Anterior Vertebral Body Tethering for Adolescent Scoliosis with Growth Remaining

Hoernschemeyer, Daniel G.; Boeyer, Melanie E; Robertson, Madeline E; Loftis, Christopher M.; Worley, John R.; Tweedy, Nicole M; Gupta, Sumit U; Duren, Dana L.; Holzhauser, Christina M; Ramachandran, Venkataraman

doi:10.2106/jbjs.19.00980

Cited by 125 publications

(165 citation statements)

References 15 publications

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“…This was based on the number of instrumented levels reported for patients across the ongoing VBT observational study (NCT02897453), and another independent study in which patients received VBT. 35,39 Comparator(s)…”

Section: Dovepressmentioning

confidence: 99%

“…To derive VBT revision rates, revision event data were pooled from the 88 patients included across NCT02897453 and Hoernschemeyer et al 35,39 Calculations used to derive these rates are presented in Supplementary Table 1 A constant rate of VBT revision was assumed, allowing for the calculation of quarterly revision rates.…”

Section: Transition Probabilitiesmentioning

confidence: 99%

“…As specified, Ahmed et al had a maximum follow-up of 10 years, whereas NCT02897453 had a mean follow-up of 4.8 years (range: 2-7 years), and Hoernschemeyer et al 3.2 years (range: 2.2-5.2 years). 35,39 Since re-revision rates were not identified in the literature, it was assumed that the rate of VBT or spinal fusion revision was independent of the number of prior revisions.…”

Section: Transition Probabilitiesmentioning

confidence: 99%

“…Anterior vertebral body tethering (VBT) is a nonfusion, minimally invasive growth-modulating procedure that can provide treatment without the need for fusion ( Figure 1B); early reports of the clinical efficacy and safety of VBT indicate some positive outcomes for skeletally immature patients aged >10 years with IS. [34][35][36][37][38] Spinal tethering offers an alternative treatment to spinal fusion for pediatric patients aged >10 years with IS where significant continued growth is expected. Compared with spinal fusion, VBT may minimize the impact on growth while offering improved range of motion and faster return to normal activities.…”

mentioning

confidence: 99%

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Cost-Utility Analysis of Anterior Vertebral Body Tethering versus Spinal Fusion in Idiopathic Scoliosis from a US Integrated Healthcare Delivery System Perspective

Polly¹,

Larson²,

Samdani³

et al. 2021

CEOR

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Anterior vertebral body tethering (VBT) is a non-fusion, minimally invasive, growth-modulating procedure with some early positive clinical outcomes reported in pediatric patients with idiopathic scoliosis (IS). VBT offers potential health-related quality of life (HRQoL) benefits over spinal fusion in allowing patients to retain a greater range of motion after surgery. We conducted an early cost-utility analysis (CUA) to compare VBT with fusion as a first-choice surgical treatment for skeletally immature patients (age >10 years) with moderate to severe IS, who have failed nonoperative management, from a US integrated healthcare delivery system perspective. Patients and Methods: The CUA uses a Markov state transition model, capturing a 15year period following index surgery. Transition probabilities, including revision risk and subsequent fusion, were based on published surgical outcomes and an ongoing VBT observational study (NCT02897453). Patients were assigned utilities derived from published patient-reported outcomes (PROs; SRS-22r mapped to EQ-5D) following fusion and the above VBT study. Index and revision procedure costs were included. Probabilistic (PSA) and deterministic sensitivity analyses (DSA) were performed. Results: VBT was associated with higher costs but also higher quality-adjusted life years (QALYs) than fusion (incremental costs: $45,546; QALYs gained: 0.54). The subsequent incremental cost-effectiveness ratio for VBT vs fusion was $84,391/QALY gained. Mean PSA results were similar to the base case, indicating that results were generally robust to uncertainty. The DSA indicated that results were most sensitive to variations in utility values. Conclusion: This is the first CUA comparing VBT with fusion in pediatric patients with IS and suggests that VBT may be a cost-effective alternative to fusion in the US, given recommended willingness-to-pay thresholds ($100,000-$150,000). The results rely on HRQoL benefits for VBT compared with fusion. For improved model accuracy, further analyses with longer-term PROs for VBT, and comparative effectiveness studies, would be needed.

