Abstract
The Hueter-Volkmann law explains the physiological response of the growth plate under mechanical loading. This law mainly explains the pathological mechanism for growing long-bone deformities. Vertebral endplates also show a similar response under mechanical loading. Experimental studies have provided information about spinal growth modulation and, now, it is possible to explain the mechanism of the curvature progression. Convex growth arrest is shown to successfully treat deformities of the growing spine and unnecessary growth arrest of the whole spine is prevented. Both anterior and posterior parts of the convexity should be addressed to achieve a satisfactory improvement in the deformity, albeit epiphysiodesis effect cannot be stipulated at all times. Anterior vertebral body stapling without fusion yielded better results with new shape memory alloys and techniques. This method can be used with minimally invasive techniques and has the potential advantage of producing reversible physeal arrest. Instrumented posterior hemiepiphysiodesis seems to be as effective as classical combined anterior and posterior arthrodesis, where it is less invasive and morbid. Convex hemiepiphysiodesis with concave-side distraction through growing rod techniques provide a better control of the curve immediately after surgery. This method has the advantages of posterior instrumented hemiepiphysiodesis, but necessitates additional surgeries. Concave-side rib shortening and/or convex-side lengthening is an experimental method with an indirect effect on spinal growth. To conclude, whatever the cause of the spinal deformity, growth modulation can be used to manage the growing spine deformities with no or shorter segment fusions.
Highlights
The treatment of the growing spine deformities are challenging
The Hueter–Volkmann law, which is primarily applicable to the long bones, indicates that the concave side of the deformity undergoes non-physiological loading, and this produces a suppression of the growth at the physis [5]
Spinal growth modulation is studied in bovine models and antero-lateral tethering with a body screw and flexible cable system yielded scoliosis with concavity on the implantation side
Summary
The treatment of the growing spine deformities are challenging. The vertebral body grows to a long bone: ossification starts posterior, radiates cranial and caudally, and fully ossifies after the age of 25 years [1]. The Hueter–Volkmann law, which is primarily applicable to the long bones, indicates that the concave side of the deformity undergoes non-physiological loading, and this produces a suppression of the growth at the physis [5]. Treatment modalities based on the Hueter–Volkmann law have been successfully used for many years in the management of long-bone deformities. J Child Orthop (2009) 3:1–9 management of long-bone deformities rely on passive tethering. Smith et al adapted this passive tethering to the spine via anterior stapling, but the results were not satisfactory mainly due to inappropriate implant designs. Recent studies have elucidated the vertebral growth mechanisms and pioneered more secure implant designs, which have made the growth modulation concept popular once again [8,9,10,11]
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