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Overcorrection and Subsequent Stabilization in Vertebral Body Tethering
Score and Comment on this Case
Clinical Details
Clinical and radiological findings: A 14-year-old premenarcheal female patient presented with a residual curve of 2 degrees following double row vertebral body tethering (VBT) surgery. Initial assessment revealed a Sanders score of 4, Thoracic Ossification Center Index (TOCI) of 6, Curve Magnitude Velocity (CMV) of 4, and Risser sign of 1. The patient's menarche status was premenarcheal.
Preoperative Plan
Planning remarks: The preoperative plan included double row VBT surgery aimed at correcting the spinal deformity while allowing for continued growth and spinal motion preservation. The surgical strategy was designed considering the patient's growth potential, as indicated by the Sanders, TOCI, CVM, and Risser scores.
Surgical Discussion
Operative remarks:At the 18-month follow-up, overcorrection was observed with a Sanders score progression to 7. A reverse brace was fitted for approximately one year to manage the overcorrection, maintaining curve stability. At 32 months post-operation, the lower two tethered segments broke, resulting in a residual curve of 2 degrees and full correction of the overcorrected deformity upon reaching full maturity. This case highlights the dynamic nature of growth modulation with VBT and the potential for overcorrection in patients with significant growth remaining.
Postoperative protocol: Postoperatively, the patient was fitted with a reverse brace to manage the overcorrection and maintain curve stability. The brace was worn for approximately one year.
Follow up: Not specified.
Orthopaedic implants used: Vertebral body screws and flexible tethers. Originally posted on LinkedIn by Prof. Dr. Ahmet Alanay
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User Discussion (1)
Guest User
You are an animal. Fantastic work
thanks