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Section: Dovepressmentioning

confidence: 99%

Section: Transition Probabilitiesmentioning

confidence: 99%

Section: Transition Probabilitiesmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Cost-Utility Analysis of Anterior Vertebral Body Tethering versus Spinal Fusion in Idiopathic Scoliosis from a US Integrated Healthcare Delivery System Perspective

Polly¹,

Larson²,

Samdani³

et al. 2021

CEOR

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show abstract

“…This technique allows for curve correction while maintaining spine mobility, which is of particular relevance in the lumbar spine. VBT has been investigated with promising results [1][2][3][4][5][6][7][8], but further research is being conducted to define the role of VBT in the treatment of AIS and to identify the ideal candidate for this intervention. VBT was developed to employ the Hüter-Volkmann principle to modulate spine growth through a unilateral block of growth plates [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Learning curve for vertebral body tethering: analysis on 90 consecutive patients

Baroncini

Trobisch²,

Migliorini

2020

Spine Deform

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Study design Retrospective study. Objectives Vertebral body tethering (VBT) is raising interest for the treatment of adolescent idiopathic scoliosis (AIS), but many scoliosis surgeons have not been trained in anterior surgical approaches. We analyzed data of our first patients to define the learning curve for VBT. Summary of background data VBT has shown encouraging results in the treatment of growing AIS patients, but there is a paucity of data and long-term results are not yet available. To our best knowledge, there is no published data regarding the learning curve for VBT. Methods A retrospective analysis was performed, of all consecutive patients who underwent VBT at our Institution. Outcomes of interest were intubation time, surgical duration and estimated blood loss per screw and hospitalization length. For the statistical analysis, we referred to a linear model regression diagnostic and we used the Pearson product-moment correlation (r) for pairwise correlation. The final effect ranked between + 1 and − 1. Results Data of 90 patients were analyzed, age 14.6 ± 1.8 years. On average, 9.4 ± 2.6 levels were instrumented. Per screw, mean intubation time was 33.1 ± 7.6 min (r = − 0.57; p > 0.0001), mean surgical duration 21.3 ± 5.7 min (r = − 0.55; p > 0.0001), mean estimated blood loss 21.3 ± 18.2 ml (r = − 0.66; p > 0.0001). Mean hospitalization length was 8.3 ± 3.1 days (r = − 0.32; p = 0.002). No intraoperative complications were reported. Conclusion VBT has a rapid learning curve: the estimated blood loss per screw is expected to decrease by 60%, intubation time and surgical duration by over 50%, and hospitalization length by 32% for each treated patient. Level of evidence III.

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Defining the segmental tension generated in a vertebral body tethering system for scoliosis

Upasani,

Farnsworth,

Caffrey

et al. 2024

Journal Orthopaedic Research

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Vertebral body tethering (VBT) uses a flexible tether affixed across the curve convexity with tension applied at each segment to treat scoliosis. Intraoperative tether tension may be achieved directly with a counter‐tensioner or with an extension spring tube. The purpose of this study was to quantify the force generated with and without the extension spring tube using current FDA‐approved VBT instrumentation, to understand the variation between surgeons using the same instrumentation, and to define the force range that is generated intra‐operatively. Using a benchtop mechanical testing setup to simulate a spinal segment, we affixed the tether and applied tension using a tensioner and counter‐tensioner alone (method T1) or by adding an extension spring tube (method T2). Eight orthopedic surgeons used T1 and T2 at six tensioner settings, and one surgeon completed three trials. A two‐way ANOVA with a Tukey's HSD post hoc test (p < 0.05) compared the tensioner methods and testing levels. Inter‐ and intra‐rater reliabilities were calculated using intraclass correlation coefficients (ICCs). Methods T1 and T2 exhibited linear tension‐setting relationships, with high determination coefficients (R2 > 0.93). T2 consistently produced higher forces (increase of 62.1 N/setting), compared to T1 (increase of 50.6 N/setting, p < 0.05). Inter‐rater reliability exhibited excellent agreement (ICC = 0.951 and 0.943 for T1 and T2, respectively), as did intra‐rater reliability (ICC = 0.971).

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Anterior Vertebral Body Tethering for Adolescent Scoliosis with Growth Remaining

Cited by 125 publications

References 15 publications

Cost-Utility Analysis of Anterior Vertebral Body Tethering versus Spinal Fusion in Idiopathic Scoliosis from a US Integrated Healthcare Delivery System Perspective

Cost-Utility Analysis of Anterior Vertebral Body Tethering versus Spinal Fusion in Idiopathic Scoliosis from a US Integrated Healthcare Delivery System Perspective

Learning curve for vertebral body tethering: analysis on 90 consecutive patients

Defining the segmental tension generated in a vertebral body tethering system for scoliosis

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