M Boudissa1,2, A Eid3, E Bourgeois3, J Griffet3, A Courvoisier3. 1. Orthopedic Pediatric Surgery Department, Grenoble Alpes University Hospital, BP 217, 38043, Grenoble, France. mboudissa@chu-grenoble.fr. 2. Orthopedic and Traumatology Surgery Department, Grenoble Alpes University Hospital, BP 217, 38043, Grenoble, France. mboudissa@chu-grenoble.fr. 3. Orthopedic Pediatric Surgery Department, Grenoble Alpes University Hospital, BP 217, 38043, Grenoble, France.
Abstract
QUESTIONS/PURPOSES: Adolescent idiopathic scoliosis is a 3D spine deformity that worsens during the whole growth. New methods for spinal growth modulation with flexible spinal implants have been described to avoid progression of the deformity during growth spurt. The main limitations are that no specific ancillaries and devices are available, which makes the surgery technically demanding. METHODS: We have developed a new method of spinal growth tethering using minimal invasive videothoracoscopic approach. Fixation is performed with staples and synthetic ligament on the lateral aspect of vertebral bodies on main curvature convexity. Patients with progressive thoracic idiopathic scoliosis despite the brace treatment were included. The clinical and radiological examinations were compared before and 2 years after surgery. RESULTS: Six patients with flexible thoracic curves with a mean age 11.2 ± 1.2 years and a mean Cobb angle 45° ± 10° (35-60) were operated. All were skeletally immature. At last follow-up, the Cobb angle was stable. None of the patient underwent fusion. CONCLUSIONS: The procedure allowed a stabilization of the deformity during growth spurt. Validated devices and further studies with longer term follow-up are needed to confirm the efficiency of this technique. This small cohort of patients is a source of reflection for further medical devices developments. LEVEL OF EVIDENCE: Level 4 case series comparing to not randomized studies.
QUESTIONS/PURPOSES: Adolescent idiopathic scoliosis is a 3D spine deformity that worsens during the whole growth. New methods for spinal growth modulation with flexible spinal implants have been described to avoid progression of the deformity during growth spurt. The main limitations are that no specific ancillaries and devices are available, which makes the surgery technically demanding. METHODS: We have developed a new method of spinal growth tethering using minimal invasive videothoracoscopic approach. Fixation is performed with staples and synthetic ligament on the lateral aspect of vertebral bodies on main curvature convexity. Patients with progressive thoracic idiopathic scoliosis despite the brace treatment were included. The clinical and radiological examinations were compared before and 2 years after surgery. RESULTS: Six patients with flexible thoracic curves with a mean age 11.2 ± 1.2 years and a mean Cobb angle 45° ± 10° (35-60) were operated. All were skeletally immature. At last follow-up, the Cobb angle was stable. None of the patient underwent fusion. CONCLUSIONS: The procedure allowed a stabilization of the deformity during growth spurt. Validated devices and further studies with longer term follow-up are needed to confirm the efficiency of this technique. This small cohort of patients is a source of reflection for further medical devices developments. LEVEL OF EVIDENCE: Level 4 case series comparing to not randomized studies.
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