Anterior vertebral body tethering shows mixed results at 2-year follow-up
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Anterior vertebral body tethering shows mixed results at 2‑year follow‑up Courtney E. Baker1 · Gary M. Kiebzak2 · Kevin M. Neal3 Received: 23 May 2020 / Accepted: 10 October 2020 © Scoliosis Research Society 2020
Abstract Study design Retrospective chart review. Objective To report 2–4-year outcomes of anterior vertebral body tethering (AVBT) for adolescent idiopathic scoliosis (AIS). Summary of background data AVBT is a relatively new procedure to correct AIS spine curvature and few outcomes studies have been published. Methods Patients from 2015 to 2017 with 2-year follow-up were included. Successful outcomes were defined as curves 35° or less without revision surgery. We also compared outcomes between thoracic and lumbar ABVT. Results There were 19 AVBTs in 17 patients, 13 thoracic and 6 lumbar. Nine curves (47%) in nine patients (53%) were successful. Preoperative kyphosis averaged 26° in the successful group and 14° in the unsuccessful group (P = 0.0337). Immediate correction for lumbar ABVTs (76%) was greater than thoracic ABVTs (43%) (P = 0.0140). Correction per level per month was greater in lumbar ABVTs (2.9° vs. 0.1°) (0.0440). Preoperative Sanders Maturity Scale (SMS) was 3.7 for successful cases and 2.5 for unsuccessful cases (P = 0.0232). Final SMS was 7.7 for successful cases and 5.7 for unsuccessful cases (P = 0.0518). All successful cases and 50% of unsuccessful cases were mature at final follow-up (P = 0.0294). There were four (24%) revision procedures, and three involving lumbar AVBTs. There were nine (47%) broken tethers. Conclusions Despite several final curves > 35°, four revisions, and nine broken tethers, the majority of patients (53%) were considered successful. Lumbar ABVTs correct more intraoperatively and faster postoperatively. Patients who are tethered during or slightly after the curve acceleration phase of growth may have more successful outcomes than patients tethered prior to the curve acceleration phase. AVBT requires further study with longer outcomes to define best practices for indications, level selections, and surgical techniques. Level of evidence IV. Keywords Adolescent idiopathic scoliosis · Vertebral body tether · Tethering · Fusionless spine surgery
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s43390-020-00226-x) contains supplementary material, which is available to authorized users. * Gary M. Kiebzak [email protected]; [email protected] Courtney E. Baker [email protected] Kevin M. Neal [email protected] 1
Treatment for adolescent idiopathic scoliosis (AIS) is based on remaining growth and curve size, and traditional options include observation, bracing, or surgery. Posterior spinal fusion (PSF) is a powerful tool to correct scoliosis, but 2
Department of Orthopaedics and Sports Medicine, Nemours Children’s Hospital, 13535 Nemours Parkway, Orlando, FL 32827, USA
3
Department of Pediatric Orthopedic Surgery, Nemours Children’s Specialty Care, 80
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