The Effect of Vertebral Body Tethering on Lumbar Paraspinal Muscle Cross-Section Area in Adolescent Idiopathic Scoliosis

NCT ID: NCT05347056

Last Updated: 2022-04-26

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Total Enrollment

16 participants

Study Classification

OBSERVATIONAL

Study Start Date

2022-05-09

Study Completion Date

2022-06-06

Brief Summary

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We aimed to compare the paraspinal muscle cross-section area and functional results of anterior vertebral tethering and selective thoracic fusion surgery.

Detailed Description

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Idiopathic scoliosis is a three-dimensional deformity of the spine. It is defined as the curvature of the spine of 10° or more detected radiologically in the coronal plane. In scoliosis, changes in axial rotation in the transverse plane and physiological curvatures in the sagittal plane (decrease or increase in kyphosis, lordosis) occur.

The incidence of scoliosis is 2-3%, but up to 10% of patients need surgical treatment. Knowing the long-term effects of posterior spinal fusion is currently the gold standard treatment because it gives good results in deformity improvement. However, fusion surgery has disadvantages such as loss of motion in the spine and long-term development of adjacent segment disease and disc degeneration. It has also been suggested that spinal fusion causes iatrogenic damage to the paraspinal muscles (especially the multifidus), which is of great importance in the alignment and movement of the spine due to the posterior approach during surgery.

As a result of damage to the lumbar multifidus muscles and the development of fatty degeneration, problems such as spinal sagittal alignment disorders and chronic low back pain can be seen. In addition, fatty degeneration and atrophy of the paraspinal muscles may lead to the development of adjacent segment disease in the segments under fusion in the long term.

In selective thoracic fusion, by protecting the mobile segments in the lumbar region, the range of motion is preserved and iatrogenic damage of the lumbar paraspinal muscles is prevented. After selective thoracic fusion (STF), some improvement occurs in the deformity in the lumbar region. However, the risk of insufficient improvement and progression of the curve in the unfused lumbar segments, especially in immature patients, should be considered.

Anterior vertebra body tethering is a surgical technique that has been used more frequently in recent years, which is thought to prevent functional complications caused by spinal fusion.With this method, which allows the growth of the spine to continue, there is no need for fusion when treating progressive curvature. Short-term radiological results of this surgical technique have been reported frequently in recent years, but the literature on functional results (spine flexibility, trunk endurance, etc.) is very limited.

In our study, we plan to evaluate the effects of AVT applied to the lumbar region on paraspinal muscle quality, trunk muscle strength and endurance, and trunk joint range of motion by evaluating patients who underwent selective thoracic fusion surgery and patients who underwent thoracic fusion + AVT to the lumbar region.

Conditions

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Idiopathic Scoliosis

Study Design

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Observational Model Type

CASE_CONTROL

Study Time Perspective

OTHER

Study Groups

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Vertebral Body Tethering Group

Vertebral Body Tethering applied to the lumbar region, with or without fusion to the thoracic region

Lumbar Spine Magnetic Resonance

Intervention Type DIAGNOSTIC_TEST

Metal artifact reduction sequence (mars), axial t2 sequence

Isokinetic trunk flexion-extension trunk muscle strength and endurance test

Intervention Type DIAGNOSTIC_TEST

To evaluate for trunk muscle strength and endurance angular velocity of 60 and 120°/s

Lomber Region Range of motion assessment

Intervention Type DIAGNOSTIC_TEST

To evaluate for lomber region ROM with digital inclinometer

Radiograph

Intervention Type DIAGNOSTIC_TEST

spinal radiograph AP/Lateral

SRS 22

Intervention Type BEHAVIORAL

SRS-22 Patient Questionnaire

Selective Thoracic Fusion Group

selective thoracic fusion was applied, no intervention was applied to the lumbar region

Lumbar Spine Magnetic Resonance

Intervention Type DIAGNOSTIC_TEST

Metal artifact reduction sequence (mars), axial t2 sequence

Isokinetic trunk flexion-extension trunk muscle strength and endurance test

Intervention Type DIAGNOSTIC_TEST

To evaluate for trunk muscle strength and endurance angular velocity of 60 and 120°/s

