Could have tethered: predicting the proportion of scoliosis patients most appropriate for thoracic anterior spinal tethering

Krakow, Arielle R; Magee, Lacey C; Cahill, Patrick J.; Flynn, John M.

doi:10.1007/s43390-021-00296-5

Cited by 10 publications

(9 citation statements)

References 28 publications

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“…VBT is a non-fusion surgical technique for correction of scoliosis in skeletally immature children ( 9 ). Current FDA indications include a skeletally immature individual age 8–16 with major Cobb angle 35°–60° involving thoracic, lumbar or thoracolumbar curves that failed or did not tolerate bracing ( 4 , 9 ). Skeletal maturity is defined as Sanders bone age ≤5 or Risser grade ≤2, and curves ≥65° are thought to be too severe for tethering.…”

Section: Methodsmentioning

confidence: 99%

“…It was found that 75/359 patients (20.9%) of patients met FDA criteria of VBT and should have undergone tethering when in fact only 18/75 (25%) underwent VBT and the rest were treated with PSF. The study found that an ideal tethering candidate is a Sanders ≤3 at the time of operation ( 4 ).…”

Section: Methodsmentioning

confidence: 99%

“…Posterior spinal fusion (PSF) with pedicle screw instrumentation is indicated in patients with advanced Cobb's angle who failed conservative treatment with evidence of progression of clinical imbalance and radiographic worsening, and have been the traditional method for scoliosis correction. Recently, however, there has been concerns about the effect of spinal fusion on the spine in terms of biomechanics and flexibility ( 4 ). As such, and in line with the concept of growth modulation, vertebral body tethering (VBT) has been introduced as a new therapeutic modality to overcome the functional complications associated with PSF by providing a means for children to harness remaining spinal growth to produce correction ( 5 , 6 ).…”

Section: Introductionmentioning

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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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

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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“…7 Due to its spinal non-fusion characteristics and reinvention of “old” anterior techniques, VBT again demonstrates the advantages of anterior techniques. Since its first application to IS in 2010, 8 VBT has gradually been widely used 9 and has become a hot topic in scoliosis orthopedic techniques. Different investigators have conducted studies on treating scoliosis with VBT, but most of these studies are case series reports lacking sufficient and effective randomized controlled trials and involving relatively few patients.…”

Section: Introductionmentioning

confidence: 99%

Minimum 3-year experience with vertebral body tethering for treating scoliosis: A systematic review and single-arm meta-analysis

Zhu

Qiu

Liu

et al. 2022

J Orthop Surg (Hong Kong)

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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.

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“…However, nonfusion techniques, including vertebral body tethering (VBT), are increasing in popularity as an alternative to treat deformity while preserving spinal motion and growth 2–4 . The ability of the anterior tether to induce growth modulation and correction of spinal deformity via the Heuter-Volkman principle has been demonstrated in both animal and clinical studies 5–9 . In addition, controversies continue to exist for patient selection and the timing of surgery in a growing adolescent or child 10 .…”

mentioning

confidence: 99%

Evidence-based Indications for Vertebral Body Tethering in Spine Deformity

Sullivan,

Jackson,

Milbrandt

et al. 2023

Clinical Spine Surgery: A Spine Publication

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Posterior spinal fusion has long been established as an effective treatment for the surgical management of spine deformity. However, interest in nonfusion options continues to grow. Vertebral body tethering is a nonfusion alternative that allows for the preservation of growth and flexibility of the spine. The purpose of this investigation is to provide a practical and relevant review of the literature on the current evidence-based indications for vertebral body tethering. Early results and short-term outcomes show promise for the first generation of this technology. At this time, patients should expect less predictable deformity correction and higher revision rates. Long-term studies are necessary to establish the durability of early results. In addition, further studies should aim to refine preoperative evaluation and patient selection as well as defining the benefits of motion preservation and its long-term effects on spine health to ensure optimal patient outcomes.

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Could have tethered: predicting the proportion of scoliosis patients most appropriate for thoracic anterior spinal tethering

Cited by 10 publications

References 28 publications

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

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

Minimum 3-year experience with vertebral body tethering for treating scoliosis: A systematic review and single-arm meta-analysis

Evidence-based Indications for Vertebral Body Tethering in Spine Deformity

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