Vertebral body tethering compared to posterior spinal fusion for skeletally immature adolescent idiopathic scoliosis patients: preliminary results from a matched case–control study

Mathew, Smitha; Hargiss, John B.; Milbrandt, Todd A.; Stans, Anthony A.; Shaughnessy, William J.; Larson, A. Noelle

doi:10.1007/s43390-022-00519-3

Cited by 20 publications

(33 citation statements)

References 16 publications

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“…In this study, we report a cable breakage rate of 13%, which is substantially lower than prior studies ranging from 44 to 73%. [2][3][4][5][6][7][8][9][10][11][12][13][14] Patients who underwent IPSF had a similar revision rate at 17% compared with 39% in the AVBT group. Literature has estimated a revision rate of 3.5% to 9.9% in IPSF, whereas studies have reported revision rates in AVBT to range from 15% to 39%.…”

Section: Discussionmentioning

confidence: 93%

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Perioperative Outcomes of Open Anterior Vertebral Body Tethering and Instrumented Posterior Spinal Fusion for Skeletally Immature Patients With Idiopathic Scoliosis

Siu

Saggi

et al. 2022

Journal of Pediatric Orthopaedics

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Background: Correcting adolescent idiopathic scoliosis (AIS) without fusion can be achieved with anterior vertebral body tethering (AVBT). However, little is known about the perioperative outcomes, pain control, and clinical outcomes in patients undergoing AVBT compared with instrumented posterior spinal fusion (IPSF). Methods: In this retrospective cohort study, we compared pediatric patients with AIS who underwent either AVBT or IPSF. Inclusion criteria were based on the AVBT group, which included primary thoracic idiopathic scoliosis, Risser ≤1, curve magnitude 40 to 70 degrees, age 9 to 15, no prior spine surgery, index surgery between 2014 and 2019, and minimum 2-year follow-up. Patient demographics, perioperative metrics, pain visual analog scale scores, opiate morphine equivalent usage, cost data, and radiographic outcomes were compared. Results: We identified 23 patients who underwent AVBT and 24 matched patients in the IPSF group based on inclusion criteria. Patients undergoing AVBT and PSF were similar in age (12±1 y vs. 13±1 y, P=0.132) and average follow-up time (3.8±1.6 y vs. 3.3±1.4 y, P=0.210). There were 23 female patients (87%) in the AVBT group and 24 female (92%) patients in the IPSF group. Intraoperatively, estimated blood loss (498±290 vs. 120±47 mL, P<0.001) and procedure duration (419±95 vs. 331±83 min, P=0.001) was significantly greater in the IPSF group compared with AVBT. Length of stay was lower in the AVBT group compared with PSF (4±1 vs. 5±2 d, P=0.04). PSF patients had significantly greater total postoperative opiate morphine equivalent use compared with AVBT (2.2±1.9 vs. 5.6±3.4 mg/kg, P<0.001). Overall direct costs following PSF and AVBT were similar ($47,655+$12,028 vs. $50,891±$24,531, P=0.58). Preoperative radiographic parameters were similar between both the groups, with a major thoracic curve at 51±10 degrees for AVBT and 54±9 degrees for IPSF (P=0.214). At the most recent follow-up, IPSF patients had greater curve reduction to a mean major thoracic curve of 11±7 degrees (79%) compared with 19±10 degrees (63%) in AVBT patients (P=0.002). Nine patients (39%) required revision surgery following AVBT compared with 4 patients(17%) following IPSF (P=0.09). Conclusions: In a select cohort of patients, AVBT offers decreased surgical time, blood loss, length of stay, and postoperative opiate usage compared with IPSF. Although IPSF resulted in greater deformity correction at 2-year follow-up, the majority of patients who underwent AVBT had ≤35 major curves and avoided fusion. There is optimism for AVBT as a treatment option for select AIS patients, but long-term complications are still being understood, and the risk for revision surgeries remains high. Level of Evidence: Level III.

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Section: Discussionmentioning

confidence: 93%

“…Revision surgeries for overcorrection, cable breakage, and progression to fusion continue to remain concerns following tethering 2–10,12,13. Further, recent comparative studies have found lower revision rates and greater curve correction in patients who have undergone traditional IPSF 5,14,15…”

mentioning

confidence: 99%

Perioperative Outcomes of Open Anterior Vertebral Body Tethering and Instrumented Posterior Spinal Fusion for Skeletally Immature Patients With Idiopathic Scoliosis

Siu

Saggi

et al. 2022

Journal of Pediatric Orthopaedics

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“…VBT group grew significantly more with mean height gain 15 cm compared to 9 cm in PSF group ( 34 ). Additionally, at 2 years follow-up, Mattew et al reported that curve correction was superior at all timepoints in immature patients following PSF than after VBT (96% vs. 77%) with 19% complication rate in VBT group ( 36 ).…”

