Cyclically controlled vertebral body tethering for scoliosis: an in vivo verification in a pig model of the pressure exerted on vertebral end plates.

STUDY DESIGN: Experimental in vivo study of the pressure exerted on the spine of a pig by a new cyclic anterior vertebral body tethering (AVBT) prototype. OBJECTIVES: To evaluate the relationship between the tether tension and the pressures transmitted onto the vertebral end plates by a cyclic AVBT prototype. AVBT is a recent surgical technique for the treatment of pediatric scoliosis that compresses the convex side of the spine with a sustained tension, to modulate the growth to progressively correct the deformity over time. Previous studies demonstrated that cyclic compression has similar growth modulation capacity but with less detrimental effects on the integrity of the discs and growth plates. METHODS: A 3-month-old healthy Duroc pig was anesthetized and a lateral thoracotomy was performed. The T7-T10 segment was instrumented and compressed during 50 s with the load oscillating (0.2 Hz) from + 30 to - 30% of the following mean tensions: 29, 35, 40, 44, and 49 N. The pressure exerted on T9 superior vertebral end plate was monitored during the cyclic loading. Three repetitions of each test were performed. RESULTS: The resulting mean pressure exerted on the vertebral end plate was linearly correlated with the mean tether tension (r2 = 0.86). Each cycle translated in a hysteresis profile of the measured pressure and tension, with amplitudes varying between ± 11.5 and ± 29.9%. CONCLUSIONS: This experimental study documented the relationship between the tether tension and the pressure. This study confirmed the feasibility of cyclic AVBT principle to transfer varying pressures on the vertebral end plates, which is intended to control vertebral growth, while keeping the spine flexibility and preserving the health of soft tissues such as the intervertebral discs and the growth plate but remained to be further verified. LEVEL OF EVIDENCE: Level IV.

In vivo demonstration of magnetic guidewire steerability in a MRI system with additional gradient coils.

PURPOSE: To assess the ability to control the steering of a modified guidewire actuated by the magnetic force of a magnetic resonance imaging system with additional gradient coils for selective arterial catheterization in rabbits. METHODS: Selective catheterizations of the right renal artery, left renal artery, superior mesenteric artery, and iliac artery were performed on two rabbits. A 3D magnetic force was applied onto a magnetic bead placed at the tip of a guidewire. The ability of the guidewire to advance in the aorta without entering the side branches when the magnetic force was not applied was also evaluated. Steering of the guidewire was combined with a dedicated tracking system and its position was registered on the 3D model of a magnetic resonance angiography (MRA). RESULTS: The magnetic catheterization of the renal arteries was successful and showed reproducibility. Superior mesenteric artery and iliac artery showed that the catheterization was feasible. These two arteries were difficult to visualize on MRA, making catheterization and setting the direction of the force more difficult. There was no inadvertent catheterization of side vessels when the guidewire was advanced with magnetic steering despite the hook shape at the tip of the guidewire caused by the alignment of the bead anisotropy with the permanent magnetic field. CONCLUSIONS: This first evaluation of selective catheterization of aortic branches with a magnetic guidewire provided a successful steering in the less angled side branches and this modified guidewire was advanced in the aorta without inadvertent selective catheterization when manipulated without magnetic actuation.

A MRI-based platform for catheter navigation.

The development of minimally invasive surgical techniques using magnetism is expanding. Our research group is exploring catheter steering using the gradient field of a modified clinical Magnetic Resonance Imaging (MRI) system. This paper focuses on the upgrade of the MRI testing platform towards an integrated system allowing for in vitro and in vivo experiments. The expected steering capabilities of the platform are evaluated through experimental tests, and catheter tracking is adapted accordingly while being tested for potential medical interventions.