Anterior Scoliosis Correction with Intervertebral De-Tethering Releases for the Treatment of Patients 5 to 10 Years of Age with Early Onset Scoliosis
Main Article Content
Abstract
Anterior Scoliosis Correction (ASC) with anterior longitudinal ligament and annular disc complex (intervertebral) de-tethering releases is the authors’ multi-year advancement of their original mini-open vertebral body tethering technique to include a dual screw-line construct and multi-level intervertebral de-tethering releases. The study included patients diagnosed with early onset scoliosis, aged 5-10 years of age, Sanders stage 2 or less, Risser sign of 0, open triradiate cartilages, and a minimum of 2 years of follow-up. Within a database encompassing 840 patients treated by ASC, 15 patients (17 curves) met the inclusion criteria. The average duration of follow-up for this cohort was 48.3 months (range 25 to 86 months). The mean age at the time of surgery was 8 years (range 5.7 to 10.1 years). Preoperative scoliosis curves averaged 81° (range 58° to 100°). At the most recent follow-up, the instrumented curves improved to an average of 22° (range -15° to 68°) and mean correction of 75%. Preoperative 3-D kyphosis, calculated as an average of -6° (range -23° to +20°), was improved to an average of + 28° (range ‑1° to +59°) at latest follow-up. As may be anticipated with early onset scoliosis, 11 of the 15 patients underwent a secondary surgical procedure an average of 43 months following the index procedure. Of these 11, lengthening was necessary for overcorrection in 3 patients (20%), revision or subsequent stage ASC was done for additional correction adjustment in 6 patients (40%), and spinal fusion was performed in 2 patients (13%). In conclusion, a cohort of 15 patients aged 5-10 years with early onset scoliosis treated by ASC with intervertebral de-tethering releases (initial average curve of 81°) demonstrated a substantial mean correction of 75% in the instrumented curve. Although 2/15 patients (13%) subsequently underwent posterior spinal fusion, these early outcomes suggest a potential alternative to traditional posterior growing rod system approaches and posterior spinal fusion for these young patients.
Keywords:
tethering, vertebral body tethering, anterior scoliosis correction, growth friendly spine surgery, de-tethering
Article Details
How to Cite
ANTONACCI, M. Darryl et al.
Anterior Scoliosis Correction with Intervertebral De-Tethering Releases for the Treatment of Patients 5 to 10 Years of Age with Early Onset Scoliosis.
Medical Research Archives, [S.l.], v. 12, n. 12, dec. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/5982>. Date accessed: 06 jan. 2025.
doi: https://doi.org/10.18103/mra.v12i12.5982.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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3. Fernandes P, Weinstein SL. Natural history of early onset scoliosis. J Bone Joint Surg Am. 2007;89(Suppl 1):21-33. DOI: 10.2106/JBJS.F.00754
4. Winter RB, Moe JH. The results of spinal arthrodesis for congenital spinal deformity in patients younger than five years old. J Bone Joint Surg Am. 1982;64(3):419-432.
5. Campbell Jr RM, Hell-Vocke AK. Growth of the thoracic spine in congenital scoliosis after expansion thoracoplasty. J Bone Joint Surg Am 2003;85(3): 409-420. DOI: 10.2106/00004623-200303000-00002
6. Karol LA, Johnston C, Mladenov K, Schochet P, Walters P, Browne RH. Pulmonary function following early thoracic fusion in non-neuromuscular scoliosis. J Bone Joint Surg Am. 2008:90(6):1272-1281. DOI: 10.2106/JBJS.G.00184
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DOI: 10.1097/JCMA.0000000000000020
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13. Motoyama EK, Yang CI, Deeney VF. Thoracic malformation with early-onset scoliosis: effect of serial VEPTR expansion thoracoplasty on lung growth and function in children. Paediatr Respir Rev. 2009;10(1):12-17.
DOI: 10.1016/j.prrv.2008.10.004
14. Skaggs DL, Akbarnia BA, Flynn JM, Myung KS, Sponseller PD, Vitale MG, Chest Wall and Spine Deformity Study Group, Growing Spine Study Group. A classification of growth friendly spine implants. J Pediatr Orthop. 2014;34(3):260-274. DOI: 10.1097/BPO.0000000000000073
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16. Agarwal A, Kelkar A, Agarwal AG, Jayaswal D, Jayaswal A, Shendge V. Device-related complications associated with Magec Rod usage for distraction-based correction of scoliosis. Spine Surg Relat Res. 2019;4(2):148-151.
