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Article: Inter-screw index as a novel diagnostic indicator of tether breakage

TitleInter-screw index as a novel diagnostic indicator of tether breakage
Authors
KeywordsAdolescent idiopathic scoliosis
Tether breakage
Vertebral body tethering
Issue Date4-Apr-2023
PublisherSpringer
Citation
Spine Deformity, 2023, v. 11, n. 4, p. 887-895 How to Cite?
Abstract

Purpose

Tether breakage is the most common complication of Vertebral Body Tethering (VBT) occurring in up to 52% of Adolescent Idiopathic Scoliosis (AIS) patients and risks continued progression and revision. Radiographical diagnosis of tether breakage is commonly defined by a 5° increase in inter-screw angle and associates breakage with loss of correction. However, the sensitivity of this method was 56% only, suggesting that tethers can break without an increase in angulation, which was supported by other studies. To our knowledge, current literature lacks a method merely focusing on the diagnosis of tether breakage radiographically that does not associate the breakages with loss of correction.

Methods

This was a retrospective review of prospectively collected data of AIS patients who underwent VBT. The “inter-screw index” is defined as the percentage increase in inter-screw distance since post-op, with ≥ 13% increase defined as tether breakage as suggested by our mechanical tests. CTs were reviewed to identify the breakages and compared with inter-screw angle and inter-screw index.

Results

94 segments from 13 CTs were reviewed, and 15 tether breakages were identified. Use of inter-screw index correctly identified 14 breakages (93%), whereas ≥ 5° increase in inter-screw angle only identified 12 breakages (80%).

Conclusion

Use of inter-screw index is proven to be more sensitive than inter-screw angle in identifying tether breakages. Therefore, we propose the use of inter-screw index to diagnose tether breakages radiographically. Tether breakages were not necessarily accompanied by a loss of segmental correction leading to an increase in inter-screw angle, especially after skeletal maturity.

Level of evidence

Level 3.


Persistent Identifierhttp://hdl.handle.net/10722/331291
ISSN
2023 Impact Factor: 1.6
2023 SCImago Journal Rankings: 0.798
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorWan, SHT-
dc.contributor.authorGuldeniz, O-
dc.contributor.authorYeung, MHY-
dc.contributor.authorCheung, JPY-
dc.contributor.authorKwan, KYH-
dc.contributor.authorCheung, KMC-
dc.date.accessioned2023-09-21T06:54:25Z-
dc.date.available2023-09-21T06:54:25Z-
dc.date.issued2023-04-04-
dc.identifier.citationSpine Deformity, 2023, v. 11, n. 4, p. 887-895-
dc.identifier.issn2212-134X-
dc.identifier.urihttp://hdl.handle.net/10722/331291-
dc.description.abstract<h3>Purpose</h3><p>Tether breakage is the most common complication of Vertebral Body Tethering (VBT) occurring in up to 52% of Adolescent Idiopathic Scoliosis (AIS) patients and risks continued progression and revision. Radiographical diagnosis of tether breakage is commonly defined by a 5° increase in inter-screw angle and associates breakage with loss of correction. However, the sensitivity of this method was 56% only, suggesting that tethers can break without an increase in angulation, which was supported by other studies. To our knowledge, current literature lacks a method merely focusing on the diagnosis of tether breakage radiographically that does not associate the breakages with loss of correction.</p><h3>Methods</h3><p>This was a retrospective review of prospectively collected data of AIS patients who underwent VBT. The “inter-screw index” is defined as the percentage increase in inter-screw distance since post-op, with ≥ 13% increase defined as tether breakage as suggested by our mechanical tests. CTs were reviewed to identify the breakages and compared with inter-screw angle and inter-screw index.</p><h3>Results</h3><p>94 segments from 13 CTs were reviewed, and 15 tether breakages were identified. Use of inter-screw index correctly identified 14 breakages (93%), whereas ≥ 5° increase in inter-screw angle only identified 12 breakages (80%).</p><h3>Conclusion</h3><p>Use of inter-screw index is proven to be more sensitive than inter-screw angle in identifying tether breakages. Therefore, we propose the use of inter-screw index to diagnose tether breakages radiographically. Tether breakages were not necessarily accompanied by a loss of segmental correction leading to an increase in inter-screw angle, especially after skeletal maturity.</p><h3>Level of evidence</h3><p>Level 3.</p>-
dc.languageeng-
dc.publisherSpringer-
dc.relation.ispartofSpine Deformity-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.subjectAdolescent idiopathic scoliosis-
dc.subjectTether breakage-
dc.subjectVertebral body tethering-
dc.titleInter-screw index as a novel diagnostic indicator of tether breakage-
dc.typeArticle-
dc.identifier.doi10.1007/s43390-023-00679-w-
dc.identifier.scopuseid_2-s2.0-85151489493-
dc.identifier.volume11-
dc.identifier.issue4-
dc.identifier.spage887-
dc.identifier.epage895-
dc.identifier.eissn2212-1358-
dc.identifier.isiWOS:000963006000001-
dc.identifier.issnl2212-134X-

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