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Operative differences for posterior spinal fusion after vertebral body tethering: Are we fusing more levels in the end?

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Abstract

Purpose

Little is known about the perioperative characteristics associated with a posterior spinal fusion (PSF) in adolescent idiopathic scoliosis patients previously treated with vertebral body tethering (VBT). We aimed to determine if operative time, estimated blood loss, postoperative length of stay, instrumentation type, and implant density differed in patients that received a PSF (i.e., PSF-Only) or a PSF following a failed VBT (i.e., PSF–VBT).

Methods

We retrospectively assessed matched cohort data (PSF–VBT = 22; PSF-Only = 22) from two multi-center registries. We obtained: (1) operative time, (2) estimated blood loss, (3) postoperative length of stay, (4) instrumentation type, and (5) implant density. Theoretical fusion levels prior to the index procedure were obtained for PSF–VBT and compared to the actual levels fused.

Results

We observed no difference in operative time, estimated blood loss, or postoperative length of stay. Instrumentation type was all-screw in PSF-Only and varied in PSF–VBT with nearly 25% of patients exhibiting a hybrid construct. There was no added benefit to removing anterior instrumentation prior to fusion; however, implant density was higher in PSF-Only (1.9 ± 0.2) than when compared to PSF–VBT (1.7 ± 0.3). An additional two levels were fused in 50% of PSF–VBT patients, most of which were added to the distal end of the construct.

Conclusions

We found that operative time, estimated blood loss, and postoperative length of stay were similar in both cohorts; however, the length of the fusion construct in PSF–VBT is likely to be two levels longer when a failed VBT is converted to a PSF.

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Data availability

The original data used in this manuscript are available from the Harms Study Group and the Setting Scoliosis Straight Registries. These data are restricted and not publicly available; however, inquires can be made to Michelle Marks at mmarks@sshsg.org.

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Funding

No direct funding was provided for the work presented herein; however, we retrospectively assessed data from the Harms Study Group and the Setting Scoliosis Straight Registry, both of which receive external funding. A detailed list can be found in the Conflicts of Interest Section.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA

    Melanie E. Boeyer & Daniel G. Hoernschemeyer

  2. School of Medicine, University of Missouri, Columbia, MO, USA

    Andrew Groneck

  3. Acibadem University School of Medicine, Istanbul, Turkey

    Ahmet Alanay

  4. Nemours Children’s Specialty Care, Jacksonville, FL, USA

    Kevin M. Neal

  5. Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA

    A. Noelle Larson

  6. Department of Surgery, Université de Montréal, Quebec, Canada

    Stefan Parent

  7. Rady Children’s Hospital, San Diego, CA, USA

    Peter Newton

  8. Columbia Department of Orthopaedics, University of British, Vancouver, Canada

    Firoz Miyanji

  9. Ochsner Medical Center, New Orleans, LA, USA

    Lawrence Haber

  10. University of Missouri Women’s and Children’s Hospital, Columbia, MO, USA

    Daniel G. Hoernschemeyer

Authors
  1. Melanie E. Boeyer
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  2. Andrew Groneck
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  3. Ahmet Alanay
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  4. Kevin M. Neal
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  5. A. Noelle Larson
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  6. Stefan Parent
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  7. Peter Newton
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  8. Firoz Miyanji
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  10. Daniel G. Hoernschemeyer
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Consortia

Harms Study Group

  • Aaron Buckland
  • , Ahmet Alanay
  • , Amer Samdani
  • , Amit Jain
  • , Baron Lonner
  • , Benjamin Roye
  • , Bob Cho
  • , Burt Yaszay
  • , Caglar Yilgor
  • , Chris Reilly
  • , Dan Hoernschmeyer
  • , Daniel Hedequist
  • , Daniel Sucato
  • , David Clements
  • , Firoz Miyanji
  • , Harry Shufflebarger
  • , Jack Flynn
  • , Jean Marc Mac Thiong
  • , John Asghar
  • , Josh Murphy
  • , Joshua Pahys
  • , Juergen Harms
  • , Keith Bachmann
  • , Kevin Neal
  • , Laurel Blakemore
  • , Lawrence Haber
  • , Lawrence Lenke
  • , Lori Karol
  • , Mark Abel
  • , Mark Erickson
  • , Michael Glotzbecker
  • , Michael Kelly
  • , Michael Vitale
  • , Michelle Marks
  • , Munish Gupta
  • , Nicholas Fletcher
  • , Noelle Larson
  • , Patrick Cahill
  • , Paul Sponseller
  • , Peter Gabos
  • , Peter Newton
  • , Peter Sturm
  • , Randal Betz
  • , Stefan Parent
  • , Stephen George
  • , Steven Hwang
  • , Suken Shah
  • , Sumeet Garg
  • , Tom Errico
  •  & Vidyadhar Upasani

