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Publications

Journal Article Ahead of print

PubMed: 42481883 DOI: 10.1007/s43390-026-01507-7

Toward biomechanically optimized intraoperative correction in lumbar vertebral body tethering.

Spine Deform

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

Affiliations

  • Department of Mechanical Engineering, Polytechnique Montréal, Downtown Station, P.O. Box 6079, Montreal, QC, H3C 3A7, Canada. Research Center, Sainte-Justine University Hospital Center, Montreal, QC, Canada.
  • Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
  • Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA.
  • Department of Mechanical Engineering, Polytechnique Montréal, Downtown Station, P.O. Box 6079, Montreal, QC, H3C 3A7, Canada.
  • Research Center, Sainte-Justine University Hospital Center, Montreal, QC, Canada.
  • Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey.
  • Boston Children's Hospital, Boston, MA, USA.
  • Department of Mechanical Engineering, Polytechnique Montréal, Downtown Station, P.O. Box 6079, Montreal, QC, H3C 3A7, Canada.
  • Research Center, Sainte-Justine University Hospital Center, Montreal, QC, Canada.

Abstract

PURPOSE

To identify the appropriate intraoperative correction in lumbar vertebral body tethering (VBT) to optimize outcomes and to avoid under- or over-correction at skeletal maturity by accounting for preoperative deformity size and stiffness, body weight, and skeletal maturity.

METHODS

Fifteen cases of pediatric idiopathic scoliosis (average lumbar Cobb angle: 48° (40-59°) were used to build validated 3D patient-specific finite element models, which were calibrated to various preoperative characteristics. Physics-based numerical simulations of VBT were performed in the intraoperative lateral decubitus position, with actual instrumented vertebrae (T10-T12 to L2-L4). Intraoperative correction levels (from 50 to 90%) were simulated under four growth remaining scenarios corresponding to Sanders Stage (SS) 3A, 3B, 4, and 5. Postoperative growth and growth modulation were simulated over a 2-year period. The targeted result was a curve at 10° ± 5° at 2-year follow-up.

RESULTS

Simulations indicated that achieving the targeted two-year coronal correction required significantly lower intraoperative correction in SS 3A compared with the more mature stages (3B, 4, 5) (p < 0.01). No significant differences were observed among SS 3B, 4, and 5. The corresponding target intraoperative corrections were 65% (53-75%), 72% (60-80%), 73% (60-80%), and 73% (68-80%) for SS 3A, 3B, 4, and 5, respectively. Separately, body weight and spinal flexibility did not statistically impact the intraoperative target. However, their interaction significantly influenced the intraoperative correction targets in SS 3A and 3B cases (p < 0.05).

CONCLUSION

Optimal intraoperative correction in lumbar VBT appears to depend primarily on preoperative skeletal maturity status. In patients who are more immature, body weight and spinal flexibility should also be considered when selecting correction targets. This simulating tool could be used as a planning tool to provides a pathway toward precise, individualized intraoperative correction strategies aimed at improving the reliability of VBT outcomes.

MeSH

Growth, Body Weight, Spine, Vertebral Body