Cyclically controlled vertebral body tethering for scoliosis: an in vivo verification in a pig model of the pressure exerted on vertebral end plates.

Abstract

Experimental in vivo study of the pressure exerted on the spine of a pig by a new cyclic anterior vertebral body tethering (AVBT) prototype. To evaluate the relationship between the tether tension and the pressures transmitted onto the vertebral end plates by a cyclic AVBT prototype. AVBT is a recent surgical technique for the treatment of pediatric scoliosis that compresses the convex side of the spine with a sustained tension, to modulate the growth to progressively correct the deformity over time. Previous studies demonstrated that cyclic compression has similar growth modulation capacity but with less detrimental effects on the integrity of the discs and growth plates. A 3-month-old healthy Duroc pig was anesthetized and a lateral thoracotomy was performed. The T7-T10 segment was instrumented and compressed during 50 s with the load oscillating (0.2 Hz) from + 30 to - 30% of the following mean tensions: 29, 35, 40, 44, and 49 N. The pressure exerted on T9 superior vertebral end plate was monitored during the cyclic loading. Three repetitions of each test were performed. The resulting mean pressure exerted on the vertebral end plate was linearly correlated with the mean tether tension (r² = 0.86). Each cycle translated in a hysteresis profile of the measured pressure and tension, with amplitudes varying between ± 11.5 and ± 29.9%. This experimental study documented the relationship between the tether tension and the pressure. This study confirmed the feasibility of cyclic AVBT principle to transfer varying pressures on the vertebral end plates, which is intended to control vertebral growth, while keeping the spine flexibility and preserving the health of soft tissues such as the intervertebral discs and the growth plate but remained to be further verified. Level IV.