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17. Thakar C, Kieser DC, Mardare M, Haleem S, Fairbank J, Nnadi C. Systematic review of the complications associated with magnetically controlled growing rods for the treatment of early onset scoliosis. Eur Spine J. 2018;27(9):2062-2071. DOI:10.1007/s00586-018-5590-4
18. Mackey C, Hanstein R, Lo Y, Vaughan M, St. Hilaire T, Luhmann SJ, Vitale MG, Glotzbecker MP, Samdani A, Parent S, Gomez JA, Pediatric Spine Study Group. Magnetically controlled growing rods (MCGR) versus single posterior spinal fusion (PSF) versus vertebral body tether (VBT) in older early onset scoliosis (EOS) patients: how do early outcomes compare? Spine (Phila Pa 1976), 2022;47(4):295-302. DOI: 10.1097/BRS.0000000000004245
19. Stokes IA, Spence H, Aronsson DD, Kilmer N. Mechanical modulation of vertebral body growth. Implications for scoliosis progression. Spine (Phila Pa 1976), 1996;21(10):1162-1167.
DOI: 10.1097/00007632-199605150-00007
20. Mehlman CT, Araghi A, Roy DR. Hyphenated history: the Hueter-Volkmann law. Am J Orthop (Belle Mead NJ). 1997;26(11):798-800.
21. Baroncini A, Courvoisier A. The different applications of vertebral body tethering - narrative review and clinical experience. J Orthop. 2023; 37:86-92. DOI: 10.1016/j.jor.2023.02.012
22. Cuddihy L, Swiercz M, Antonacci C, Betz R, Antonacci M (2021) Predicting the major coronal curve angle on initial standing x-rays based on intraoperative correction during anterior scoliosis correction and vertebral body tethering: comparison of single vs. double cord/screw constructs. 28th International Meeting on Advanced Spine Techniques (virtual), April 23-25, 2021.
23. Cuddihy LA, Antonacci MD, Vig KS, Hussain AK, Levin D, Betz RR. Progressive double major scoliotic curve with concurrent lumbosacral spondylolisthesis in a skeletally immature patient with Marfan syndrome treated with anterior scoliosis correction. Spine Deform. 2020;8(1):139-146. DOI: 10.1007/s43390-020-00031-6
24. Cuddihy LA, Antonacci MD, Hussain AK, Vig KS, Mulcahey MJ, Betz RR. Progressive neuromuscular scoliosis secondary to spinal cord injury in a young patient treated with nonfusion anterior scoliosis correction. Top Spinal Cord Inj Rehabil. 2019;25(2):150-156. DOI: 10.1310/sci2502-150
25. Betz RR, Antonacci MD, Cuddihy LA. Alternatives to spinal fusion surgery in pediatric deformity. Curr Orthop Pract. 2018:29(5):430-435
26. Antonacci MD, Yung A, Kozicz A, Cerrone J, Antonacci CL, Verma Y, Sweeney M, Cuddihy LA, Betz RR. Double screw-line technique of anterior scoliosis correction with thoracic disc releases for thoracic curves > 65 degrees: surgical techniques and outcomes. Med Res Arch J. 2023;11(7.1). DOI: 10.18103/mra.v11i7.1.4095
27. Antonacci CL, Antonacci MD, Bassett WP, Cerrone JL, Haas AR, Haoson DS, Cuddihy LA, Betz RR. Treatment of patients with scoliosis using a unique anterior scoliosis correction technique. Med Res Arch J. 2021;9(7).
