Anterior Vertebral Body Tethering (AVBT) for Treatment Of Idiopathic Scoliosis in the Skeletally Immature

Prospective case series. OBJECTIVE. Determine the efficacy of anterior vertebral body tethering (AVBT) in skeletally immature patients. SUMMARY OF BACKGROUND DATA. The value of AVBT is currently unclear given the paucity of available data. METHODS. Consecutive skeletally immature patients with idiopathic scoliosis were treated with AVBT between 2012 and 2018 by one of two surgeons working at two independent centers and followed up for >2 years. Data were collected prospectively and supplemented retrospectively where necessary. Outcomes were measured preoperatively, at first erect radiograph (FE), 1-year postoperatively and at most recent follow up (FU). RESULTS. One hundred twelve patients underwent 116 primary tethering procedures (108 thoracic and eight lumbar tethers). Four patients had primary tethering of both lumbar and thoracic curves. At surgery mean age was 12.7 ± 1.4 years (8.2–16.7) and Risser 0.5 ± 0.9 (0–3). Follow up was mean 37 ± 9 months (15–64). Preoperative mean coronal Cobb angle of the 130 tethered curves was 50.8° ± 10.2 (31–81) and corrected significantly to 26.6° ± 10.1 (−3–61) at FE radiograph (P < 0.001). Further significant improvement was seen from FE to 1-year, to mean 23.1° ± 12.4 (−37–57) (P < 0.001). There was a small but significant increase between 1-year and FU to 25.7° ± 16.3 (−32–58) (P < 0.001), which appeared to reflect tether breakage. Untethered minor curves were corrected from 31.0° ± 9.5 (3–57) to 20.3° ± 10.3 (0–52) at FU (P < 0.001). Rib hump was corrected from 14.1 ± 4.8 (0–26) to 8.8° ± 5.4 (0–22) at FU (P < 0.01). Twenty-five patients (22%) had 28 complications. Fifteen patients (13%) requiring 18 revision operations including six completed and one awaited fusions. CONCLUSION. AVBT of immature cases is associated with satisfactory deformity correction in the majority of cases. However, complication and revision rates suggest the need for improved implants and patient selection. Long-term follow-up remains crucial to establish the true efficacy of this procedure. Level of Evidence:

Anterior Vertebral Body Tethering for Treatment of Idiopathic Scoliosis in the Skeletally Immature: Results of 112 Cases

Study Design. Prospective case series.Objective. Determine the efficacy of anterior vertebral body tethering (AVBT) in skeletally immature patients.Summary of Background Data. The value of AVBT is currently unclear given the paucity of available data.Methods. Consecutive skeletally immature patients with idiopathic scoliosis were treated with AVBT between 2012 and 2018 by one of two surgeons working at two independent centers and followed up for &gt;2 years. Data were collected prospectively and supplemented retrospectively where necessary. Outcomes were measured preoperatively, at first erect radiograph (FE), 1-year postoperatively and at most recent follow up (FU).Results. One hundred twelve patients underwent 116 primary tethering procedures (108 thoracic and eight lumbar tethers). Four patients had primary tethering of both lumbar and thoracic curves. At surgery mean age was 12.7 +/- 1.4 years (8.2-16.7) and Risser 0.5 +/- 0.9 (0-3). Follow up was mean 37 +/- 9 months (15-64). Preoperative mean coronal Cobb angle of the 130 tethered curves was 50.8 degrees +/- 10.2 (31-81) and corrected significantly to 26.6 degrees +/- 10.1 (-3-61) at FE radiograph (P&lt;0.001). Further significant improvement was seen from FE to 1-year, to mean 23.1 degrees +/- 12.4 (-37-57) (P&lt;0.001). There was a small but significant increase between 1-year and FU to 25.7 degrees +/- 16.3 (-32-58) (P&lt;0.001), which appeared to reflect tether breakage. Untethered minor curves were corrected from 31.0 degrees +/- 9.5 (3-57) to 20.3 degrees +/- 10.3 (0-52) at FU (P&lt;0.001). Rib hump was corrected from 14.1 +/- 4.8 (0- 26) to 8.8 degrees +/- 5.4 (0-22) at FU (P&lt;0.01). Twenty-five patients (22%) had 28 complications. Fifteen patients (13%) requiring 18 revision operations including six completed and one awaited fusions.Conclusion. AVBT of immature cases is associated with satisfactory deformity correction in the majority of cases. However, complication and revision rates suggest the need for improved implants and patient selection. Long-term follow-up remains crucial to establish the true efficacy of this procedure

The Effects of Naproxen on Chondrogenesis of Human Mesenchymal Stem Cells

Currently, there are no established treatments to prevent, stop, or even retard the degeneration of articular cartilage in osteoarthritis (OA). Biological repair of the degenerating articular cartilage would be preferable to surgery. There is no benign site where autologous chondrocytes can be harvested and used as a cell source for cartilage repair, leaving mesenchymal stem cells (MSCs) as an attractive option. However, MSCs from OA patients have been shown to constitutively express collagen type X (COL-X), a marker of late-stage chondrocyte hypertrophy. We recently found that naproxen (Npx), but not other nonsteroidal anti-inflammatory drugs, can induce collagen type X alpha 1 (COL10A1) gene expression in bone marrow-derived MSCs from healthy and OA donors. In this study, we determined the effect of Npx on COL10A1 expression and investigated the intracellular signaling pathways that mediate such effect in normal human MSCs during chondrogenesis. MSCs were cultured in standard chondrogenic differentiation media supplemented with or without Npx. Our results show that Npx can regulate chondrogenic differentiation by affecting the gene expression of both Indian hedgehog and parathyroid hormone/parathyroid hormone-related protein signaling pathways in a time-dependent manner, suggesting a complex interaction of different signaling pathways during the process

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population