Flexible posterior vertebral tethering for the management of Scheuermann's kyphosis: correction by using growth modulation-clinical and radiographic outcomes of the first 10 patients with at least 3 years of follow-up.

Eur Spine J

Department of Orthopaedic Surgery and Traumatology, Emsey Advanced Spine Surgery Center, Surgical Spine Center of Excellence Certified By EUROSPINE, Emsey Hospital, Çamlık Mahallesi, Selçuklu Caddesi; No:22, Pendik, 34912, Istanbul, Turkey.

Published: July 2024

AI Article Synopsis

  • The study aimed to evaluate the outcomes of flexible posterior vertebral tethering (PVT) over a minimum of three years in 10 skeletally immature patients with Scheuermann’s kyphosis (SK), questioning its effectiveness as an alternative to spinal fusion.
  • Ten patients aged 11 to 15 were monitored for an average of 47.6 months, with PVT showing significant improvements in thoracic kyphosis and overall spinal alignment while maintaining mobility at the tethered vertebrae.
  • The findings suggest that flexible PVT can gradually correct kyphosis in growing patients, providing successful clinical results and positioning it as a viable option over traditional fusion methods in treating SK.

Article Abstract

Purpose: The present prospective cohort study was intended to present the minimum 3 years' results of flexible posterior vertebral tethering (PVT) applied to 10 skeletally immature patients with SK to question, if it could be an alternative to fusion.

Methods: Ten skeletally immature patients with radiographically confirmed SK, who had flexible (minimum 35%) kyphotic curves (T2-T12), were included. A decision to proceed with PVT was based on curve progression within the brace, and/or persistent pain, and/or unacceptable cosmetic concerns of the patient/caregivers, and/or non-compliance within the brace.

Results: Patients had an average age of 13.1 (range 11-15) and an average follow-up duration of 47.6 months (range 36-60). Posterior vertebral tethering (PVT) was undertaken to all patients by utilizing Wiltse approach and placing monoaxial pedicle screws intermittently. At the final follow-up: mean pre-operative thoracic kyphosis and lumbar lordosis improved from 73.6°-45.7° to 34.7°-32.1°. Mean sagittal vertical axis, vertebral wedge angle and total SRS-22 scores improved significantly. A fulcrum lateral X-ray obtained at the latest follow-up, showed that the tethered levels remained mobile.

Conclusion: This study, for the first time in the literature, concluded, that as a result of growth modulation applied to skeletally immature patients with SK, flexible PVT was detected to yield gradual correction of the thoracic kyphosis by reverting the pathological vertebral wedging process, while keeping the mobility of the tethered segments in addition to successful clinical-functional results. The successful results of the present study answered the role of the PVT as a viable alternative to fusion in skeletally immature patients with SK.

Level Of Evidence: IV.

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00586-024-08297-4DOI Listing

Publication Analysis

Top Keywords

skeletally immature
16
immature patients
16
posterior vertebral
12
vertebral tethering
12
flexible posterior
8
tethering pvt
8
applied skeletally
8
thoracic kyphosis
8
patients
7
vertebral
5

Similar Publications

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!