DOI: 10.18103/mra.v4i7.2463
28. Trobisch P, Mahoney JM, Eichenlaub EK, Antonacci CL, Cuddiny L, Amin DB, Razo-Castaneda D, Orbach MR, McGuckin JP, Bucklen BS, Antonacci MD, Betz RR. An investigation of range of motion preservation in fusionless anterior double screw and cord constructs for scoliosis correction. Eur Spine J. 2023;32(4):1173-1186. DOI: 10.1007/s00586-023-07608-5
29. Parvaresh KC, Osborn EJ, Reighard FG, Doan J, Bastrom TP, Newton PO. Predicting 3D thoracic kyphosis using traditional 2D radiographic measurements in adolescent idiopathic scoliosis. Spine Deform. 2017;5(3):159-165. DOI: 10.1016/j.jspd.2016.12.002
30. Newton PO, Bartley CE, Bastrom TP, Kluck DG, Saito W, Yaszay B. 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 Joint Surg Am. 2020;102(9):769-777. DOI: 10.2106/JBJS.19.01176
31. Ellinger F, Tropp H, Gerdhem P, Hallgren HB, Ivars K. Magnetically controlled growing rod treatment for early-onset scoliosis: analysis of 52 consecutive cases demonstrates improvement of coronal deformity. J Spine Surg. 2023;9(3):259-268. DOI: 10.21037;jss-22-70
32. Urbański W, Tucker S, Ember T, Nadarajah R. Single vs dual rod constructs in early onset scoliosis treated with magnetically controlled growing rods. Adv Clin Exp Med. 2020;29(10):1169-1174. DOI: 10.17218/acem/126289
33. Acaroglu E, Yazici M, Alanay A, Surat A. Three-dimensional evolution of scoliotic curve during instrumentation without fusion in young children. J Pediatr Orthop. 2002;22(4):492-496
34. Klemme WR, Denis F, Winter RB, Lonstein JW, Koop SE. Spinal instrumentation without fusion for progressive scoliosis in young children. J Pediatr Orthop. 1997;17:734-742
35. Moe JH, Kharrat K, Winter RB, Cummine JL. Harrington instrumentation without fusion plus external orthotic support for the treatment of difficult curvature problems in young children. Clin Orthop Relat Res. 1984;185:35-45
36. Harrington PR. Treatment of scoliosis. Correction and internal fixation by spine instrumentation. J Bone Joint Surg Am. 1962;44: 591-610
2. Jones RS, Kennedy JD, Hasham F, Owen R, Taylor JF. Mechanical inefficiency of the thoracic cage in scoliosis. Thorax. 1981;36 (6):456-461. DOI:10.1136/thx.36.6.456
3. Fernandes P, Weinstein SL. Natural history of early onset scoliosis. J Bone Joint Surg Am. 2007;89(Suppl 1):21-33. DOI: 10.2106/JBJS.F.00754
4. Winter RB, Moe JH. The results of spinal arthrodesis for congenital spinal deformity in patients younger than five years old. J Bone Joint Surg Am. 1982;64(3):419-432.
5. Campbell Jr RM, Hell-Vocke AK. Growth of the thoracic spine in congenital scoliosis after expansion thoracoplasty. J Bone Joint Surg Am 2003;85(3): 409-420. DOI: 10.2106/00004623-200303000-00002
6. Karol LA, Johnston C, Mladenov K, Schochet P, Walters P, Browne RH. Pulmonary function following early thoracic fusion in non-neuromuscular scoliosis. J Bone Joint Surg Am. 2008:90(6):1272-1281. DOI: 10.2106/JBJS.G.00184
7. Vitale MG, Matsumoto H, Bye MR, Gomez JA, Booker WA, Hyman JE, Roye Jr DP. A retrospective cohort study of pulmonary function, radiographic measures, and quality of life in children with congenital scoliosis: an evaluation of patient outcomes after early spinal fusion. Spine (Phila Pa 1976). 2008; 33(11):1242-1249.
DOI: 10.1097/BRS.0b013e3181714536
8. Danielsson AJ, Nachemson AL. Back pain and function 22 years after brace treatment for adolescent idiopathic scoliosis: a case-control study—part I. Spine (Phila Pa 1976). 2003;28(18):2078-2085. DOI: 10.1097/01.BRS.0000084268.77805.6F
9. Green DW, Lawhorne 3rd TW, Widmann RF, Kepler CK, Ahern C, Mintz DN, Rawlins BA, Burke SW, Boachie-Adjei O. Long-term magnetic resonance imaging follow-up demonstrates minimal transitional level lumbar disc degeneration after posterior spine fusion for adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2011;36(23):1948-1954. DOI: 10.1097/BRS.0b013e3181ff1ea9
10. Hsu PC, Feng CK, Huang SH. Chiu JW, Chou CL, Yang TF. Health-related quality of life in children and adolescent with different types of scoliosis: a cross-sectional study. J Chin Med Assoc. 2019;82(2):161-166.
