Related Experiment Video
Updated: Nov 4, 2025
Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
Published on: November 8, 2024
Does vertebral body tethering cause disc and facet joint degeneration? A preliminary MRI study with minimum two years
Altug Yucekul1, Burcu Akpunarli2, Atahan Durbas3
1Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey.
Background Context:
Vertebral body tethering (VBT), a flexible compression-based growth modulation technique, was claimed to prevent disc degeneration due to its less rigid nature compared to other growth-friendly techniques. Yet, the consequences of VBT surgery on discs and facet joints have not been precisely acknowledged.
Purpose:
The purpose of this study was to determine the changes in the intermediate and adjacent levels at least 2 years after surgery.
Study Design/Setting:
Prospectively-followed consecutive patient cohort PATIENT SAMPLE: Adolescent idiopathic scoliosis patients who underwent thoracoscopic VBT between 2014 and 2017 were included.
Outcome Measures:
Degeneration of the intervertebral discs using the Pfirrmann classification; Degeneration of facet joints using a scale of 0 to 3.
Methods:
Demographic, perioperative, clinical, radiographic data were collected. Skeletal maturity and height gain were assessed in every follow-up. Overcorrection, tether breakage, mechanical and pulmonary complications as well as readmission and reoperations were recorded. MRIs taken before surgery and at a minimum of 2 years follow-up were evaluated for degeneration at the intermediate and adjacent segment intervertebral discs and facet joints by a blinded senior radiologist and compared.
Results:
Twenty-five patients with a mean of 38.6±10.6 months (24-62) of follow-up were included. The mean age at surgery was 12.2 (10-14), and the median Sanders stage was 3 (1-7). A mean of 7.7±1.1 (6-11) levels were tethered. The mean preoperative main thoracic curve magnitude of 46°±7.7° was corrected to 23.3°±5.9° postoperatively, which was subsequently modulated to 12° ±11.5° during the follow-up. At the time of the MRI (mean 29±9.5 (24-62) months), the median Sanders stages was 7 (5-8). A total of 217 levels of discs and bilateral facet joints were evaluated in the preoperative and follow-up MRI images. Analyses of disc and facet scores revealed no significant differences between patients. Deterioration of previously degenerated discs was noted in one patient (from grade 2 to 3), while previously healthy lower adjacent facet joints were degenerated (grade 2) in another patient.
Conclusions:
Intermediate discs and facet joints were preserved after growth modulation with VBT surgery at a mean of 29 months of follow-up. Studies in larger cohorts with longer follow-up are warranted to have more in-depth analyses of the effects of relative stabilization and altered biomechanical loads.
