Lumbar Vertebral Body Tethering: Single Center Outcomes and Reoperations in a Consecutive Series of 106 Patients

Alan A Stein; Amer F Samdani; Alexander J Schupper; Zan Naseer; Ronit V Shah; Sabrina Zeller; Joshua M Pahys; Solomon Praveen Samuel; Alejandro Quinonez; Steven W Hwang

doi:10.1097/BRS.0000000000004967

Lumbar Vertebral Body Tethering: Single Center Outcomes and Reoperations in a Consecutive Series of 106 Patients

Spine (Phila Pa 1976). 2024 Feb 20. doi: 10.1097/BRS.0000000000004967. Online ahead of print.

Authors

Alan A Stein^{1

2}, Amer F Samdani¹, Alexander J Schupper^{1

3}, Zan Naseer^{1

2}, Ronit V Shah⁴, Sabrina Zeller², Joshua M Pahys⁵, Solomon Praveen Samuel⁶, Alejandro Quinonez⁷, Steven W Hwang¹

Affiliations

¹ Department of Neurosurgery, Shriners Children's - Philadelphia, PA, USA.
² Brain and Spine Institute at Westchester Medical Center, Valhalla, NY, USA.
³ Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁴ Department of Orthopaedic Surgery, Temple University Hospital, Philadelphia, PA, USA.
⁵ Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
⁶ Department of Clinical Research, Shriners Children's - Philadelphia, PA, USA.
⁷ Department of Orthopaedic Surgery, Shriners Children's - Philadelphia, PA, USA.

PMID: 38375615
DOI: 10.1097/BRS.0000000000004967

Abstract

Study design: Retrospective cohort study.

Objective: To evaluate the outcomes and reoperation rates in patients with adolescent idiopathic scoliosis (AIS) undergoing lumbar anterior vertebral body tethering (AVBT).

Summary of background data: Anterior vertebral body tethering (AVBT) is a viable option in growing children. The benefit of motion preservation must be balanced by a higher reoperation rate. A paucity of reports has addressed lumbar AVBT.

Methods: A single-center retrospective study was conducted to identify all patients who underwent lumbar AVBT (lowest instrumented vertebra L3 or L4) with a minimum 2 years of follow-up. Clinical and radiographic parameters, including complications and reoperations, were also collected. Statistical analysis was performed using Student's t-test for qualitative variables.

Results: From a dataset of 551 patients, we identified 106 patients (89% female) who underwent a lumbar AVBT (33 lumbar only, 73 bilateral thoracic/lumbar) with mean follow-up of 4.1±1.6 years at which point 85% (90/106) had reached skeletal maturity. Preoperatively, these patients were skeletally immature (age: 12.8±1.3 y, Sanders: 3.3±0.8, R=0.6±0.9) with a lumbar coronal curve angle of 49.6°±11.2 which corrected to 19.9°±11.2 (P <0.0001) at most recent follow-up. At the latest follow-up, 76.4% (81/106) of the patients harbored a coronal curve angle of < 30°. Twenty patients (18.9%) underwent 23 reoperations, with overcorrection being the most common (10/23, 43%). Broken tethers led to reoperation in 3 instances (3/23, 13%). Six patients in the cohort needed a posterior spinal fusion (6/106, 5.4%).

Conclusions: Vertebral body tethering is a viable treatment option for skeletally immature patients with idiopathic scoliosis. This report is the largest to date for lumbar AVBT, highlighting that 84% of patients harbored a curve < 35° at the latest follow-up but with an 18.9% reoperation rate.

Level of evidence: 3.