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Anterior vertebral body tethering shows mixed results at 2-year follow-up

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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.

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References

  1. Nohara A, Kawakami N, Seki K, Tsuji T, Ohara T, Saito T, Kawakami K (2015) The effects of spinal fusion on lumbar disc degeneration in patients with adolescent idiopathic scoliosis: a minimum 10-year follow-up. Spine Deform 3(5):462–468. https://doi.org/10.1097/BRS.0000000000000917

    Article  PubMed  Google Scholar 

  2. Weinstein SL, Dolan LA, Wright JG, Dobbs MB (2013) Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med 369(16):1512–1521. https://doi.org/10.1056/NEJMoa1307337

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Schwieger T, Campo S, Weinstein SL, Dolan LA, Ashida S, Steuber KR (2017) Body image and quality of life and brace wear adherence in females with adolescent idiopathic scoliosis. J Pediatr Orthop 37(8):e519–e523. https://doi.org/10.1097/Bpo.0000000000000734

    Article  PubMed  Google Scholar 

  4. Schwieger T, Campo S, Weinstein SL, Dolan LA, Ashida S, Steuber KR. Body image and quality-of-life in untreated versus brace-treated females with adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2016;41(4):311–9. DOI:10.1097/Brs.0000000000001210.

  5. Sanders JO, Newton PO, Browne RH, Katz DE, Birch JG, Herring JA (2014) Bracing for idiopathic scoliosis: How many patients require treatment to prevent one surgery? J Bone Joint Surg Am 96(8):649–653. https://doi.org/10.2106/Jbjs.M.00290

    Article  PubMed  Google Scholar 

  6. Crawford CH 3rd, Lenke LG (2010) Growth modulation by means of anterior tethering resulting in progressive correction of juvenile idiopathic scoliosis: a case report. J Bone Joint Surg Am 92(1):202–209. https://doi.org/10.2106/Jbjs.H.01728

    Article  PubMed  Google Scholar 

  7. Braun JT (2014) Comparison of two fusionless scoliosis surgery methods in the treatment of progressive adolescent idiopathic scoliosis: a preliminary study. Dartmouth Orthopaedic J 1:25–33

    Google Scholar 

  8. Ergene G (2019) Early-term postoperative thoracic outcomes of videothor acoscopic vertebral body tethering surgery. Turk Gogus Kalp Damar Cerrahisi Derg 27(4):526–531. https://doi.org/10.5606/tgkdc.dergisi.2019.17889

    Article  PubMed  PubMed Central  Google Scholar 

  9. Samdani AF, Ames RJ, Kimball JS, Pahys JM, Grewal H, Pelletier GJ, Betz RR (2015) Anterior vertebral body tethering for immature adolescent idiopathic scoliosis: one-year results on the first 32 patients. Eur Spine J 24(7):1533–1539. https://doi.org/10.1007/s00586-014-3706-z

    Article  PubMed  Google Scholar 

  10. Newton PO, Kluck DG, Saito W, Yaszay B, Bartley CE, Bastrom TP (2018) Anterior spinal growth tethering for skeletally immature patients with scoliosis: a retrospective look two to four years postoperatively. J Bone Joint Surg Am 100(19):1691–1697. https://doi.org/10.2106/Jbjs.18.00287

    Article  PubMed  Google Scholar 

  11. Samdani AF, Ames RJ, Kimball JS, Pahys JM, Grewal H, Pelletier GJ, Betz RR. Anterior vertebral body tethering for idiopathic scoliosis: two-year results. Spine (Phila Pa 1976). 2014;39(20):1688–93. DOI: 10.1097/Brs.0000000000000472.

  12. Boudissa M, Eid A, Bourgeois E, Griffet J, Courvoisier A (2017) Early outcomes of spinal growth tethering for idiopathic scoliosis with a novel device: a prospective study with 2 years of follow-up. Childs Nerv Syst 33(5):813–818. https://doi.org/10.1007/s00381-017-3367-4

    Article  CAS  PubMed  Google Scholar 

  13. Wong HK, Ruiz JNM, Newton PO, Gabriel Liu KP (2019) Non-fusion surgical correction of thoracic idiopathic scoliosis using a novel, braided vertebral body tethering device: minimum follow-up of 4 years. JB JS Open Access 4(4):e0026. https://doi.org/10.2106/JBJS.OA.19.00026

    Article  PubMed  PubMed Central  Google Scholar 

  14. Acheson RM (1957) The Oxford method of assessing skeletal maturity. Clin Orthop 10:19–39 (PMID: 13561550)

    CAS  PubMed  Google Scholar 

  15. Neal KM, Shirley ED, Kiebzak GM. maturity indicators and adolescent idiopathic scoliosis: evaluation of the sanders maturity scale. Spine (Phila Pa 1976). 2018;43(7):E406-E412. DOI: 10.1097/BRS.0000000000002483.

