Early operative morbidity in 184 cases of anterior vertebral body tethering

Meyers, James H.; Eaker, Lily; Treuheim, Theodor Di Pauli von; Dolgovpolov, Sergei; Lonner, Baron

doi:10.1038/s41598-021-02358-0

Cited by 9 publications

(3 citation statements)

References 40 publications

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“…As VBT requires an intrathoracic access with lung deflation, the use of an intrathoracic drain is necessary to prevent the development of secondary pneumothorax and pleural effusion. Nonetheless, pulmonary complications are not infrequent and occur in 7–10% of patients [ 1 – 5 ]. While recent studies have showed that the short-term lung function is not affected by the development of these complications [ 6 , 7 ], there is an ongoing effort toward identifying their possible risk factors [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical experience and complications with limited pleural dissection combined with a novel, simplified technique for thoracic Redon-like drain in vertebral body tethering

Courvoisier,

Maximin,

Daniel

et al. 2023

Spine Deform

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Purpose To report on our experience with a simplified, suction-bottle-drain technique of thoracic drain (Redon-like) combined with fully thoracoscopic vertebral body tethering (VBT) and a limited pleural approach, with particular focus on the rate of pulmonary complications. Methods A retrospective study was performed on all consecutive patients who underwent VBT for adolescent idiopathic scoliosis. For all subjects, a 10G Redon drain, an active drain system consisting of a perforated tube and a suction bottle, was placed intrathoracically and tunneled under the skin. All drains were removed on the first postoperative day. Perioperative and postoperative data such as type of access, length of surgery, amount of fluid collection in the drain, and length of hospital stay were collected. The type and number of pulmonary complications occurring in the first 3 months after surgery, along with their symptoms and management, were recorded. Results One Hundred eighty-two patients were included in the analysis. The mean length of surgery was 97 min (75–120). The average fluid collection in the drain was 30 ml (5–50), the mean length of hospital stay was 3 days (2–4). During the observation period, pulmonary complications occurred in five patients (2%). Two patients presented an aseptic right pleural effusion; for two patients, a residual pneumothorax was diagnosed on the X-rays in the recovery room and one patient developed a chylothorax. All patients recovered without sequelae. Conclusion The simplified, Redon-like drain combined with a fully thoracoscopic VBT and limited pleural approach seems a safe and effective alternative to the chest drain. This technique allows to remove the drain on the first postoperative day, thus simplifying the management of the patients and improving their comfort.

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Section: Introductionmentioning

confidence: 99%

Clinical experience and complications with limited pleural dissection combined with a novel, simplified technique for thoracic Redon-like drain in vertebral body tethering

Courvoisier,

Maximin,

Daniel

et al. 2023

Spine Deform

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“…2 Spine flexibility and motion are maintained. 2,3 Early studies have demonstrated effective deformity correction-up to 71%-the complication rate was not trivial; 1,[4][5][6][7] the reoperation rate ranges from 3% to 24%. 1,2,5,6 Some reoperations involve the release of the tether secondary to overcorrection.…”

mentioning

confidence: 99%

What Happens After a Vertebral Body Tether Break? Incidence, Location, and Progression with 5-Year Follow-up

Yang

Samdani²,

Pahys³

et al. 2023

Spine

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Study Design. Retrospective review. Objective. To study risk factors for anterior vertebral body tether (VBT) breakage. Summary of Background Data. VBT is used to treat adolescent idiopathic scoliosis in skeletally immature patients. However, tethers break in up to 48% of cases. Materials and Methods. We reviewed 63 patients who underwent thoracic and/or lumbar VBT with a minimum fiveyear follow-up. We radiographically characterized suspected tether breaks as a change in interscrew angle > 5°. Demographic, radiographic, and clinical risk factors for presumed VBT breaks were evaluated. Results. In confirmed VBT breaks, the average interscrew angle change was 8.1°, and segmental coronal curve change was 13.6°, with a high correlation (r = 0.82). Our presumed VBT break cohort constituted 50 thoracic tethers, four lumbar tethers, and nine combined thoracic/lumbar tethers; the average age was 12.1 ± 1.2 years and the mean follow-up was 73.1 ± 11.7 months. Of 59 patients with thoracic VBTs, 12 patients (20.3%) had a total of 18 breaks. Eleven thoracic breaks (61.1%) occurred between two and five years postoperatively, and 15 (83.3%) occurred below the curve apex (P < 0.05). The timing of thoracic VBT breakage moderately correlated with more distal breaks (r = 0.35). Of 13 patients who underwent lumbar VBT, eight patients (61.5%) had a total of 12 presumed breaks. Six lumbar breaks (50%) occurred between one and two years postoperatively, and seven (58.3%) occurred at or distal to the apex. Age, sex, body mass index, Risser score, and curve flexibility were not associated with VBT breaks, but the association between percent curve correction and thoracic VBT breakage trended toward significance (P = 0.054). Lumbar VBTs were more likely to break than thoracic VBTs (P = 0.016). Seven of the patients with presumed VBT breaks (35%) underwent revision surgery. Conclusions. Lumbar VBTs broke with greater frequency than thoracic VBTs, and VBT breaks typically occurred at levels distal to the curve apex. Only 15% of all patients required revision.

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“…Few studies, however, have compared AVBT and IPSF with respect to perioperative outcomes, which is a potential area where AVBT patients can derive the greatest benefit 5,10,11,16,17. Newton et al5 compared perioperative metrics for AVBT and IPSF, reporting increased surgical time and blood loss in patients undergoing IPSF.…”

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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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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Early operative morbidity in 184 cases of anterior vertebral body tethering

Cited by 9 publications

References 40 publications

Clinical experience and complications with limited pleural dissection combined with a novel, simplified technique for thoracic Redon-like drain in vertebral body tethering

Clinical experience and complications with limited pleural dissection combined with a novel, simplified technique for thoracic Redon-like drain in vertebral body tethering

What Happens After a Vertebral Body Tether Break? Incidence, Location, and Progression with 5-Year Follow-up

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

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