![]() To control this growth, surgeons have attempted asymmetrical hemiepiphyseodesis to the spine, but this has remained unpredictable. According to the Hueter-Volkman principle, distraction of the growth plate promotes and compression inhibits growth. Both endochondral ossification (length) and appositional ossification (volume) lead to growth of the spine. It is known that every human vertebral body between C3 and L5 has a growth plate (apophysis) on its upper and lower endplates. ![]() These disadvantages have led surgeons to investigate other methods to correct adolescent idiopathic scoliosis without spinal fusion. On the other hand, it leads to an irreversible stage of permanent spinal fusion and straining of the remaining mobile segment due to reduced spinal mobility. Spinal fusion provides sustainable long-term outcomes but is associated with reduced spinal mobility and hence reduced functional outcomes as compared with the normal population. Additional length obtained from correction of spinal deformity averages about 25 mm in normal AIS. A recommended minimum length of the thoracic spine before posterior fusion is 22 cm. Normal lung development is dependent on the length of the thoracic spine and its final length is closely related to the lung volume obtained at skeletal maturity. Posterior spinal fusion with pedicle screw instrumentation has been the traditional method to address these curves. Three-dimensional correction of scoliosis and continued growth should be the aim of the treatment of spinal deformity on a growing child. Additionally, thoracic curves of over 50 degrees are associated with reduced lung volumes. A curve of 45 degrees or higher is typically regarded as an indication to surgical treatment as these curves typically continue to progress even in skeletally mature patients. While the reported median-term results of VBT appear promising, long-term results of this technique are currently lacking.Īdolescent idiopathic scoliosis (AIS) is a three-dimensional deformity including a lateral deviation of the spine, reduced thoracic kyphosis, and rotation of the vertebral bodies. The results showed that 15% of VBT patients required reoperations for pulmonary or tether-related issues (10%) and less than 5% required conversion to spinal fusion. In a total of 23 included studies on 843 patients, the preoperative main thoracic curve corrected from 49 to 23 degrees in a minimum 2 year follow-up. Further, a systematic review of published studies was conducted to critically evaluate the results and complications of this technique. This review describes the indications and surgical technique of VBT. VBT was designed to modulate spinal growth of vertebral bodies and hence, the term ‘growth modulation’ has also been used. According to the Hueter-Volkmann principle, compression reduces and distraction increases growth on the growth plates. Vertebral body tethering (VBT) represents a new surgical technique to correct idiopathic scoliosis using an anterior approach, spinal instrumentation with vertebral body screws, and a cable compressing the convexity of the curve.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |