Double-sided vertebral body tethering of double adolescent idiopathic scoliosis curves: radiographic outcomes of the first 13 patients with 2 years of follow-up
“…Sixteen studies reported the major curve pre- and post-operation and at final follow-up 13,14,22,23,25,28–31,34,35,37,38,41,43,45 (Figure 3). Ten studies reported kyphosis angle pre- and post-operation and at final follow-up 13,14,23,28,30,34,37,38,41,45 (Figure 4). Figure 2.Illustration of vertebral body tethering.…”
Purpose Over the past 12 years, vertebral body tethering (VBT) has been gradually promoted for treating scoliosis, but there are few published studies, with only short-term follow-up. This study aimed to systematically review VBT efficacy and safety for treating scoliosis. Methods PubMed, Web of Science, Embase, and the Cochrane Library were searched for studies on VBT treatment of scoliosis published up to November 2021. Two researchers independently screened the literature, extracted data, and assessed the risk of bias in included studies. Data on clinical efficacy, unplanned reoperations, and complications were extracted. The meta-analysis was performed with R 4.1.0. Results Twenty-six studies involving 1045 patients were included in the meta-analysis. The correction rate of major curve immediately post-operation was 46.6% ± 13.8% (16%–69%) and that at final follow-up was 53.2% ± 17.9% (16%–79%). The single-arm meta-analysis results of all included studies showed that VBT was effective in general. The overall clinical success rate was 73.02% (95% confidence interval [CI]: 68.31%–78.05%). The pooled overall unplanned reoperation rate was 8.66% (95% CI: 5.53%–13.31%). The overall incidence rate of complications was 36.8% (95% CI: 23.9%–49.7%). The subgroup analysis based on follow-up time indicated that patients with follow-up time >36 months had increased clinical success rate, unplanned reoperation rate, and incidence rate of complications compared with those with <36 months’ follow-up time. The preliminary results showed that after 36 months of follow-up, only 7.17% (95% CI: 4.81%–10.55%) of patients required posterior spinal fusion (PSF) surgery and nearly 93% of patients avoided spinal fusion surgeries. Conclusions The current evidence from at least 3-year follow-up in different countries indicates that VBT is an effective surgical approach for treating scoliosis, with 73.88% of patients achieving clinical success. Nevertheless, about one in seven patients (15.8%) required unplanned reoperations, but only 7.17% required PSF. About half (52.17%) of the patients experienced complications. Due to the limitation of the study number and quality, our conclusion may be biased and requires verification by further studies with longer follow-up times.
“…Sixteen studies reported the major curve pre- and post-operation and at final follow-up 13,14,22,23,25,28–31,34,35,37,38,41,43,45 (Figure 3). Ten studies reported kyphosis angle pre- and post-operation and at final follow-up 13,14,23,28,30,34,37,38,41,45 (Figure 4). Figure 2.Illustration of vertebral body tethering.…”
Purpose Over the past 12 years, vertebral body tethering (VBT) has been gradually promoted for treating scoliosis, but there are few published studies, with only short-term follow-up. This study aimed to systematically review VBT efficacy and safety for treating scoliosis. Methods PubMed, Web of Science, Embase, and the Cochrane Library were searched for studies on VBT treatment of scoliosis published up to November 2021. Two researchers independently screened the literature, extracted data, and assessed the risk of bias in included studies. Data on clinical efficacy, unplanned reoperations, and complications were extracted. The meta-analysis was performed with R 4.1.0. Results Twenty-six studies involving 1045 patients were included in the meta-analysis. The correction rate of major curve immediately post-operation was 46.6% ± 13.8% (16%–69%) and that at final follow-up was 53.2% ± 17.9% (16%–79%). The single-arm meta-analysis results of all included studies showed that VBT was effective in general. The overall clinical success rate was 73.02% (95% confidence interval [CI]: 68.31%–78.05%). The pooled overall unplanned reoperation rate was 8.66% (95% CI: 5.53%–13.31%). The overall incidence rate of complications was 36.8% (95% CI: 23.9%–49.7%). The subgroup analysis based on follow-up time indicated that patients with follow-up time >36 months had increased clinical success rate, unplanned reoperation rate, and incidence rate of complications compared with those with <36 months’ follow-up time. The preliminary results showed that after 36 months of follow-up, only 7.17% (95% CI: 4.81%–10.55%) of patients required posterior spinal fusion (PSF) surgery and nearly 93% of patients avoided spinal fusion surgeries. Conclusions The current evidence from at least 3-year follow-up in different countries indicates that VBT is an effective surgical approach for treating scoliosis, with 73.88% of patients achieving clinical success. Nevertheless, about one in seven patients (15.8%) required unplanned reoperations, but only 7.17% required PSF. About half (52.17%) of the patients experienced complications. Due to the limitation of the study number and quality, our conclusion may be biased and requires verification by further studies with longer follow-up times.
