Preliminary outcomes after vertebral body tethering (VBT) for lumbar curves and subanalysis of a 1- versus 2-tether construct

Trobisch, Per; Baroncini, Alice

doi:10.1007/s00586-021-07009-6

Cited by 33 publications

(55 citation statements)

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“…The effect and relevance of tether breakage on the clinical results of VBT have been questioned [17,18]. In fact, some authors have observed that not all patients requiring revision had a tether breakage [19], while others have shown that a breakage does not always imply the necessity of revision surgery [20]. The timing of the breakage may, at least in part, offer an explanation for these unclear findings, as only early breakages occurring within the first 12 months would lead to a significant loss of correction.…”

Section: Discussionmentioning

confidence: 99%

The timing of tether breakage influences clinical results after VBT

et al. 2022

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Introduction Tether breakage is a frequent mechanical complications after vertebral body tethering (VBT), but not all patients with a breakage show loss of correction. The reason of this clinical finding has not yet been clarified. We hypothesized that the integrity of the tether is relevant only in the early stages after VBT, when it drives growth modulation and tissue remodelling. After these mechanisms have taken place, the tether loses its function and a breakage will not alter the new shape of the spine. Thus, tether breakage would have a greater clinical relevance when occurring shortly after surgery. Methods All consecutive patients who underwent VBT and had a min. 2-year follow-up were included. The difference in curve magnitude between the 1st standing x-ray and the last follow-up was calculated (ΔCobb). For each curve, the presence and timing of tether breakage were recorded. The curves were grouped according to if and when the breakage was observed (no breakage, breakage at 0–6 months, 6–12 months, > 12 months). The ΔCobb was compared among these groups with the analysis of variance (ANOVA). Results Data from 152 curves were available: 68 with no breakage, 12 with a breakage at 0–6 months, 37 at 6–12 months and 35 > 12 months. The ANOVA found significant difference in the ΔCobb among the groups (Sum of square 2553.59; degree of freedom 3; mean of square 851.1; Fisher test 13.8; P < 0.0001). Patients with no breakage or breakage at > 12 months had similar ΔCobb (mean 4.8° and 7.8°, respectively, P = 0.3), smaller than the 0–6 or 6–12 groups (15.8° and 13.8°, respectively). Conclusion Tether breakage leads to a consistent loss of correction when occurring within the first 12 months, while it has limited clinical relevance when occurring later on.

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Section: Discussionmentioning

confidence: 99%

The timing of tether breakage influences clinical results after VBT

et al. 2022

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“…All complications were assessed. Tether breakage was assessed radiographically by the coronal angulation between adjacent screws increasing 5 degrees or more between first erect and latest follow-up [ 1 , 10 , 17 ]. Clinical success has been previously defined elsewhere as residual major curvature of either ≤35° or ≤30° and no indication for PSF at latest follow-up [ 1 , 10 ].…”

Section: Methodsmentioning

confidence: 99%

Vertebral Body Tethering in 49 Adolescent Patients after Peak Height Velocity for the Treatment of Idiopathic Scoliosis: 2–5 Year Follow-Up

Meyers

Eaker

Zhang

et al. 2022

JCM

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Vertebral Body Tethering (VBT) is a non-fusion surgical treatment for Adolescent Idiopathic Scoliosis (AIS) that elicits correction via growth modulation in skeletally immature patients. VBT after peak height velocity is controversial and is the subject of this study. A retrospective review of Risser 3–5 AIS patients treated with VBT, and min. 2-year FU was performed. Pre to post-op changes in clinical outcomes were compared using Student’s t-test or the Mann-Whitney test. A total of 49 patients met criteria, age 15.0 ± 1.9 years, FU 32.5 ± 9.1 months. For thoracic (T) major curvatures, T curvature improved from 51.1 ± 6.9° to 27.2° ± 8.1° (p < 0.01) and TL from 37.2° ± 10.7° to 19.2° ± 6.8° (p < 0.01). For thoracolumbar (TL) major curvatures, T improved from 37.2° ± 10.7° to 18.8° ± 9.4° (p < 0.01) and TL from 49.0° ± 6.4° to 20.1° ± 8.5° (p < 0.01). Major curve inclinometer measurements and SRS-22 domains, except activity, improved significantly (p ≤ 0.05). At the latest FU, one (2%) patient required fusion of the T curve and revision of the TL tether due to curve progression in the previously uninstrumented T curve and tether breakage (TB) in the TL. Twenty (41%) patients experienced TB. VBT in AIS patients with limited remaining skeletal growth resulted in satisfactory clinical outcomes at the latest FU.

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“…This study performed in Simmerath (Germany) analyzed the preliminary outcomes after VBT of the lumbar spine in 30 patients. 6 Patients had a mean age of 14.7 years and a mean thoracic and lumbar Cobb angle of 52.5° and 52.3°, respectively. Nine vertebrae were instrumented, with the lowest instrumented vertebra being either L3 or L4, and all patients had a oneyear follow-up.…”

Section: Vertebral Body Tethering For Lumbar Curvesmentioning

confidence: 99%

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2022

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Preliminary outcomes after vertebral body tethering (VBT) for lumbar curves and subanalysis of a 1- versus 2-tether construct

Cited by 33 publications

References 14 publications

The timing of tether breakage influences clinical results after VBT

The timing of tether breakage influences clinical results after VBT

Vertebral Body Tethering in 49 Adolescent Patients after Peak Height Velocity for the Treatment of Idiopathic Scoliosis: 2–5 Year Follow-Up

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