Anterior Vertebral Body Tethering for Scoliosis Patients With and Without Skeletal Growth Remaining: A Retrospective Review With Minimum 2-Year Follow-Up

Theodor Di Pauli von Treuheim; Lily Eaker; Jonathan Markowitz; Dhruv Shankar; James Meyers; Baron Lonner

doi:10.14444/8357

Anterior Vertebral Body Tethering for Scoliosis Patients With and Without Skeletal Growth Remaining: A Retrospective Review With Minimum 2-Year Follow-Up

Int J Spine Surg. 2023 Feb;17(1):6-16. doi: 10.14444/8357. Epub 2022 Sep 16.

Authors

Theodor Di Pauli von Treuheim¹, Lily Eaker¹, Jonathan Markowitz¹, Dhruv Shankar¹, James Meyers¹, Baron Lonner²

Affiliations

¹ Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY, USA.
² Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY, USA baron.lonner@mountsinai.org.

PMID: 36113952
PMCID: PMC10025839
DOI: 10.14444/8357

Abstract

Background: Anterior vertebral body tethering (AVBT) has been approved for skeletally immature (IM) adolescent idiopathic scoliosis patients, but the role of AVBT in patients with minimal remaining skeletal growth is controversial. The purpose of this study was to compare minimum 2-year (YR2) outcomes in skeletally IM patients vs those with minimal remaining skeletal growth.

Methods: Patients with single thoracic AVBT were grouped by their preoperative (PR) skeletal maturity: IM (n = 16, Risser 0-2) vs mature (M, n = 19, Risser 3-5). Outcomes were assessed at PR, first erect (FE), and YR2. Median (range) was compared with nonparametric tests (P < 0.05).

Results: The PR age was 12.5 (9-16) vs 15 (12-18) years with major Cobb 51° (36°-69°) and 49° (40°-69°) for IM and M, respectively. At FE, there was no difference in correction; however, at YR2, the IM group yielded a lower residual curve (15° [-16° to 38°] vs 29° [12°-42°], P = 0.008). Thoracolumbar/lumbar curves were corrected without group differences. Clinically successful correction (<35°) (15 [94%] vs 15 [79%]) and suspected cord breakages (2 [13%] vs 2 [12%]) were similar at YR2. Two overcorrections occurred, both in IM patients. Scoliosis Research Society-22 outcomes at final follow-up were similar between groups. No revision reoperations or conversions to spinal fusion were needed.

Conclusions: Skeletally IM patients benefit from greater growth-modulated curve correction than M patients, however, at the increased risk of overcorrection. M patients maintained clinically significant correction at latest follow-up. Longer-term follow-up is required to determine durability of outcomes for patients undergoing AVBT who have minimal remaining growth at the time of index surgery.

Clinical relevance: This study is relevant to spine surgeons, spine physiotherapists, and patients with idiopathic scoliosis. It offers evidence of clinical correction of scoliosis in mature patients.

Keywords: adolescent idiopathic scoliosis; non-fusion surgery; scoliosis; vertebral body tethering.

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