Safety and efficacy of anterior vertebral body tethering in the treatment of idiopathic scoliosis

Abstract

Aims Spinal fusion remains the gold standard in the treatment of idiopathic scoliosis. However, anterior vertebral body tethering (AVBT) is gaining widespread interest, despite the limited data on its efficacy. The aim of our study was to determine the clinical efficacy of AVBT in skeletally immature patients with idiopathic scoliosis. Methods All consecutive skeletally immature patients with idiopathic scoliosis treated with AVBT enrolled in a longitudinal, multicentre, prospective database between 2013 and 2016 were analyzed. All patients were treated by one of two surgeons working at two independent centres. Data were collected prospectively in a multicentre database and supplemented retrospectively where necessary. Patients with a minimum follow-up of two years were included in the analysis. Clinical success was set a priori as a major coronal Cobb angle of < 35° at the most recent follow-up. Results A total of 57 patients were included in the study. Their mean age was 12.7 years (SD 1.5; 8.2 to 16.7), with 95% being female. The mean preoperative Sanders score and Risser grade was 3.3 (SD 1.2), and 0.05 (0 to 3), respectively. The majority were thoracic tethers (96.5%) and the mean follow-up was 40.4 months (SD 9.3). The mean preoperative major curve of 51° (SD 10.9°; 31° to 81°) was significantly improved to a mean of 24.6° (SD 11.8°; 0° to 57°) at the first postoperative visit (45.6% (SD 17.6%; 7% to 107%); p < 0.001)) with further significant correction to a mean of 16.3° (SD 12.8°; -12 to 55; p < 0.001) at one year and a significant correction to a mean of 23° (SD 15.4°; -18° to 57°) at the final follow-up (42.9% (-16% to 147%); p < 0.001). Clinical success was achieved in 44 patients (77%). Most patients reached skeletal maturity, with a mean Risser score of 4.3 (SD 1.02), at final follow-up. The complication rate was 28.1% with a 15.8% rate of unplanned revision procedures. Conclusion AVBT is associated with satisfactory correction of deformity and an acceptable complication rate when used in skeletally immature patients with idiopathic scoliosis. Improved patient selection and better implant technology may improve the 15.8% rate of revision surgery in these patients. Further scrutiny of the true effectiveness and long-term risks of this technique remains critical. Cite this article: Bone Joint J 2020;102-B(12):1703–1708.

Video-Assisted Thoracoscopy for Vertebral Body Tethering of Juvenile and Adolescent Idiopathic Scoliosis: Tips and Tricks of Surgical Multidisciplinary Management

“…Our results seem consistent with the previous experiences of AVBT reported in the literature so far, with a 13% of complication/reoperation rate and a mean curve correction of 43%, that are similar to other series [ 4 , 17 , 18 ]. The thoracoscopic set-up and time did not affect the duration of surgery, with a mean duration of 250 min that results comparable to other published experiences [ 18 ].…”

Dual modality of vertebral body tethering

“…It should be noted that when our series began, the criteria were more in keeping with the Shriners Hospital model, but expanded to include more skeletally mature patients after the first two years at our institution. Miyanji et al 25 chose patients with Risser 0 to 3 only for their multicentre study. They have a similar follow-up time as our study.…”

Bewegungserhaltende operative Korrektur der idiopathischen adoleszenten Skoliose – Pro Fusion

“…Demgegenüber steht eine Komplikationsrate von 15,8-41% [21,22,28] und eine Revisionsrate von 6,7-41% (Lockerung des Tethers aufgrund von Überkorrektur, posteriore Fusion, Ersetzen des Tethers bei Ruptur, ergänzendes lumbales Tether) [3,14,15,21]. Die operative Revisionsrate variiert in den einzelnen Studien, ist aber dennoch hoch im Vergleich zur ventralen oder dorsalen Fusion.…”

“…Die operative Revisionsrate variiert in den einzelnen Studien, ist aber dennoch hoch im Vergleich zur ventralen oder dorsalen Fusion. Insgesamt erhielten 6-12% der Patienten in einer Revisionsoperation eine DKS [14,16,21,22]. In der Studie von Miyanji et al erhielten 6 Patienten im Verlauf eine DKS.…”

“…Diese Patienten hatten einen mittleren präoperativen Cobb-Winkel von 60,8°(SD 18,5°) mit einer Korrektur auf nur (!) 44,3°( 27% Korrektur) [22].…”