Prediction of post-operative adding-on or compensatory lumbar curve correction after anterior vertebral body tethering.
Spine Deform
; 11(1): 27-33, 2023 01.
Article
em En
| MEDLINE
| ID: mdl-35986884
ABSTRACT
PURPOSE:
Anterior Vertebral Body Tethering (AVBT), a fusionless surgical technique based on growth modulation, aims to correct pediatric scoliosis over time. However, medium-term curvature changes of the non-instrumented distal lumbar curve remains difficult to predict. The objective was to biomechanically analyze the level below the LIV to evaluate whether adding-on or compensatory lumbar curve after AVBT can be predicted by intervertebral disc (ID) wedging and force asymmetry.METHODS:
33 retrospective scoliotic cases instrumented with AVBT were used to computationally simulate their surgery and 2-year post-operative growth modulation using a finite element model. The cohort was divided into two subgroups according to the lumbar curvature evolution over 2 years (1) correction > 10° (C); (2) maintaining ± 10° (M). The lumbar Cobb angle and residual ID wedging angle under LIV were measured. Simulated pressures and moments at the superior endplate of LIV + 1 were post-processed. These parameters were correlated at 2 years postoperatively.FINDINGS:
On average, the LIV + 1 simulated moment was 538 Nmm for subgroup C, 155 Nmm for subgroup M with lumbar Cobb angle > 20° and 34 Nmm for angle < 20° whereas the ID angle was 1° for C and 0° for M.INTERPRETATION:
On average, a positive moment on the LIV + 1 superior growth plate led to correction of the lumbar curvature, whereas a null moment kept it stable, and a parallel immediate postoperative ID under LIV contributed to its correction or preservation. Nevertheless, the significant interindividual variability suggested that other parameters are involved in the distal non-instrumented curvature evolution. LEVEL OF EVIDENCE IV.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Escoliose
/
Fusão Vertebral
Tipo de estudo:
Prognostic_studies
/
Risk_factors_studies
Limite:
Child
/
Humans
Idioma:
En
Revista:
Spine Deform
Ano de publicação:
2023
Tipo de documento:
Article
País de afiliação:
Canadá