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Spinal Growth Modulation with Use of a Tether in an Immature Porcine Model

Newton, Peter O. MD; Upasani, Vidyadhar V. MD; Farnsworth, Christine L. MS; Oka, Richard MS; Chambers, Reid C. BA; Dwek, Jerry MD; Kim, Jung Ryul MD; Perry, Andrew MD; Mahar, Andrew T. MS

Journal of Bone & Joint Surgery - American Volume: 01 December 2008 - Volume 90 - Issue 12 - p 2695–2706
doi: 10.2106/JBJS.G.01424
Scientific Articles
Supplementary Content

Background: Spinal growth modulation by tethering the anterolateral aspect of the spine, as previously demonstrated in a nonscoliotic calf model, may be a viable fusionless treatment method for idiopathic scoliosis. The purpose of the present study was to evaluate the radiographic, histologic, and biomechanical results after six and twelve months of spinal growth modulation in a porcine model with a growth rate similar to that of adolescent patients.

Methods: Twelve seven-month-old mini-pigs underwent instrumentation with a vertebral staple-screw construct connected by a polyethylene tether over four consecutive thoracic vertebrae. The spines were harvested after six (n = 6) or twelve months (n = 6) of growth. Monthly radiographs, computed tomography and magnetic resonance imaging scans (made after the spines were harvested), histologic findings, and biomechanical findings were evaluated. Analysis of variance was used to compare preoperative, six-month postoperative, and twelve-month postoperative data.

Results: Radiographs demonstrated 14° ± 4° of coronal deformity after six months and 30° ± 13° after twelve months of growth. Coronal vertebral wedging was observed in all four tethered vertebrae and progressed throughout each animal's survival period. Disc wedging was also created; however, in contrast to the findings associated with vertebral wedging, the tethered side was taller than the untethered side. Magnetic resonance images revealed no evidence of disc degeneration; however, the nucleus pulposus had shifted toward the side of the tethering. Midcoronal undecalcified histologic sections showed intact bone-screw interfaces with no evidence of implant failure or loosening. With the tether cut, stiffness decreased and range of motion increased in lateral bending away from the tether at both time-points (p < 0.05).

Conclusions: In this porcine model, mechanical tethering during growth altered spinal morphology in the coronal and sagittal planes, leading to vertebral and disc wedging proportional to the duration of tethering. The resulting concave thickening of the disc in response to the tether was not anticipated and may suggest a capacity for the nucleus pulposus to respond to the compressive loads created by growth against the tether.

Clinical Relevance: Multilevel flexible tether placement may provide a growth-modulating mechanism for scoliosis correction while maintaining disc health. Understanding the response of the growing vertebrae and discs in this proposed method of fusionless scoliosis treatment remains paramount.

1Rady Children's Hospital San Diego, 3030 Children's Way, Suite 410, San Diego, CA 92123. E-mail address for P.O. Newton: pnewton@rchsd.org

2University of California at San Diego, 9500 Gilman Drive, San Diego, CA 92093

3Chonbuk National University, 634-18 Geumam-dong, Jeonju 561712, Republic of Korea

Copyright 2008 by The Journal of Bone and Joint Surgery, Incorporated
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