Nonfusion treatment of adolescent idiopathic XXXX by growth modulation and remodeling.

@entity1 @entity1615 @entity1635 @entity15296 @entity13949
BACKGROUND: @entity1615 ( @entity1615 ) is a common disorder in which the spine gradually develops a curvature that is first detected in @entity1 between 11 and 17 years of age. The only accepted treatment methods are bracing and surgery. Whether brace treatment alters the natural history is being questioned, and @entity1 compliance is low. Surgery usually includes a spinal fusion that creates a rigid spine and concentrates stresses at the ends. METHODS: This study focuses on correlating the laboratory results with clinical reports for @entity15296 @entity1 with @entity1615 . In the laboratory, @entity1635 with @entity13949 has been created by asymmetric mechanical loading and has been corrected by reversing the loading. In the clinic, bracing and derotational casting have been successful in some reports, but compliance has been a problem with bracing and derotational casts have mainly been used in young @entity1 . Operative treatment has been successful, but a nonfusion operation remains elusive. FINDINGS AND RESULTS: In the laboratory, axial loading of growth plates altered growth according to the Hueter-Volkmann law, which states that compression decreases and distraction increases growth. Asymmetric loading of the spine caused asymmetric growth resulting in @entity1635 with @entity13949 . Asymmetric loading of tail vertebrae created @entity13949 according to Wolff's law, which states that the bone remodels over time in response to prevailing mechanical demands. In the clinic, studies have shown that bracing may work if @entity1 wore the brace as prescribed. Derotational casting in young @entity1 has been shown to prevent progression and even correct the @entity1635 in some @entity1 . Convex vertebral stapling has been successful in mild curves, but the results in larger curves have been disappointing. Anterolateral tethering has been successful in mild curves in young @entity1 , but there is limited experience with this technique in @entity1 with large curves. CONCLUSIONS: A brace that applies the appropriate loading and is worn as prescribed may dramatically improve the results of brace treatment. A procedure using external fixation or adjustable anterolateral tethering may achieve a nonfusion correction of @entity1615 . LEVEL OF EVIDENCE: Level II.
