Patient-specific biomechanical modeling of intraoperative scoliosis correction on the 2-year outcomes for thoracolumbar/lumbar vertebral body tethering.

IF 1.8 Q3 CLINICAL NEUROLOGY

Spine deformity Pub Date : 2025-08-29 DOI:10.1007/s43390-025-01166-0

Marine Gay, Nikita Cobetto, Christiane Caouette, A Noelle Larson, Isabelle Villemure, Daniel Hoernschemeyer, Melanie Boeyer, Ron El-Hawary, Ahmet Alanay, Carl-Eric Aubin

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引用次数: 0

Abstract

Purpose: To biomechanically assess the influence of intraoperative correction and presenting Sanders maturity scores (SS) on growth modulation correction after 2 years in pediatric idiopathic scoliosis treated with Vertebral Body Tethering (VBT).

Methods: Lumbar VBT was simulated using patient-specific finite element models (FEMs) from 20 cases of pediatric idiopathic scoliosis (average thoracolumbar/lumbar Cobb 47°; min: 34°, max: 63°), calibrated for preoperative SS, weight, and spine flexibility. The validated FEM included lateral decubitus positioning and VBT instrumentation at the actual upper instrumented vertebra (UIV: T9-T12) and lower instrumented vertebra (LIV: L2-L4). Simulations tested three intraoperative nominal correction levels (35, 50, and 70%) across SS stages (3A, 3B, 4, 5), with immediate and 2-year postoperative corrections computed and analyzed.

Results: A 35% intraoperative correction resulted in an immediate post-operative Cobb angle of 37° (23°-54°) but led to under-correction, with a final deformity of 38° (22°-63°) at 2 years. Curve progression occurred in 40% of SS3A cases, particularly in heavier patients (54 kg vs. 38 kg, p < 0.05). A 50% intraoperative correction yielded an immediate post-operative Cobb angle of 27° (16°-40°), with significant improvement at 2 years only in SS3A (p < 0.05). Clinically successful growth modulation (>5° improvement) correlated with lower weight (40 ± 6 kg vs. 54 ± 6 kg, p < 0.05). A 70% intraoperative correction produced an immediate post-operative Cobb angle of 17° (11°-22°) and significant improvement across all SS levels (p < 0.05), with final 2-year angles of 1° (-27° to 10°) for SS3A, 10° (-5° to 10°) for SS3B, 12° (0°-18°) for SS4, and 13° (4°-19°) for SS5. Overcorrection occurred in SS3A (4 cases) and SS3B (1 case).

Conclusion: Successful outcomes at 2 years depend on the interaction of key factors, such as intraoperative correction, residual growth potential as defined by preoperative SS, patient weight, spinal flexibility, and mechanobiological growth modulation. The advanced and validated planning tool used for the simulations incorporates these elements, integrating both biomechanical and biological growth dynamics to support a more precise and personalized surgical approach.

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胸腰椎/腰椎系扎术中脊柱侧凸矫正2年疗效的患者特异性生物力学模型

目的：从生物力学角度评估术中矫正和呈现Sanders成熟度评分（SS）对儿童特发性脊柱侧凸椎体系扎术（VBT）治疗2年后生长调节矫正的影响。方法：对20例儿童特发性脊柱侧凸（平均胸腰椎/腰椎Cobb为47°，最小值为34°，最大值为63°）的患者使用特定的有限元模型（fem）模拟腰椎VBT，并对术前SS、体重和脊柱柔韧性进行校准。验证的FEM包括侧卧定位和VBT内固定在实际上固定椎体（UIV: T9-T12）和下固定椎体（LIV: L2-L4）。模拟测试了SS分期（3A、3B、4、5）的三个术中标称矫正水平（35,50和70%），并计算和分析了即刻和术后2年的矫正。结果：术中35%的矫正导致术后即刻Cobb角为37°（23°-54°），但导致矫正不足，2年后最终畸形为38°（22°-63°）。40%的SS3A患者发生曲线进展，特别是体重较重的患者（54 kg对38 kg， p 5°改善）与体重较轻的患者（40±6 kg对54±6 kg， p）相关。结论：2年的成功结果取决于关键因素的相互作用，如术中矫正、术前SS定义的剩余生长潜力、患者体重、脊柱柔韧性和机械生物学生长调节。用于模拟的先进且经过验证的计划工具包含了这些元素，整合了生物力学和生物生长动力学，以支持更精确和个性化的手术方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Spine deformity

CiteScore

3.20

自引率

18.80%

发文量

167

期刊介绍： Spine Deformity the official journal of the?Scoliosis Research Society is a peer-refereed publication to disseminate knowledge on basic science and clinical research into the?etiology?biomechanics?treatment?methods and outcomes of all types of?spinal deformities. The international members of the Editorial Board provide a worldwide perspective for the journal's area of interest.The?journal?will enhance the mission of the Society which is to foster the optimal care of all patients with?spine?deformities worldwide. Articles published in?Spine Deformity?are Medline indexed in PubMed.? The journal publishes original articles in the form of clinical and basic research. Spine Deformity will only publish studies that have institutional review board (IRB) or similar ethics committee approval for human and animal studies and have strictly observed these guidelines. The minimum follow-up period for follow-up clinical studies is 24 months.