Section: Resultsmentioning

confidence: 98%

“…Non-revision related complication following VBT include atelectasis, pulmonary edema, hemothorax/chylothorax, Horner syndrome, wound infection, spinal canal penetrations among others ( 34 , 36 ). Pulmonary complications are the most frequent non-mechanical complications occurring within 6 weeks of VBT and all resolve without remaining complaints.…”

Section: Resultsmentioning

confidence: 99%

“…A study by Theologis et al comparing VBT and PSF at index and revision surgeries showed that VBT procedure had shorter operation time, fewer spinal levels instrumented, less blood loss with similar length of in-hospital stay but higher costs and more revision operations compared to PSF ( 43 ). Mathew et al found shorter recovery (lower operative time, blood loss, length of stay) in patients undergoing VBT group compared to those undergoing PSF ( 36 ). Average cost of VBT was greater than PSF at index surgery due to implant cost and postoperative care but similar at readmission/revision surgery in case of VBT related overcorrection/curve progression or PSF related junctional deformity ( 43 ).…”

Section: Resultsmentioning

confidence: 99%

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Vertebral body tethering: An alternative to posterior spinal fusion in idiopathic scoliosis?

Hammad

Balsano²,

Ahmad

2023

Front. Pediatr.

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IntroductionSkeletally immature patient with adolescent idiopathic scoliosis (AIS) whose curves continue to progress despite bracing should be treated surgically. Vertebral body tethering (VBT) is a non-fusion, compression-based, growth preserving alternative to posterior spinal fusion (PSF) based on the concept of ‘growth modulation’ to prevent possible functional complications secondary to fusion while correcting scoliotic deformity. This review aims to shed light on the indications of VBT, short- and medium-term outcomes, describe the surgical technique and associated complications, and to compare its efficacy to that of PSF.MethodsA review of peer-reviewed literature on VBT as a surgical technique, its indications, outcomes, complications, and comparison with other surgical interventions to correct AIS was conducted in December 2022.ResultsIndications remain controversial and mainly include stage of skeletal maturity based on radiographic markers, curve location, magnitude and flexibility, and presence of secondary curve. Assessment of VBT clinical success should not be restricted to improvement in radiographic parameters but should include functional results and patient-centered outcomes, improved body image and pain, and durability of outcomes. In contrast to fusion, VBT seems to be associated with preserved spinal growth, shorter recovery, potentially better functional outcomes, less motion loss but possibly less curve correction.DiscussionYet still, with VBT there exists a risk of overcorrection, construct breakage or failure of procedure which require revision and at times conversion to PSF. Patient and family preferences must be accounted for acknowledging gaps in knowledge, attributes and drawbacks of each intervention.

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Can anterior vertebral body tethering provide superior range of motion outcomes compared to posterior spinal fusion in adolescent idiopathic scoliosis? A systematic review

Wong,

Mong,

et al. 2023

Eur Spine J

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Purpose Anterior vertebral body tethering (AVBT) was introduced as a fusionless alternative to treating adolescent idiopathic scoliosis (AIS) while preserving range of motion (ROM). This is the first systematic review to compare the ROM outcomes between AVBT and PSF in treating AIS. Methods We conducted a comprehensive search on PubMed, EMBASE, MEDLINE, and Cochrane Library. Inclusion criteria were patients with AIS treated with AVBT or PSF or both, and clearly defined ROM outcomes; exclusion criteria were scoliosis other than AIS, biomechanical or cadaveric studies, non-English publications, case reports, conference summaries, unpublished literature, commentaries, and reviews. Primary outcome was ROM. Secondary outcomes included Cobb angle correction, quality of life (QOL), complications, and muscle strength and endurance. Results Twelve studies were included in this review. We found moderate evidence to support that AVBT results in superior ROM outcomes than PSF while achieving comparable Cobb angle correction with low evidence. The comparison of QOL outcomes between AVBT and PSF remained inconclusive. In addition to the complications noted conventionally in PSF, AVBT could result in over-correction and distal adding-on. We also found very low evidence to support that AIS patients treated with AVBT have superior muscle strength and endurance when compared to those treated with PSF. Conclusions AVBT provides better preservation of ROM and muscle strength postoperatively when compared with PSF, while achieving comparable curve correction. Future studies should explore the spinal growth trajectory to determine the window of opportunity for AVBT in AIS.

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Vertebral body tethering compared to posterior spinal fusion for skeletally immature adolescent idiopathic scoliosis patients: preliminary results from a matched case–control study

Cited by 20 publications

References 16 publications

Perioperative Outcomes of Open Anterior Vertebral Body Tethering and Instrumented Posterior Spinal Fusion for Skeletally Immature Patients With Idiopathic Scoliosis

Perioperative Outcomes of Open Anterior Vertebral Body Tethering and Instrumented Posterior Spinal Fusion for Skeletally Immature Patients With Idiopathic Scoliosis

Vertebral body tethering: An alternative to posterior spinal fusion in idiopathic scoliosis?

Can anterior vertebral body tethering provide superior range of motion outcomes compared to posterior spinal fusion in adolescent idiopathic scoliosis? A systematic review

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