Lomber Region Range of motion assessment

Intervention Type DIAGNOSTIC_TEST

To evaluate for lomber region ROM with digital inclinometer

Radiograph

Intervention Type DIAGNOSTIC_TEST

spinal radiograph AP/Lateral

SRS 22

Intervention Type BEHAVIORAL

SRS-22 Patient Questionnaire

Interventions

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Lumbar Spine Magnetic Resonance

Metal artifact reduction sequence (mars), axial t2 sequence

Intervention Type DIAGNOSTIC_TEST

Isokinetic trunk flexion-extension trunk muscle strength and endurance test

To evaluate for trunk muscle strength and endurance angular velocity of 60 and 120°/s

Intervention Type DIAGNOSTIC_TEST

Lomber Region Range of motion assessment

To evaluate for lomber region ROM with digital inclinometer

Intervention Type DIAGNOSTIC_TEST

Radiograph

spinal radiograph AP/Lateral

Intervention Type DIAGNOSTIC_TEST

SRS 22

SRS-22 Patient Questionnaire

Intervention Type BEHAVIORAL

Other Intervention Names

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Cybex

Eligibility Criteria

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Inclusion Criteria

Males or females age 12 to 19 years old Diagnosis of idiopathic scoliosis At least 6 months have passed since surgical intervention Spina bifida occulta is permitted

Exclusion Criteria

Pregnancy Prior spinal or chest surgery MRI abnormalities (including syrinx greater than 4mm, Chiari malformation, or tethered cord) Neuromuscular, thoracogenic, cardiogenic scoliosis, or any other non-idiopathic scoliosis Associated syndrome, including Marfan syndrome or neurofibromatosis
Minimum Eligible Age

12 Years

Maximum Eligible Age

19 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Istanbul University

OTHER

Sponsor Role lead

Responsible Party

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Esin Nur Taşdemir

MD

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Esin Nur Taşdemir, MD

Role: PRINCIPAL_INVESTIGATOR

Istanbul Medicine Faculty Department of Sports Medicine

Central Contacts

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Esin Nur Taşdemir, MD

Role: CONTACT

905353661124

References

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Green DW, Lawhorne TW 3rd, Widmann RF, Kepler CK, Ahern C, Mintz DN, Rawlins BA, Burke SW, Boachie-Adjei O. Long-term magnetic resonance imaging follow-up demonstrates minimal transitional level lumbar disc degeneration after posterior spine fusion for adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2011 Nov 1;36(23):1948-54. doi: 10.1097/BRS.0b013e3181ff1ea9.

Reference Type BACKGROUND
PMID: 21289549 (View on PubMed)

Pehlivanoglu T, Oltulu I, Erdag Y, Akturk UD, Korkmaz E, Yildirim E, Sarioglu E, Ofluoglu E, Aydogan M. Comparison of clinical and functional outcomes of vertebral body tethering to posterior spinal fusion in patients with adolescent idiopathic scoliosis and evaluation of quality of life: preliminary results. Spine Deform. 2021 Jul;9(4):1175-1182. doi: 10.1007/s43390-021-00323-5. Epub 2021 Mar 8.

Reference Type RESULT
PMID: 33683642 (View on PubMed)

Kim HJ, Yang JH, Chang DG, Suk SI, Suh SW, Nam Y, Kim SI, Song KS. Long-Term Influence of Paraspinal Muscle Quantity in Adolescent Idiopathic Scoliosis Following Deformity Correction by Posterior Approach. J Clin Med. 2021 Oct 19;10(20):4790. doi: 10.3390/jcm10204790.

Reference Type RESULT
PMID: 34682913 (View on PubMed)

Baroncini A, Trobisch PD, Berrer A, Kobbe P, Tingart M, Eschweiler J, Da Paz S, Migliorini F. Return to sport and daily life activities after vertebral body tethering for AIS: analysis of the sport activity questionnaire. Eur Spine J. 2021 Jul;30(7):1998-2006. doi: 10.1007/s00586-021-06768-6. Epub 2021 Feb 27.

Reference Type RESULT
PMID: 33638722 (View on PubMed)

Other Identifiers

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ENTASDEMIR

Identifier Type: -

Identifier Source: org_study_id

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