DOI: 10.1097/JCMA.0000000000000020
11. Kepler CK, Meredith DS, Green DW, Widmann RF. Long-term outcomes after posterior spine fusion for adolescent idiopathic scoliosis. Curr Opin Pediatr. 2012;24(1):68-75. DOI: 10.1097/MOP.0b013e32834ec982
12. Lykissas MG, Jain VV, Nathan ST, Pawar V, Eismann EA, Sturm PF, Crawford AH. Mid- to long-term outcomes in adolescent idiopathic scoliosis after instrumented posterior spinal fusion: a meta-analysis. Spine (Phila Pa 1976). 2013;38(2):E113-119. DOI 10.1097/BRS.0b013e31827ae3d0
13. Motoyama EK, Yang CI, Deeney VF. Thoracic malformation with early-onset scoliosis: effect of serial VEPTR expansion thoracoplasty on lung growth and function in children. Paediatr Respir Rev. 2009;10(1):12-17.
DOI: 10.1016/j.prrv.2008.10.004
14. Skaggs DL, Akbarnia BA, Flynn JM, Myung KS, Sponseller PD, Vitale MG, Chest Wall and Spine Deformity Study Group, Growing Spine Study Group. A classification of growth friendly spine implants. J Pediatr Orthop. 2014;34(3):260-274. DOI: 10.1097/BPO.0000000000000073
15. Bess S, Akbarnia BA, Thompson GH, Sponseller PD, Shah SA, El Sebaie H, Boachie-Adjei O, Karlin LI, Canale S, Poe-Kochert C, Skaggs DL. Complications of growing-rod treatment for early-onset scoliosis: analysis of one hundred and forty patients. J Bone Joint Surg Am. 2010;92(15): 2533-2543. DOI 10.2106/jbjs.i.01471
16. Agarwal A, Kelkar A, Agarwal AG, Jayaswal D, Jayaswal A, Shendge V. Device-related complications associated with Magec Rod usage for distraction-based correction of scoliosis. Spine Surg Relat Res. 2019;4(2):148-151.
DOI: 10.22603/ssrr.2019-0041
17. Thakar C, Kieser DC, Mardare M, Haleem S, Fairbank J, Nnadi C. Systematic review of the complications associated with magnetically controlled growing rods for the treatment of early onset scoliosis. Eur Spine J. 2018;27(9):2062-2071. DOI:10.1007/s00586-018-5590-4
18. Mackey C, Hanstein R, Lo Y, Vaughan M, St. Hilaire T, Luhmann SJ, Vitale MG, Glotzbecker MP, Samdani A, Parent S, Gomez JA, Pediatric Spine Study Group. Magnetically controlled growing rods (MCGR) versus single posterior spinal fusion (PSF) versus vertebral body tether (VBT) in older early onset scoliosis (EOS) patients: how do early outcomes compare? Spine (Phila Pa 1976), 2022;47(4):295-302. DOI: 10.1097/BRS.0000000000004245
19. Stokes IA, Spence H, Aronsson DD, Kilmer N. Mechanical modulation of vertebral body growth. Implications for scoliosis progression. Spine (Phila Pa 1976), 1996;21(10):1162-1167.
DOI: 10.1097/00007632-199605150-00007
20. Mehlman CT, Araghi A, Roy DR. Hyphenated history: the Hueter-Volkmann law. Am J Orthop (Belle Mead NJ). 1997;26(11):798-800.
21. Baroncini A, Courvoisier A. The different applications of vertebral body tethering - narrative review and clinical experience. J Orthop. 2023; 37:86-92. DOI: 10.1016/j.jor.2023.02.012
22. Cuddihy L, Swiercz M, Antonacci C, Betz R, Antonacci M (2021) Predicting the major coronal curve angle on initial standing x-rays based on intraoperative correction during anterior scoliosis correction and vertebral body tethering: comparison of single vs. double cord/screw constructs. 28th International Meeting on Advanced Spine Techniques (virtual), April 23-25, 2021.
