ROCHESTER, Minn. — For a long time, patients with scoliosis (the curvature of the left and right sides of the spine) could only be treated with fusion surgery. But there are now other options, including tethering the vertebral body for children with scoliosis .
"Vertebral tethering is a new treatment in the scoliosis treatment toolkit," said A. Noelle Larson, MD, a pediatric orthopedic surgeon and scoliosis surgery specialist at Mayo Clinic in Rochester, Minnesota. .
The cause of scoliosis is unknown, but it affects approximately 1 in 300 people worldwide . A curvature of the spine of more than 10 degrees is defined as scoliosis. Severe scoliosis requires treatment and is more common in women.
Mild scoliosis requires long-term observation. Slight curvatures in developing children may progress rapidly if left untreated. Moderate scoliosis in developing children can be treated with braces. Until recently, severe scoliosis could only be treated with fusion surgery.
In fusion surgery, the surgeon joins the bones in the spine (vertebrae) by making an incision in the patient's back, driving screws into the spine, and attaching rods to the screws to pull the spine into place , and eventually these vertebrae fuse into one solid bone.
Dr. Larson said, "Fusion surgery has always been a reliable treatment with long-lasting long-term results and a powerful correction of spinal curvature. But after fusion surgery, the spine does not regrow, and the fused spine does not regrow. There is no flexibility in the vertebrae. Some patients and families value the mobility and growth of the spine and prefer an alternative approach for severe scoliosis."
In August 2019, the U.S. Food and Drug Administration (FDA) granted Humane Use Medical Exemptions for two non-fusion surgical implants — vertebral tethering and posterior dynamic traction. This is a more limited approval that mentions the safety of the procedure but not its effectiveness. In this procedure, a frenulum is placed in the front of the spine through a small incision and secured to the vertebra where screws are placed through a 1-inch incision.
在手术过程中收紧这根系带，使脊柱伸直。随着儿童的发育，脊柱可能会变得更直。发育期儿童患有中度至重度脊柱侧凸以及某些类型的弯曲，可以有资格接受该医疗程序。
尽管能保留脊柱的运动性和生长，但该手术有潜在的缺陷。目前，若对脊柱侧凸矫正过度或矫正不足，二次手术的风险相比融合手术更高。该手术的长期耐久性尚不清楚，并且最终可能需要进行融合手术。
自FDA批准以来，于美国全国性地开展了更多关于椎体拴系术的研究。Larson医生和她的同事Todd Milbrandt医学博士正在领导一项经FDA批准的研究，旨在评估椎体拴系术后两年的效果。Larson医生还是Setting Scoliosis Foundation（矫正脊柱侧凸基金会）和Pediatric Spine Foundation（小儿脊柱基金会）为接受了椎体拴系术治疗的患者所建立的国际脊柱侧凸登记数据的妙佑医疗首席研究员。
Larson医生表示，“应该告知患者和家属他们有哪些治疗选择，因为有些家庭会想要融合手术的替代方案。关于非融合脊柱侧凸手术的更多信息将会陆续发布。如果患者对椎体拴系术感兴趣，我会建议他们去有经验的医学中心，因为这是一项新兴技术。”
相关英文内容：
妙佑医疗国际问与答：脊柱侧凸治疗选择
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