Yizhar Floman1, Ron El-Hawary2, Baron S Lonner3, Randal R Betz4, Uri Arnin5. 1. Israel Spine Center, Assuta Hospital, 20 Habarzel, Tel Aviv, Israel. yizharfloman@gmail.com. 2. Division of Orthopedic Surgery, IWK Health Center, University Ave, PO Box 9700, Halifax, NS, 5850 B3K-6R8, Canada. 3. Mount Sinai Hospital, 1468 Madison Ave, New York, NY, 10029, USA. 4. Institute for Spine and Scoliosis, 3100 Princeton Pike, Lawrenceville, NJ, USA. 5. ApiFix LTD, Kochav Yokneam Bldg, 1 Hacarmel street, Yokneam Ilit, Israel.
Abstract
STUDY DESIGN: Retrospective, comparative, multicenter. INTRODUCTION: Growth modulating spinal implants are used in the management of scoliosis such as anterior vertebral body tethering. A motion-sparing posterior device (PDDC) was recently approved for the treatment of moderate AIS. The purpose of this study was to determine if the PDDC can modulate growth in skeletally immature patients with AIS. METHODS: From a database of patients treated with the PDDC over 4 years, we identified those who had a minimum of 2 years follow-up. Pre-operative and post-operative Cobb angles and coronal plane wedging of the apical vertebra were evaluated on standing full length radiographs. Independent sample t test and one-way ANOVA with post-hoc Tukey HSD analysis was used to compare three groups in varying skeletal maturity: Risser 0-1, Risser 2-3, and Risser 4-5. RESULTS: 45 patients (14.2-years old, 11-17) were evaluated with a mean pre-op curve of 46° (35°-66°). The average preoperative major curve magnitude, of either Lenke 1 or 5 curve type, was similar among the three groups 47.6°, 46° and 41.5°. Deformity correction was similar in the three groups, with reduction to 26.4°, 20.4° and 26.2°, respectively, at final follow-up [p < 0.05]. Pre-op wedging 7.4° (3.8°-15°) was reduced after surgery to 5.7° (1°-15°) (p < 0.05). Of those patients, Risser 0-1 (n = 16) had preoperative wedging of 9.5° (6°-14.5°) that was reduced to 5.4° (1°-8°) postoperatively (p < 0.05); Risser 2-3 (n = 15) had pre-op 7.7° (4°-15°) vs. post-op 7.0° (3°-15°); Risser 4-5 (n = 14) had pre-op 4.8° (3.8°-6.5°) vs. post-op 4.7° (3.7°-6.5°). Delta Wedging in Risser 0-1 stage was significantly different than for Risser 2-3 and for Risser 4-5. CONCLUSION: The posterior dynamic deformity correction device was able to modulate vertebral body wedging in skeletally immature patients with AIS. This was most evident in patients who were Risser 0-1. In contrast, curve correction was similar among the three groups. This finding lends support to the device's ability to modulate growth.
STUDY DESIGN: Retrospective, comparative, multicenter. INTRODUCTION: Growth modulating spinal implants are used in the management of scoliosis such as anterior vertebral body tethering. A motion-sparing posterior device (PDDC) was recently approved for the treatment of moderate AIS. The purpose of this study was to determine if the PDDC can modulate growth in skeletally immature patients with AIS. METHODS: From a database of patients treated with the PDDC over 4 years, we identified those who had a minimum of 2 years follow-up. Pre-operative and post-operative Cobb angles and coronal plane wedging of the apical vertebra were evaluated on standing full length radiographs. Independent sample t test and one-way ANOVA with post-hoc Tukey HSD analysis was used to compare three groups in varying skeletal maturity: Risser 0-1, Risser 2-3, and Risser 4-5. RESULTS: 45 patients (14.2-years old, 11-17) were evaluated with a mean pre-op curve of 46° (35°-66°). The average preoperative major curve magnitude, of either Lenke 1 or 5 curve type, was similar among the three groups 47.6°, 46° and 41.5°. Deformity correction was similar in the three groups, with reduction to 26.4°, 20.4° and 26.2°, respectively, at final follow-up [p < 0.05]. Pre-op wedging 7.4° (3.8°-15°) was reduced after surgery to 5.7° (1°-15°) (p < 0.05). Of those patients, Risser 0-1 (n = 16) had preoperative wedging of 9.5° (6°-14.5°) that was reduced to 5.4° (1°-8°) postoperatively (p < 0.05); Risser 2-3 (n = 15) had pre-op 7.7° (4°-15°) vs. post-op 7.0° (3°-15°); Risser 4-5 (n = 14) had pre-op 4.8° (3.8°-6.5°) vs. post-op 4.7° (3.7°-6.5°). Delta Wedging in Risser 0-1 stage was significantly different than for Risser 2-3 and for Risser 4-5. CONCLUSION: The posterior dynamic deformity correction device was able to modulate vertebral body wedging in skeletally immature patients with AIS. This was most evident in patients who were Risser 0-1. In contrast, curve correction was similar among the three groups. This finding lends support to the device's ability to modulate growth.
Authors: Davide Bizzoca; Andrea Piazzolla; Lorenzo Moretti; Giovanni Vicenti; Biagio Moretti; Giuseppe Solarino Journal: World J Orthop Date: 2022-05-18