23. Cuddihy LA, Antonacci MD, Vig KS, Hussain AK, Levin D, Betz RR. Progressive double major scoliotic curve with concurrent lumbosacral spondylolisthesis in a skeletally immature patient with Marfan syndrome treated with anterior scoliosis correction. Spine Deform. 2020;8(1):139-146. DOI: 10.1007/s43390-020-00031-6
24. Cuddihy LA, Antonacci MD, Hussain AK, Vig KS, Mulcahey MJ, Betz RR. Progressive neuromuscular scoliosis secondary to spinal cord injury in a young patient treated with nonfusion anterior scoliosis correction. Top Spinal Cord Inj Rehabil. 2019;25(2):150-156. DOI: 10.1310/sci2502-150
25. Betz RR, Antonacci MD, Cuddihy LA. Alternatives to spinal fusion surgery in pediatric deformity. Curr Orthop Pract. 2018:29(5):430-435
26. Antonacci MD, Yung A, Kozicz A, Cerrone J, Antonacci CL, Verma Y, Sweeney M, Cuddihy LA, Betz RR. Double screw-line technique of anterior scoliosis correction with thoracic disc releases for thoracic curves > 65 degrees: surgical techniques and outcomes. Med Res Arch J. 2023;11(7.1). DOI: 10.18103/mra.v11i7.1.4095
27. Antonacci CL, Antonacci MD, Bassett WP, Cerrone JL, Haas AR, Haoson DS, Cuddihy LA, Betz RR. Treatment of patients with scoliosis using a unique anterior scoliosis correction technique. Med Res Arch J. 2021;9(7).
DOI: 10.18103/mra.v4i7.2463
28. Trobisch P, Mahoney JM, Eichenlaub EK, Antonacci CL, Cuddiny L, Amin DB, Razo-Castaneda D, Orbach MR, McGuckin JP, Bucklen BS, Antonacci MD, Betz RR. An investigation of range of motion preservation in fusionless anterior double screw and cord constructs for scoliosis correction. Eur Spine J. 2023;32(4):1173-1186. DOI: 10.1007/s00586-023-07608-5
29. Parvaresh KC, Osborn EJ, Reighard FG, Doan J, Bastrom TP, Newton PO. Predicting 3D thoracic kyphosis using traditional 2D radiographic measurements in adolescent idiopathic scoliosis. Spine Deform. 2017;5(3):159-165. DOI: 10.1016/j.jspd.2016.12.002
30. Newton PO, Bartley CE, Bastrom TP, Kluck DG, Saito W, Yaszay B. 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 Joint Surg Am. 2020;102(9):769-777. DOI: 10.2106/JBJS.19.01176
31. Ellinger F, Tropp H, Gerdhem P, Hallgren HB, Ivars K. Magnetically controlled growing rod treatment for early-onset scoliosis: analysis of 52 consecutive cases demonstrates improvement of coronal deformity. J Spine Surg. 2023;9(3):259-268. DOI: 10.21037;jss-22-70
32. Urbański W, Tucker S, Ember T, Nadarajah R. Single vs dual rod constructs in early onset scoliosis treated with magnetically controlled growing rods. Adv Clin Exp Med. 2020;29(10):1169-1174. DOI: 10.17218/acem/126289
33. Acaroglu E, Yazici M, Alanay A, Surat A. Three-dimensional evolution of scoliotic curve during instrumentation without fusion in young children. J Pediatr Orthop. 2002;22(4):492-496
34. Klemme WR, Denis F, Winter RB, Lonstein JW, Koop SE. Spinal instrumentation without fusion for progressive scoliosis in young children. J Pediatr Orthop. 1997;17:734-742
35. Moe JH, Kharrat K, Winter RB, Cummine JL. Harrington instrumentation without fusion plus external orthotic support for the treatment of difficult curvature problems in young children. Clin Orthop Relat Res. 1984;185:35-45
36. Harrington PR. Treatment of scoliosis. Correction and internal fixation by spine instrumentation. J Bone Joint Surg Am. 1962;44: 591-610