Abstract：
OBJECTIVE: To radiographically evaluate if vertebral body tethering (VBT) can maintain differential peri-apical vertebral growth at medium-term follow-up of 4 years.
METHODS: A prospective, international, multicenter database was queried to identify idiopathic scoliosis patients treated with thoracic VBT. Concave vs. convex vertebral body height, vertebral wedging, and disc wedging of the 3 peri-apical vertebrae were measured by two independent observers at 5 timepoints (pre-operative to 4-year follow-up).
RESULTS: 65 skeletally immature patients (60 female, mean 12.8 years old, 21 with open triradiate cartilages) met inclusion criteria. Mean pre-operative maximum scoliosis of 50 ± 8° decreased significantly post-operatively to 27 ± 9° (p < 0.001), which remained stable at 4-year follow-up 30 ± 17° (p = 0.38 vs. post-operative). Mean instrumented scoliosis was 21 ± 14° at 4-year follow-up, which was significantly different than 4-year maximum scoliosis (p < 0.001). Mean pre-operative kyphosis of 30 ± 12° did not significantly change post-operatively (p = 1.0) and remained stable at 4-year follow-up (35 ± 18°; p = 0.05). Mean individual convex vertebral height increased from 17.7 ± 1.9 mm to 19.8 ± 1.5 mm (p < 0.001), while mean individual concave height increased from 14.8 ± 1.9 mm to 17.6 ± 1.6 mm (p < 0.001). Summing the peri-apical heights, the difference in height from pre-operative to 4-year follow-up was greater on the concave (8.3 ± 4.7 mm) than on the convex side (6.2 ± 4.7 mm) (p < 0.001). Mean individual vertebral wedging decreased from 6 ± 2° at pre-operative to 4 ± 2° at 4-year follow-up (p < 0.001). Mean total vertebral and disc wedging started at 29 ± 7° pre-operatively, decreased to 16 ± 6° at post-operative (p < 0.001), then further decreased to 14 ± 8° at 4-year follow-up (p < 0.001). Patients with open triradiate cartilages at the time of surgery had a larger height change over the 4 years compared to those with closed triradiate cartilages (p < 0.001).
CONCLUSIONS: Patients with idiopathic scoliosis treated with VBT demonstrated differential vertebral growth which was maintained at minimum 4-year follow-up. This effect was more pronounced in patients whose triradiate cartilages were open at the time of surgery.
METHODS: III.
METHODS: A prospective, international, multicenter database was queried to identify idiopathic scoliosis patients treated with thoracic VBT. Concave vs. convex vertebral body height, vertebral wedging, and disc wedging of the 3 peri-apical vertebrae were measured by two independent observers at 5 timepoints (pre-operative to 4-year follow-up).
RESULTS: 65 skeletally immature patients (60 female, mean 12.8 years old, 21 with open triradiate cartilages) met inclusion criteria. Mean pre-operative maximum scoliosis of 50 ± 8° decreased significantly post-operatively to 27 ± 9° (p < 0.001), which remained stable at 4-year follow-up 30 ± 17° (p = 0.38 vs. post-operative). Mean instrumented scoliosis was 21 ± 14° at 4-year follow-up, which was significantly different than 4-year maximum scoliosis (p < 0.001). Mean pre-operative kyphosis of 30 ± 12° did not significantly change post-operatively (p = 1.0) and remained stable at 4-year follow-up (35 ± 18°; p = 0.05). Mean individual convex vertebral height increased from 17.7 ± 1.9 mm to 19.8 ± 1.5 mm (p < 0.001), while mean individual concave height increased from 14.8 ± 1.9 mm to 17.6 ± 1.6 mm (p < 0.001). Summing the peri-apical heights, the difference in height from pre-operative to 4-year follow-up was greater on the concave (8.3 ± 4.7 mm) than on the convex side (6.2 ± 4.7 mm) (p < 0.001). Mean individual vertebral wedging decreased from 6 ± 2° at pre-operative to 4 ± 2° at 4-year follow-up (p < 0.001). Mean total vertebral and disc wedging started at 29 ± 7° pre-operatively, decreased to 16 ± 6° at post-operative (p < 0.001), then further decreased to 14 ± 8° at 4-year follow-up (p < 0.001). Patients with open triradiate cartilages at the time of surgery had a larger height change over the 4 years compared to those with closed triradiate cartilages (p < 0.001).