  16. Newton PO, Farnsworth CL, Faro F, Mahar AT, Odell T, Mohamad F, Breisch E, Fricka, Upasani VV, Amiel D. Spinal growth modulation with an anterolateral flexible tether in an immature bovine model: disc health and motion preservation. Spine (Phila Pa 1976). 2008;33(7):724–33. doi: 10.1097/BRS.0b013e31816950a0.

  17. Newton https://pubmed.ncbi.nlm.nih.gov/20595923/ - affiliation-1 PO, Farnsworth CL, Upasani VV, Chambers RC, Varley E, Tsutsui S. Effects of intraoperative tensioning of an anterolateral spinal tether on spinal growth modulation in a porcine model. Spine (Phila Pa 1976). 2011;36(2):109–17. doi: 10.1097/BRS.0b013e3181cc8fce.

  18. Newton PO, Faro FD, Farnsworth CL, Shapiro G, Mohamad F, Parent S, Fricka K (2005) Multilevel spinal growth modulation with an anterolateral flexible tether in an immature bovine model . Spine (Phila Pa 1976). 30(23):2608–13. doi: 10.1097/01.brs.0000188267.66847.bf.

  19. El-Fiky T, Elsagheer H, Darwish M, Essmat H, Kamal R, Hasan A, Shoukry F, Allam Y (2019) The sagittal thoracic modifier component of the lenke classification system in moderate and severe adolescent idiopathic scoliosis: reliability and reproducibility of measurements among 5 observers. Clin Spine Surg 32(6):E266–E271. https://doi.org/10.1097/BSD.0000000000000805

    Article  PubMed  Google Scholar 

  20. Richards BS, Sucato DJ, Konigsberg DE, Ouellet JA (2003) Comparison of reliability between the Lenke and King classification systems for adolescent idiopathic scoliosis using radiographs that were not premeasured. Spine (Phila Pa 1976). 28(11):1148–56. DOI: 10.1097/01.BRS.0000067265.52473.C3 .

  21. Cobetto N, Aubin CE, Parent S. Contribution of lateral decubitus positioning and cable tensioning on immediate correction in anterior vertebral body growth modulation. Spine Deform. 20186(5):507–513. DOI: 10.1016/j.jspd.2018.01.013

  22. Schwytzer FX (1977) Study of the growth of the vertebral bodies in adolescents. Acta Anat (Basel) 98(1):52–61 (PMID: 871076)

    Article  CAS  Google Scholar 

  23. Taylor JR (1975) Growth of human intervertebral discs and vertebral bodies. J Anat 120(Pt 1):49–68 (PMID: 1184458)

    CAS  PubMed  PubMed Central  Google Scholar 

  24. Roaf R. Vertebral growth and its mechanical control. J Bone Joint Surg Br. 1960;42-B:40–59. PMID: 13854527.

  25. Sanders JO, Browne RH, McConnell SJ, Margraf SA, Cooney TE, Finegold DN (2007) Maturity assessment and curve progression in girls with idiopathic scoliosis. J Bone Joint Surg Am 89(1):64–73. https://doi.org/10.2106/Jbjs.F.00067

    Article  PubMed  Google Scholar 

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Funding

The study was not externally funded.

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Authors and Affiliations

Authors

Contributions

CEB, GMK, KMN: each author contributed equally to this work, CEB, GMK, KMN: substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work.

Corresponding author

Correspondence to Gary M. Kiebzak.

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Conflicts of interest

The authors have no conflicts of interest related to this work.

Ethical approval

This retrospective chart review was approved by our local Institutional Review Board.

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Baker, C.E., Kiebzak, G.M. & Neal, K.M. Anterior vertebral body tethering shows mixed results at 2-year follow-up. Spine Deform 9, 481–489 (2021). https://doi.org/10.1007/s43390-020-00226-x

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