{Reference Type}: Journal Article
{Title}: Does vertebral body tethering cause disc and facet joint degeneration? A preliminary MRI study with minimum two years follow-up.
{Author}: Yucekul A;Akpunarli B;Durbas A;Zulemyan T;Havlucu I;Ergene G;Senay S;Yalinay Dikmen P;Turgut Balci S;Karaarslan E;Yavuz Y;Yilgor C;Alanay A;
{Journal}: Spine J
{Volume}: 21
{Issue}: 11
{Year}: Nov 2021
{Factor}: 4.297
{DOI}: 10.1016/j.spinee.2021.05.020
{Abstract}: <B>BACKGROUND: </B>Vertebral body tethering (VBT), a flexible compression-based growth modulation technique, was claimed to prevent disc degeneration due to its less rigid nature compared to other growth-friendly techniques. Yet, the consequences of VBT surgery on discs and facet joints have not been precisely acknowledged.<BR><B>OBJECTIVE: </B>The purpose of this study was to determine the changes in the intermediate and adjacent levels at least 2 years after surgery.<BR><B>METHODS: </B>Prospectively-followed consecutive patient cohort PATIENT SAMPLE: Adolescent idiopathic scoliosis patients who underwent thoracoscopic VBT between 2014 and 2017 were included.<BR><B>METHODS: </B>Degeneration of the intervertebral discs using the Pfirrmann classification; Degeneration of facet joints using a scale of 0 to 3.<BR><B>METHODS: </B>Demographic, perioperative, clinical, radiographic data were collected. Skeletal maturity and height gain were assessed in every follow-up. Overcorrection, tether breakage, mechanical and pulmonary complications as well as readmission and reoperations were recorded. MRIs taken before surgery and at a minimum of 2 years follow-up were evaluated for degeneration at the intermediate and adjacent segment intervertebral discs and facet joints by a blinded senior radiologist and compared.<BR><B>RESULTS: </B>Twenty-five patients with a mean of 38.6±10.6 months (24-62) of follow-up were included. The mean age at surgery was 12.2 (10-14), and the median Sanders stage was 3 (1-7). A mean of 7.7±1.1 (6-11) levels were tethered. The mean preoperative main thoracic curve magnitude of 46°±7.7° was corrected to 23.3°±5.9° postoperatively, which was subsequently modulated to 12° ±11.5° during the follow-up. At the time of the MRI (mean 29±9.5 (24-62) months), the median Sanders stages was 7 (5-8). A total of 217 levels of discs and bilateral facet joints were evaluated in the preoperative and follow-up MRI images. Analyses of disc and facet scores revealed no significant differences between patients. Deterioration of previously degenerated discs was noted in one patient (from grade 2 to 3), while previously healthy lower adjacent facet joints were degenerated (grade 2) in another patient.<BR><B>CONCLUSIONS: </B>Intermediate discs and facet joints were preserved after growth modulation with VBT surgery at a mean of 29 months of follow-up. Studies in larger cohorts with longer follow-up are warranted to have more in-depth analyses of the effects of relative stabilization and altered biomechanical loads.