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Anterior vertebral body tethering for idiopathic scoliosis: how well does the tether hold up?

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Abstract

Purpose

Durability of outcomes following vertebral body tethering (VBT) is a concern and may be impacted by tether breakage (TB), which has been unstudied in a large cohort. We characterized TB rates and their impact on clinical outcomes in the largest single-surgeon series to date.

Methods

Inclusion criteria were VBT patients with AIS, major Cobb angle ≤ 75°, and minimum 2-year follow-up (FU). TBs were identified on 1- and 2-year FU X-rays. TB rates between single-cord and double-cord tethers were evaluated using two-proportion z test. Curve correction rates and SRS-22 scores between patients with and without TB at 2 years were evaluated using Mann–Whitney U test.

Results

69 patients were included. By 2-year FU, 18 (27%) had experienced TB. TB primarily occurred in major (70%) versus minor curves and thoracolumbar tethers (75%) versus thoracic. TB rates between thoracolumbar single (32%) and double-cord tethers (30%) were not significantly different (p = 0.88). Mean major curve correction at 2-year FU was lower (p = 0.02) in patients with major curve TB (48° to 24°, 50%) versus those without (53°–21°, 60%). 2 patients (3%) required reoperation, 1 due to foraminal encroachment from a screw tip and 1 for curve progression with TB.

Conclusion

TB rate was 27% at 2 years following VBT. Broken major curve tethers are associated with minor loss of correction that may not be clinically significant. TB rates are higher for thoracolumbar curvatures and double cords may not be protective against TB. Further study of long-term TB rates is imperative.

Level of evidence

IV

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Funding

No funding was received for this work.

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Authors and Affiliations

  1. Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Dhruv Shankar, Lily Eaker, Theodor Di Pauli von Treuheim & Baron S. Lonner

  2. Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA

    Jared Tishelman

  3. Department of Trauma and Orthopaedic Surgery, The Royal London Hospital, Barts Health NHS Trust, London, UK

    Zacharia Silk

Authors
  1. Dhruv Shankar
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  2. Lily Eaker
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  3. Theodor Di Pauli von Treuheim
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  4. Jared Tishelman
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  5. Zacharia Silk
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  6. Baron S. Lonner
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Corresponding author

Correspondence to Baron S. Lonner.

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Conflict of interest

Dr. Lonner reports personal fees and royalty fees from Zimmer Biomet for The Tether implant. Dr. Lonner also reports personal fees, non-financial support and other from Depuy Synthes, personal fees and non-financial support from OrthoPediatrics, stocks/stock options from Spine Search, grants and other from Setting Scoliosis Straight Foundation, outside the submitted work. The remaining authors have no disclosures to report.

Ethical approval

This work was approved by the Institutional Review Board at Mount Sinai Hospital.

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This work was performed under a waiver of informed consent approved by the Institutional Review Board at Mount Sinai Hospital.

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Not applicable.

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Data will be maintained for this study for up to 7 years post-publication as required by our institution’s review board.

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Shankar, D., Eaker, L., von Treuheim, T.P. et al. Anterior vertebral body tethering for idiopathic scoliosis: how well does the tether hold up?. Spine Deform 10, 799–809 (2022). https://doi.org/10.1007/s43390-022-00490-z

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  • DOI: https://doi.org/10.1007/s43390-022-00490-z

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