Contributions

B involved in conception and design, data analysis and interpretation, drafted manuscript, and approved final manuscript; G involved in data acquisition and analysis, drafted manuscript, and approved final manuscript; A involved in data acquisition, drafted manuscript, and approved final manuscript; N involved in data acquisition, drafted manuscript, and approved final manuscript; P involved in data acquisition, drafted manuscript, and approved final manuscript; N involved in conception and design, data acquisition, drafted manuscript, and approved final manuscript, M involved in data acquisition, drafted manuscript, and approved final manuscript; H involved in conception and design, data acquisition, drafted manuscript, and approved final manuscript; Harms Study Group involved in conception and design, funding acquisition, data acquisition, and approved final manuscript; H involved in conception and design, data acquisition and interpretation, drafted manuscript, and approved final manuscript.

Corresponding author

Correspondence to Daniel G. Hoernschemeyer.

Ethics declarations

Conflict of interests

Boeyer Zimmer: Research Support. Groneck None. Alanay DePuy: Research Support, European Spine Journal: Editorial or Governing Board, Globus Medical: Paid Consultant, JBJS: Editorial or Governing Board, Medtronic: Research Support, Scoliosis Research Society: Board Member, Zimmer: IP Royalties; Paid Consultant. Neal AAOS: Board Member, Orthopediatrics: IP Royalties; Paid Consultant; Stock Options, POSNA: Board Member, Scoliosis Research Society: Board Member. Larson DePuy: Research Support, Globus Medical: Research Support, Medtronic: Research Support, Orthopediatrics: Research Support, POSNA: Board Member, Scoliosis Research Society: Board Member, Zimmer: Research Support. Parent Canadian Spine Society: Board Member, DePuy: Paid Consultant; Paid Presenter or Speaker; Research Support, EOS Imaging: IP Royalties; Paid Consultant; Research Support, POSNA: Board Member, Rodin 4D: IP Royalties, Scoliosis Research Society: Board Member, Setting Scoliosis Straight Foundation: Research Support, Spinologics: Employee; Stock Options. Newton DePuy Synthes Spine via Setting Scoliosis Straight Foundation: Research Support, DePuy Synthes Spine: IP Royalties, DePuy: Paid Consultant, EOS Imaging via Setting Scoliosis Straight Foundation: Research Support. Globus Medical: Paid Consultant, Harms Study Group: Board Member, International Pediatric Orthopedic Think Tank: Board Member, Medtronic Sofamor Danek: Paid Presenter or Speaker, Medtronic via Setting Scoliosis Straight: Research Support, Mirus: Paid Consultant, Nuvasive via Setting Scoliosis Straight Foundation: Research Support, Pacira: Paid Consultant, Scoliosis Research Society: Board Member, Setting Scoliosis Straight Foundation: Board Member, Stryker K2M: IP Royalties; Paid Consultant, Stryker K2M via Setting Scoliosis Straight Foundation: Research Support, Theime Publishing: Publishing Royalties, Financial or Material Support, Zimmer Biomet via Setting Scoliosis Straight Foundation: Research Support. Miyanji DePuy: Paid Consultant; Research Support, Orthopediatrics: Paid Consultant, POSNA: Board Member, Stryker: Paid Consultant, Zimmer: IP Royalties; Paid Consultant. Haber AAOS: Board Member, Orthopaediatrics: Paid Consultant, OrthoPediatrics: IP Royalties; Stock Options, POSNA: Board Member, Scoliosis Research Society: Board Member, Zimmer: Paid Presenter or Speaker. Harms Study Group Setting Scoliosis Straight via DePuy Synthes Spine, EOS Imaging, K2M, Medtronic, NuVasive, Zimmer, and Food and Drug Administration: Financial Support. Setting Scoliosis Straight Foundation via Orthopaediatrics, Mazor Robotics, Stryker, Ellipse, Globus, and SpineGaurd: Educations Grants. Hoernschemeyer Biomarin: Paid Presenter or Speaker; Research Support, Orthopediatrics: IP Royalties; Paid Consultant; Stock Options. Zimmer: Paid Presenter or Speaker; Research Support

Ethics approval

The procedures outlined herein were approved by the Institutional Review Board for each participating Medical Center.

Consent for participation and publication

This was a retrospective study that did not require assent and/or consent specific to this study for any of the participants. This procedure was approved by the Institutional Review Board for each participating Medical Center.

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Boeyer, M.E., Groneck, A., Alanay, A. et al. Operative differences for posterior spinal fusion after vertebral body tethering: Are we fusing more levels in the end?. Eur Spine J 32, 625–633 (2023). https://doi.org/10.1007/s00586-022-07450-1

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  • DOI: https://doi.org/10.1007/s00586-022-07450-1

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