When successful, anterior vertebral body tethering (VBT) induces differential segmental growth of vertebrae: an in vivo study of 51 patients and 764 vertebrae

McDonald, Tyler; Shah, Suken A.; Hargiss, John B.; Varghese, Jeffrey; Boeyer, Melanie E; Pompliano, Michael; Neal, Kevin M.; Lonner, Baron S.; Larson, A. Noelle; Yaszay, Burt; Newton, Peter O.; Hoernschemeyer, Daniel G.

doi:10.1007/s43390-022-00471-2

Cited by 19 publications

(11 citation statements)

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“…VBT can be employed both in its growth-modulating form for skeletally immature patients (VBT-growth modulation, VBT-GM) and as a tissue remodelling technique in patients who are approaching or have reached skeletal maturity (VBT-anterior scoliosis correction, VBT-ASC) [6][7][8]. Growth modulation is regulated by the Hueter-Volkmann principle [9,10], while tissue remodelling follows the principles of Wolff's law. Irrespectively of the underlying biomechanical driving force, it can be hypothesized that, once a corrective mechanism has taken place and the spine has obtained a new shape, the tether loses its function.…”

Section: Introductionmentioning

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: Introductionmentioning

confidence: 99%

The timing of tether breakage influences clinical results after VBT

et al. 2022

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“…Two non-fusion devices, 1 for vertebral body tethering 19 and 1 for posterior dynamic distraction 20 , were approved by the FDA for the treatment of AIS via humanitarian device exemptions in August 2019, and a second VBT device was approved in 2023. VBT offers the potential for preservation of motion and growth over the instrumented segments, with decreased blood loss and shorter recovery, but it provides less-reliable correction of the deformity than fusion surgery and has a much higher reoperation rate compared with fusion surgery 7,9,11 . Furthermore, there are minimal data regarding the long-term durability of VBT, and opinions from surgeons may vary according to each surgeon’s clinical experience.…”

Section: Discussionmentioning

confidence: 99%

“…However, non-fusion approaches continue to have high reoperation rates, and a functional benefit of non-fusion as compared with fusion has not yet been proven. There is a paucity of peer-reviewed studies on the results of this technology [9][10][11] . Thus, definitive comparative data are lacking on whether non-fusion procedures provide similar or superior results to fusion for patients with AIS.…”

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confidence: 99%

“…Although posterior spinal fusion surgery is currently the primary surgical treatment option for AIS, non-fusion approaches are now available and increasing in popularity [4][5][6][7][8] . The proposed advantages of non-fusion surgery for the treatment of AIS are preserved spinal growth and spinal mobility, which may reduce the risk of adjacent-segment disease 1,[9][10][11] . However, non-fusion approaches continue to have high reoperation rates, and a functional benefit of non-fusion as compared with fusion has not yet been proven.…”

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confidence: 99%

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Non-Fusion Versus Fusion Surgery in Pediatric Idiopathic Scoliosis

Larson,

Marks,

Gonzalez Sepulveda

et al. 2023

Journal of Bone and Joint Surgery

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Background: Vertebral body tethering and other non-fusion techniques for the treatment of pediatric idiopathic scoliosis are increasing in popularity. There is limited physician consensus on this topic as the result of a paucity of published data regarding which patients most benefit from non-fusion strategies. Thus, much of the decision-making is left to patients and parents, who must select a treatment based on their goals and values and the information available from health-care providers, the internet, and social media. We sought to understand patient and family preferences regarding the attributes of fusion versus non-fusion surgery that drive these choices. Methods: Patients and families were recruited from 7 pediatric spine centers and were asked to complete a survey-based choice experiment that had been jointly developed with the U.S. Food and Drug Administration (FDA) to evaluate patient preferences. Choices between experimentally designed alternatives were analyzed to estimate the relative importance of outcomes and requirements associated with the choice options (attributes). The attributes included appearance, confidence in the planned correction, spinal motion, device failure, reoperation, and recovery period. The inclusion criteria were (1) an age of 10 to 21 years and (2) a diagnosis of adolescent idiopathic scoliosis in patients who were considering, or who had already undergone, treatment with fusion or non-fusion surgery. Preference weights were estimated from the expected changes in choice given changes in the attributes. Results: A total of 344 respondents (124 patients, 92 parents, and 128 parent/patient dyads) completed the survey. One hundred and seventy-three patients were enrolled prior to surgery, and 171 were enrolled after surgery. Appearance and motion were found to be the most important drivers of choice. For the entire cohort, fusion was preferred over non-fusion. For patients who were considering surgery, the most important attributes were preservation of spinal motion and appearance. Conclusions: Patients and families seeking treatment for idiopathic scoliosis value appearance and preservation of spinal motion and, to a lesser extent, reoperation rates when considering fusion versus non-fusion surgery.

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“…Vertebral Body Tethering (VBT) is increasingly and rapidly becoming popular as a non-fusion surgical alternative for selected patients with adolescent idiopathic scoliosis (AIS). While VBT was originally developed as a growth-modulating technique for skeletally immature patients [1,2], recent evidence shows its efficacy as a correction technique also in patients approaching skeletal maturity [3,4]. Several studies have observed success rates above 80% when success is defined as a patient with a controlled scoliosis, ideally below 30 • , two or more years after VBT or at skeletal maturity [5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Pulmonary Complications after Vertebral Body Tethering: Incidence, Treatment, Outcomes and Risk Factor Analysis

Trobisch¹,

Migliorini

Vanspauwen³

et al. 2022

JCM

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Introduction: Vertebral body tethering (VBT) is gaining popularity for the management of selected AIS patients. The most frequent non-mechanical complications after VBT are pulmonary complications, with a reported incidence of up to 8% for recurrent pleural effusion. However, only trace data have been published on this topic. We aimed to analyze the incidence, timing, treatment, outcomes and risk factors of pulmonary complications after VBT. Materials and Methods: All patients who underwent VBT between September 2018 and September 2022 were retrospectively reviewed. The rate of pulmonary complications was analyzed and the symptoms, timing of onset, treatment and outcomes were recorded. An analysis of demographic, radiographic, surgical and pulmonary function data was conducted to explore possible risk factors for pulmonary complications. Results: Data from 140 patients were available: 14 experienced a pulmonary complication 1 day to 6 weeks after VBT, with 9 presenting a recurrent pleural effusion. A total of 13 patients required invasive treatment. All recovered without sequelae. The risk factor analysis did not result in any significant observations. However, 11/14 patients had had a diaphragm split. Conclusion: Pulmonary complications were observed in 10% of patients. The timing, symptoms and required treatment were heterogeneous. Pleural effusion seems to be more common after diaphragm crossing, but evidence is not yet conclusive.

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When successful, anterior vertebral body tethering (VBT) induces differential segmental growth of vertebrae: an in vivo study of 51 patients and 764 vertebrae

Cited by 19 publications

References 18 publications

The timing of tether breakage influences clinical results after VBT

The timing of tether breakage influences clinical results after VBT

Non-Fusion Versus Fusion Surgery in Pediatric Idiopathic Scoliosis

Pulmonary Complications after Vertebral Body Tethering: Incidence, Treatment, Outcomes and Risk Factor Analysis

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