Flexible posterior vertebral tethering for the management of Scheuermann's kyphosis: correction by using growth modulation-clinical and radiographic outcomes of the first 10 patients with at least 3 years of follow-up

Mehmet Aydogan; Tuna Pehlivanoglu; Yigit Erdag; Umut Dogu Akturk; Abdulhalim Akar

doi:10.1007/s00586-024-08297-4

Flexible posterior vertebral tethering for the management of Scheuermann's kyphosis: correction by using growth modulation-clinical and radiographic outcomes of the first 10 patients with at least 3 years of follow-up

Eur Spine J. 2024 May 14. doi: 10.1007/s00586-024-08297-4. Online ahead of print.

Authors

Mehmet Aydogan¹, Tuna Pehlivanoglu^{2

3}, Yigit Erdag⁴, Umut Dogu Akturk⁵, Abdulhalim Akar¹

Affiliations

¹ Department of Orthopaedic Surgery and Traumatology, Emsey Advanced Spine Surgery Center, Surgical Spine Center of Excellence Certified By EUROSPINE, Emsey Hospital, Çamlık Mahallesi, Selçuklu Caddesi; No:22, Pendik, 34912, Istanbul, Turkey.
² Department of Orthopedic Surgery and Traumatology, Liv Spine Center, Liv Hospital Ulus, Ulus Mahallesi, Ahmet Adnan Saygun Caddesi, Canan Sokak, No:4, Beşiktaş, 34340, Istanbul, Turkey. dr.tuna@hotmail.com.
³ Department of Ortopedic Surgery and Traumatology, Faculty of Medicine, Istinye University, Hamidiye, Kâğıthane, 34408, Istanbul, Turkey. dr.tuna@hotmail.com.
⁴ Department of Orthopedic Surgery and Traumatology, Medar Hospital, Osman Yılmaz Mahallesi, İstanbul Caddesi, No:26, Gebze, 41400, Kocaeli, Turkey.
⁵ Department of Neurosurgery, Emsey Advanced Spine Surgery Center, Surgical Spine Center of Excellence Certified By EUROSPINE, Emsey Hospital, Çamlık Mahallesi, Selçuklu Caddesi, No:22, Pendik, 34912, Istanbul, Turkey.

PMID: 38740612
DOI: 10.1007/s00586-024-08297-4

Abstract

Purpose: The present prospective cohort study was intended to present the minimum 3 years' results of flexible posterior vertebral tethering (PVT) applied to 10 skeletally immature patients with SK to question, if it could be an alternative to fusion.

Methods: Ten skeletally immature patients with radiographically confirmed SK, who had flexible (minimum 35%) kyphotic curves (T2-T12), were included. A decision to proceed with PVT was based on curve progression within the brace, and/or persistent pain, and/or unacceptable cosmetic concerns of the patient/caregivers, and/or non-compliance within the brace.

Results: Patients had an average age of 13.1 (range 11-15) and an average follow-up duration of 47.6 months (range 36-60). Posterior vertebral tethering (PVT) was undertaken to all patients by utilizing Wiltse approach and placing monoaxial pedicle screws intermittently. At the final follow-up: mean pre-operative thoracic kyphosis and lumbar lordosis improved from 73.6°-45.7° to 34.7°-32.1°. Mean sagittal vertical axis, vertebral wedge angle and total SRS-22 scores improved significantly. A fulcrum lateral X-ray obtained at the latest follow-up, showed that the tethered levels remained mobile.

Conclusion: This study, for the first time in the literature, concluded, that as a result of growth modulation applied to skeletally immature patients with SK, flexible PVT was detected to yield gradual correction of the thoracic kyphosis by reverting the pathological vertebral wedging process, while keeping the mobility of the tethered segments in addition to successful clinical-functional results. The successful results of the present study answered the role of the PVT as a viable alternative to fusion in skeletally immature patients with SK.

Level of evidence: IV.

Keywords: Curve correction; Functional outcome; Fusionless treatment; Growth modulation; Motion preservation; Posterior vertebral tethering (PVT); Scheuermann’s kyphosis (SK); Vertebral body tethering (VBT).