None listed
Conditions
Brief summary
Idiopathic Scoliosis is a progressive condition, which presents most commonly in early teenage years. If a curve reaches 50° at skeletal maturity it is likely to progress at a rate of 1° or more per year leading to increased deformity and disability in adult life. For this reason, most people with a curve 50° or more are treated with a spinal fusion to correct deformity and prevent progression. Curves 20-40° (with remaining growth) can be treated effectively with bracing and approximately one in three will avoid spinal fusion. Spinal fusion while effective, is non-physiological and increases stress on non-fused spinal segments. Potential complications include disc degeneration and progressive deformity in unfused segments, and pseudoarthrosis within the fused spine. Growth modulation is a technique used to treat limb deformities in the paediatric population either by surgically damaging the physis or by placing plates across it. A similar technique has been attempted in the spine by placing staples across the discs. This has been largely unsuccessful as the implants aren’t strong enough to prevent the deformity progressing. An alternative technique has been developed involving thoracoscopic placement of anterior vertebral body screws connected by a flexible tether. This relies on the Heuter-Volkmann law; slowing growth by increasing tension on the convexity of the curve, allowing catch up growth on the concave side. This technique has shown promise preventing >70% of patients meeting the criteria for fusion within 5 years. Currently there is a moderately high reoperation rate in these patients due to over correction or progressive deformity. Further information will help guide indications for this procedure and hopefully lower the reoperation rate.
Interventions
Thoracoscopic anterior vertebral body tethering.
All patients who meet eligibility criteria will be given the option of thoracoscopic anterior vertebral body tethering. The intervention will be performed by a Fellowship trained Scoliosis Surgeon. Intraoperative spinal cord monitoring will be utilised. The patient will be positioned in the lateral decubitus position with the convex side up. Surgery will be undertaken through 4-7 thoracoscopic portals. Pleura is dissected off the vertebral b
Thoracoscopic anterior vertebral body tethering. All patients who meet eligibility criteria will be given the option of thoracoscopic anterior vertebral body tethering. The intervention will be performed by a Fellowship trained Scoliosis Surgeon. Intraoperative spinal cord monitoring will be utilised. The patient will be positioned in the lateral decubitus position with the convex side up. Surgery will be undertaken through 4-7 thoracoscopic portals. Pleura is dissected off the vertebral bodies and segmental vessels diathermied. Radiographic spinal level check is undertaken prior to placement of bicortical transverse vertebral body screws into each vertebra that requires instrumentation. The tether is connected to the screws and tensioned appropriately. A chest drain is placed prior to layered closure. The intervention will be performed once, with a surgical time of approximately 3 hours.
Sponsors
Mr. Robert Rowan
Study design
Allocation
Non-randomised trial
Intervention model
Parallel
Primary purpose
Treatment
Eligibility
Sex/Gender
All
Age
8 Years to 16 Years
Healthy volunteers
No
Inclusion criteria
Inclusion Criteria: - Patients treated through CCDHB with a 40-75° flexible idiopathic curve, AND - Sufficient remaining growth (defined as Risser 0, Sanders stage 2-4). - Parental consent and patient assent to: o Procedure o Follow-up clinical assessment (either in clinic or virtual) o Follow-up x-rays
Exclusion criteria
- Hyperkyphosis - Patients who fail to meet indications and inclusion criteria.
Outcome results
None listed