magnitudes of the thoracic and lumbar curves were recorded preoperatively and at the first-erect and 2-year postoperative visits. Lumbar curves were further stratified according to their lumbar modifier (A, B, or C). Analysis of variance (ANOVA) and repeated-measures ANOVA were performed to compare correction rates, and the Pearson coefficient was utilized to determine the correlation between the tethered thoracic curve and uninstrumented lumbar curve magnitudes.

Results: 

A total of 218 patients were included. Thoracic curve correction was 40% at the first-erect visit and 43% at 2 years (p = 0.012). Lumbar correction was 30%, 26%, and 18% at the first-erect visit (p < 0.001 for all compared with preoperatively) and minimally changed at 31%, 26%, and 24% at 2 years for lumbar modifiers A, B, and C, respectively. A total of 118 patients (54%) showed thoracic curve improvement between the first-erect and 2-year visits. In a subgroup analysis, these patients had a correction in lumbar curve magnitude from preoperatively to the first-erect visit of 30%, 22%, and 16% for lumbar modifiers A, B, C, respectively, that increased to 42%, 34%, and 31% at 2 years, with strong correlation to thoracic correction at 2-year follow-up (r = 0.557, p < 0.001).

Conclusions: 

Although there was immediate lumbar correction following AVBT of a main thoracic curve, further improvement following initial correction was only observed among patients with growth modulation of the thoracic curve. Considering all patients, the uninstrumented lumbar curve corrected 30% at 2 years and the instrumented thoracic curve corrected 40%. As indications for AVBT are refined, these data will provide insight into the response of the uninstrumented lumbar curve.

Level of Evidence: 

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.



中文翻译:

主要胸椎曲线椎体栓系后的自发腰椎曲线矫正

背景: 

通过前椎体束缚(AVBT)进行生长调节已成为治疗进行性脊柱侧凸的无融合选择。当束缚主胸椎曲线时,补偿性胸腰椎/腰椎曲线必须间接校正。本研究评估了主要胸部曲线 AVBT 后这些腰部曲线的响应。

方法: 

接受胸部 AVBT 且至少随访 2 年的患者被纳入。术前、首次直立时和术后 2 年就诊时记录胸椎和腰椎曲线的幅度。腰部曲线根据其腰部调节器(A、B 或 C)进一步分层。进行方差分析(ANOVA)和重复测量方差分析来比较校正率,并利用皮尔逊系数来确定系留的胸椎曲线和未测量的腰椎曲线幅度之间的相关性。

结果: 

总共包括 218 名患者。首次直立就诊时胸廓曲线矫正率为 40%,2 年时为 43% (p = 0.012)。腰椎矫正器 A、B 的首次直立就诊时的腰椎矫正度分别为 30%、26% 和 18%(与术前相比,所有值均 < 0.001),2 年时的变化最小,分别为 31%、26% 和 24% 、 和 C 分别。共有 118 名患者 (54%) 在首次直立就诊和 2 年就诊期间表现出胸廓曲线改善。在亚组分析中,腰椎调节器 A、B、C 从术前到首次直立就诊时,这些患者的腰椎曲线幅度分别校正了 30%、22% 和 16%,而腰椎矫正器 A、B、C 分别增加至 42%、34 %,2 年时为 31%,与 2 年随访时的胸部矫正有很强的相关性(r = 0.557,p < 0.001)。

结论: 

尽管在主胸椎曲线的 AVBT 后立即进行了腰椎矫正,但仅在胸椎曲线生长调节的患者中观察到初始矫正后的进一步改善。考虑到所有患者,未使用仪器的腰椎曲线在 2 年时矫正了 30%,使用仪器的胸部曲线矫正了 40%。随着 AVBT 适应症的完善,这些数据将提供对未检测腰椎曲线反应的深入了解。

证据级别: 

治疗三级。有关证据级别的完整描述,请参阅作者须知。

更新日期:2022-09-21
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