Thoracoscopic Vertebral Body Tethering for Adolescent Idiopathic Scoliosis: A Minimum of 2 Years’ Results of 21 Patients

Abstract

Background: Anterior vertebral body tethering (VBT) is a growth modulating and fusionless treatment option that is considered as a new promising method for the management of adolescent idiopathic scoliosis (AIS). This prospective cohort study aimed to present the minimum 2-year results of anterior VBT applied to 21 skeletally immature patients with AIS. Methods: Twenty-one skeletally immature patients with a diagnosis of AIS were included. A decision to proceed with surgery was established after the detection of curve progression despite the brace (>40 degrees) with a minimum curve flexibility of 30%. Results: Patients had an average age of 11.1 and an average follow-up period of 27.4 months. All patients underwent thoracoscopic placement of thoracic screws, from the convex side of curves. An average of 7.1 levels of tethering was undertaken. Average preoperative major thoracic curve magnitudes improved from 48.2 to 16 degrees on the first erect postoperative x-ray, and to 10 degrees at the last follow-up (P<0.001). Immediate postoperatively, 1 case with chylothorax was detected and treated conservatively, and another case with tether breakage was detected at the third postoperative year and replaced thoracoscopically. No other major complication was acquired. Conclusions: Anterior VBT as a growth modulating treatment option by allowing the correction of the scoliotic deformity and preserving coronal balance was detected to be a safe and effective option for the surgical treatment of AIS in skeletally immature patients, if applied under strict inclusion criteria. VBT by allowing preservation of spinal segmental motion is yielding promising radiographic results without causing any major complications. Level of Evidence: Level IV.

Validation of A New Classification System For Surgical Planning of Vertebral Body Tethering (VBT)

“…This surgical technique has been shown to have an acceptably low perioperative complication pro le and a relatively short learning curve even for surgeons not previously familiar with anterior spinal surgery [11,25,26]. Although promising results are increasingly being reported, little is as yet known about the ideal candidate, the optimal surgical planning and the best surgical technique [8,25,27,28]. In our own clinical experience, we noticed that skeletal maturity and curve exibility may not be the most important parameters for our decision making, as good results have been obtained both in growing patients and in patients approaching skeletal maturity [1,20].…”

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

“…57 At this WTP threshold, VBT was cost-effective in 66.4% of probabilistic iterations, suggesting that the results are robust with respect to combined parameter uncertainty, although the limitations associated with studies reporting clinical outcomes for the VBT procedure should be considered in the interpretation of these findings. At the time of these analyses, studies reporting clinical outcomes for the VBT procedure include relatively small patient numbers, [34][35][36][37][38] with a small subset of those who reported key patient-reported outcomes 34,35 needed for a costeffectiveness analysis as compared to the extensive reporting of studies describing spinal fusion for pediatric patients with IS spanning decades and large sample sizes. 7,43 Also, studies reporting clinical outcomes for the VBT procedure provide a maximum length of follow-up of 7 years, whereas the base case time horizon for the CUA was 15 years.…”

“…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.…”

The Role of Vertebral Body Tethering in Treating Skeletally Immature Scoliosis

“…The latter authors evaluated preliminary 1-year outcomes of VBT patients and demonstrated a mean 24.9° correction of thoracic curves, with only 1 reported medical complication (atelectasis). Like other previous studies, their emphasis was on Lenke 1 (main thoracic) curves [6,8,[11][12][13]15], whereas Hoernschemeyer et al evaluated efficacy across subgroups on the basis of curve type and treatment, maintained a high follow-up rate (93.5%), and had well-defined time points to assess radiographic outcomes postoperatively and at 6 months, 1 and 2 years, and most recent follow-up.…”

“…Given its novelty, the optimal indications and long-term outcomes for VBT have yet to be elucidated. Several studies have shown successful VBT treatment with intervention limited to patients with main thoracic curves [6,11,13,15]. Without long-term outcomes, it is difficult to compare VBT to other methods of spinal deformity correction.…”