title: Spinal growth modulation with an anterolateral flexible tether in an immature bovine model: disc health and motion preservation.
abstract: METHODS
  An immature bovine model was used to evaluate multilevel anterolateral flexible tethering in a growing spine.
  
  
  OBJECTIVE
  To evaluate radiographic, biochemical, histologic, and biomechanical results of tethered spinal growth.
  
  
  BACKGROUND
  An anterolateral flexible tether has been shown to create a kyphotic and scoliotic spinal deformity in calves. Subsequent disc health and spinal motion has not been analyzed.
  
  
  METHODS
  Four consecutive thoracic vertebral bodies (T6-T9) were instrumented anteriorly in 36 1-month-old calves. Seventeen animals (Tether Group) were instrumented with a vertebral staple-two screw construct connected by 2 flexible stainless steel cables. Nineteen animals (Control Group) were instrumented with 1 vertebral body screw with no connecting cable. After a 6-month survival period, the spines were harvest en-bloc and underwent radiographic, computed tomography, biochemical, histologic, and biomechanical analysis.
  
  
  RESULTS
  On average, 37.6 degrees +/- 10.6 degrees of coronal and 18.0 degrees +/- 9.9 degrees of sagittal deformity was created in the Tether Group, with significant vertebral wedging toward the tether (P < 0.001). Disc thickness decreased significantly in the Tether Group (P < 0.001), however, disc wedging was not observed. There was no change in gross morphologic disc health or disc water content (P = 0.73). However, proteoglycan synthesis was significantly greater in the tethered discs compared with controls (P < 0.001), and collagen type distribution was different with a trend toward increased type II collagen present on the tethered side of the disc (P = 0.09). Tethers significantly increased spinal stiffness in lateral bending and in flexion/extension (P < 0.05) without affecting torsional stiffness, however, after tether removal range of motion returned to control values.
  
  
  CONCLUSIONS
  Tethering resulted in vertebral wedging while maintaining spinal flexibility. Although changes in proteoglycan synthesis, collagen type distribution, and disc thickness were observed, the tethered discs had similar water content to control discs and did not demonstrate gross morphologic signs of degeneration. Growth modulation is an attractive treatment option for growing patients with scoliosis, avoiding multilevel fusions or brace wear. Strategies for fusionless scoliosis correction should preserve disc health, as adolescent patients will rely on these discs for decades after treatment.
authors: Rady Children's Hospital, San Diego, Children's Way, San Diego, California 92123, USA. pnewton@chsd.org
authors: Peter O
authors: PO
authors: Newton
authors: Christine L
authors: CL
authors: Farnsworth
authors: Frances D
authors: FD
authors: Faro
authors: Andrew T
authors: AT
authors: Mahar
authors: Tim R
authors: TR
authors: Odell
authors: Fazir
authors: F
authors: Mohamad
authors: Eric
authors: E
authors: Breisch
authors: Kevin
authors: K
authors: Fricka
authors: Vidyadhar V
authors: VV
authors: Upasani
authors: David
authors: D
authors: Amiel
mesh_terms: D000704:Analysis of Variance; D000818:Animals; D001696:Biomechanical Phenomena; D001863:Bone Screws; D002417:Cattle; D004195:Disease Models, Animal; D007738:Kyphosis / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D009068:Movement; D011859:Radiography; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000503:physiopathology; D013121:Spinal Curvatures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000254:growth & development* / Q000601:surgery