Anterior vertebral body tethering for idiopathic scoliosis: two-year results

Spine (Phila Pa 1976). 2014 Sep 15;39(20):1688-93. doi: 10.1097/BRS.0000000000000472.

Abstract

Study design: Retrospective review.

Objective: To report the 2-year results of the initial cohort undergoing anterior vertebral body tethering (VBT).

Summary of background data: Anterior VBT is a promising new technique with abundant preclinical studies but very few clinical results. It is a growth modulation technique, which utilizes patients' growth to attain progressive correction of their scoliosis. We report 2-year results of the initial cohort undergoing this procedure.

Methods: After obtaining institutional review board approval, we retrospectively reviewed our first 11 consecutive patients who underwent anterior VBT with 2-year follow-up. We collected pertinent preoperative, intraoperative, and most recent clinical and radiographical data. Student t test and Fisher exact test were utilized to compare different time points.

Results: Eleven patients with thoracic idiopathic scoliosis (8 females) were identified, with a mean age of 12.3 ± 1.6 years. Preoperatively, all were skeletally immature (Sanders mean = 3.4 ± 1.1; Risser mean = 0.6 ± 1.1). All underwent tethering of an average of 7.8 ± 0.9 (range: 7-9) levels, with the most proximal being T5 and the most distal L2. Preoperative thoracic Cobb angle averaged 44.2 ± 9.0° and corrected to 20.3 ± 11.0° on first erect, with progressive improvement at 2 years (Cobb angle = 13.5 ± 11.6°, % correction = 70%; P < 0.00002). Similarly, the preoperative lumbar curve of 25.1 ± 8.7° demonstrated progressive correction (first erect = 14.9 ± 4.9°, 2 yr = 7.2 ± 5.1°, % correction = 71%; P < 0.0002). Thoracic axial rotation as measured by a scoliometer went from 12.4 ± 3.3° preoperatively to 6.9 ± 3.4° at the most recent measurement (P < 0.01). No major complications were observed. As anticipated, 2 patients returned to the operating room at 2 years postoperatively for loosening of the tether to prevent overcorrection.

Conclusion: Anterior VBT is a promising technique for skeletally immature patients with idiopathic scoliosis. This technique can be performed safely and can result in progressive correction.

Level of evidence: 4.

MeSH terms

  • Adolescent
  • Child
  • Female
  • Follow-Up Studies
  • Humans
  • Lumbar Vertebrae / diagnostic imaging
  • Lumbar Vertebrae / surgery*
  • Male
  • Orthopedic Procedures / methods*
  • Radiography
  • Retrospective Studies
  • Scoliosis / diagnostic imaging
  • Scoliosis / surgery*
  • Thoracic Vertebrae / diagnostic imaging
  • Thoracic Vertebrae / surgery*
  • Treatment Outcome