CONCLUSIONS: Patients with idiopathic scoliosis treated with VBT demonstrated differential vertebral growth which was maintained at minimum 4-year follow-up. This effect was more pronounced in patients whose triradiate cartilages were open at the time of surgery.
METHODS: III.
摘要：
目的：在4年的中期随访中，影像学评估椎体束缚（VBT）是否可以维持不同的根尖周围椎体生长。
方法：前瞻性，国际,查询多中心数据库以确定特发性脊柱侧凸患者接受胸椎VBT治疗。凹vs.凸椎体高度，椎体楔入，由两名独立观察者在5个时间点（术前至4年随访）测量3个根尖周围椎骨的椎间盘楔入。
结果：65名骨骼未成熟患者（60名女性，平均12.8岁，21个开放的三辐射软骨）符合纳入标准。术前平均最大脊柱侧凸50±8°,术后显著下降至27±9°(p<0.001),在4年随访30±17°时保持稳定(p=0.38vs.术后)。在4年随访时，平均器械脊柱侧弯为21±14°，与4年最大脊柱侧凸有显著差异(p<0.001)。30±12°的平均术前脊柱后凸在术后没有显着变化（p=1.0），并且在4年随访时保持稳定（35±18°；p=0.05）。平均个体凸椎体高度从17.7±1.9mm增加到19.8±1.5mm(p<0.001),而平均个体凹面高度从14.8±1.9mm增加到17.6±1.6mm(p<0.001)。总结根尖周围的高度，术前到4年随访的身高差异在凹侧(8.3±4.7mm)大于凸侧(6.2±4.7mm)(p<0.001).平均椎体楔入从术前的6±2°下降到4年随访时的4±2°（p<0.001）。平均总椎体和椎间盘楔入在术前29±7°开始，术后降至16±6°（p<0.001），然后在4年随访时进一步降低至14±8°（p<0.001）。与闭合的三辐射软骨相比，手术时开放的三辐射软骨患者在4年内的身高变化更大（p<0.001）。
结论：接受VBT治疗的特发性脊柱侧凸患者表现出差异的椎体生长，并在至少4年的随访中保持。在手术时三辐射软骨开放的患者中，这种作用更为明显。
方法：III.
方法：前瞻性，国际,查询多中心数据库以确定特发性脊柱侧凸患者接受胸椎VBT治疗。凹vs.凸椎体高度，椎体楔入，由两名独立观察者在5个时间点（术前至4年随访）测量3个根尖周围椎骨的椎间盘楔入。
结果：65名骨骼未成熟患者（60名女性，平均12.8岁，21个开放的三辐射软骨）符合纳入标准。术前平均最大脊柱侧凸50±8°,术后显著下降至27±9°(p<0.001),在4年随访30±17°时保持稳定(p=0.38vs.术后)。在4年随访时，平均器械脊柱侧弯为21±14°，与4年最大脊柱侧凸有显著差异(p<0.001)。30±12°的平均术前脊柱后凸在术后没有显着变化（p=1.0），并且在4年随访时保持稳定（35±18°；p=0.05）。平均个体凸椎体高度从17.7±1.9mm增加到19.8±1.5mm(p<0.001),而平均个体凹面高度从14.8±1.9mm增加到17.6±1.6mm(p<0.001)。总结根尖周围的高度，术前到4年随访的身高差异在凹侧(8.3±4.7mm)大于凸侧(6.2±4.7mm)(p<0.001).平均椎体楔入从术前的6±2°下降到4年随访时的4±2°（p<0.001）。平均总椎体和椎间盘楔入在术前29±7°开始，术后降至16±6°（p<0.001），然后在4年随访时进一步降低至14±8°（p<0.001）。与闭合的三辐射软骨相比，手术时开放的三辐射软骨患者在4年内的身高变化更大（p<0.001）。
结论：接受VBT治疗的特发性脊柱侧凸患者表现出差异的椎体生长，并在至少4年的随访中保持。在手术时三辐射软骨开放的患者中，这种作用更为明显。
方法：III.