“…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].…”
BACKGROUND: Vertebral body tethering (VBT) may represent a paradigm shift in the management of adolescent idiopathic scoliosis (AIS). However, the ideal candidates, who may profit the most from this technique, have not yet been identified. We evaluated patients based on their curve type and on the potential benefits of VBT over fusion and developed a new classification to guide decision making for VBT, evaluating 5 different curve types (lumbar, double, long thoracic, short thoracic, presence of high thoracic curve). This study analyzed the inter- and intrarater variability of this new classification. METHODS: 11 spinal deformity surgeons contributed to the validation. Four radiographs (p. a., lateral, right and left p. a. side bending) were prepared for 27 patients. Two sets of the patients’ images were sent to each participant, with identical radiographs but in different order. Each participant was given instructions on how to employ the classification and was asked to apply it to the radiographs. The inter- and intra-observer reliability was assessed evaluating the kappa coefficient (k).RESULTS: The overall inter-observer reliability was k = 0.84 (confidence interval: 0.76 to 0.91). The overall intra-observer reliability was k = 0.88 (confidence interval 95%: 0.68 to 1.00). All k values were statistically significant and indicated an excellent inter- and intra-observer reliability of the classification.CONCLUSION: The newly developed classification for VBT planning showed an excellent reliability.
“…Bei den thorakolumbalen/lumbalen Kurven ist die Indikation nach Newton [10] und damit einem der Inauguratoren des Verfahrens als noch nicht klar definiert anzusehen. Pehlivanoglu et al [19] sehen die oben genannten Kriterien auch für die Versorgung von Lenke 1c Kurven bzw. Typ 6 Kurven.…”
Section: Indikationunclassified
“…Über die operativ-technische Machbarkeit der Versorgung von Doppelkurven berichten Baroncini et al [29]. Pehlivanoglu et al [19] stellen eine Studie mit einem 2 Jahres Follow-up bei Doppelkurven (Lenke 1c oder 6) mit Korrekturen von 80% ohne relevante Komplikationen vor.…”
Section: Initiale Korrektur Und Wachstumslenkungunclassified
ZusammenfassungMit dem Anterior Vertebral Body Tethering (AVBT) steht eine Technik zur Verfügung, welche für die idiopathische Adoleszentenskoliose unter definierten Voraussetzungen eine Wachstumslenkung und damit Korrektur bei weitestgehend Funktionserhalt verspricht. Evidenz liegt im Moment nur für das thorakale AVBT entsprechend den Evidenzgraden III und IV vor. Für lumbale und thorakolumbale Kurven ist auf der Grundlage der zur Verfügung stehenden Literatur in Bezug auf eine mögliche Evidenz keine Aussage möglich. Für einen Einsatz nach Wachstumsabschluss findet sich in der Literatur keine Unterstützung. In Diskussion verbleibt der optimale Operationszeitpunkt in Bezug auf die Skelettreife. Die hohe in der Literatur dokumentierte Zahl an Komplikationen und Nachoperationen erfordert eine weitere Evaluation und Optimierung des Verfahrens.
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