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Bilateral vertebral body tethering: identifying key factors associated with successful outcomes

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Abstract

Purpose

The treatment of operative double major pediatric spinal deformities (e.g., Lenke 3 or 6) with bilateral vertebral body tethering (VBT) can be significantly more challenging when compared to other deformity patterns (e.g., Lenke 1) or treatment with a posterior spinal fusion. We aimed to identify preoperative and perioperative characteristics that were associated with successful postoperative outcomes in patients treated with both a thoracic and thoracolumbar (e.g., bilateral) tether.

Methods

We retrospectively assessed radiographic and clinical data from patients enrolled in a large multi-center study who had a minimum postoperative follow-up of two years. Standard radiographic parameters were extracted from standing spine and left hand-wrist radiographs at various timepoints. We classified patients based on their preoperative deformity pattern (Primary Thoracic [TP] vs. Primary Thoracolumbar [TLP]) and assessed: (1) deformity balance, (2) tilt of the transitional vertebra, and (3) postoperative success.

Results

We analyzed data from thirty-six patients (TP: 19 and TLP: 17). We observed no relationship between deformity balance at first erect and postoperative success (p = 0.354). Patients with a horizontal transitional vertebra at first erect were significantly (p = 0.001) more likely to exhibit a successful outcome when compared to those who exhibited a tilted transitional vertebra (83% vs. 62%). Patients who had TLP were also more likely to exhibit a successful outcome when compared to patients who exhibited TP (76% vs. 50%).

Conclusion

These data indicate that double major deformities can be successfully treated with VBT, particularly for those who exhibit TLP.

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Availability of data and material

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.

Code availability

Not applicable.

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Acknowledgements

Harms Study Group Consortium Members: Aaron Buckland, MD; New York University. Ahmet Alanay, MD; Acibadem Maslak Hospital, Turkey. Amer Samdani, MD; Shriners Hospitals for Children—Philadelphia. Amit Jain, MD; Johns Hopkins Hospital. A. Noelle Larson, MD; Mayo Clinic Rochester Minnesota. Baron Lonner, MD; Mount Sinai Hospital. Benjamin Roye, MD; Columbia University. Bob Cho, MD; Shriner’s Pasadena CA. Burt Yaszay, MD; Seattle Children's Hospital. Caglar Yilgor, MD; Acibadem Maslak Hospital, Turkey. Chris Reilly, MD; BC Children’s Hospital. Dan Hoernschmeyer, MD; University of Missouri Health Care. Daniel Hedequist, MD; Boston Children’s Hospital. Daniel Sucato, MD; Texas Scottish Rite Hospital. David Clements, MD; Cooper Bone & Joint Institute New Jersey. Firoz Miyanji, MD; BC Children’s Hospital. Harry Shufflebarger, MD; Paley Orthopedic & Spine Institute. Jack Flynn, MD; Children’s Hospital of Philadelphia. Jean Marc Mac Thiong, MD; CHU Sainte-Justine. John Asghar, MD; Paley Orthopedic & Spine Institute. Josh Murphy, MD; Children's Healthcare of Atlanta. Joshua Pahys, MD; Shriners Hospitals for Children—Philadelphia. Juergen Harms, MD; Klinikum Karlsbad-Langensteinbach, Karlsbad. Keith Bachmann, MD; University of Virginia. Kevin Neal, MD; Nemours Children’s Clinic, Jacksonville. Laurel Blakemore, MD; Pediatric Specialists of Virginia/Children’s National. Lawrence Haber, MD; Ochsner Health Center for Children, New Orleans. Lawrence Lenke, MD; Columbia University. Lori Karol, MD; Children’s Hospital, Denver Colorado. Mark Abel, MD; University of Virginia. Mark Erickson, MD; Children’s Hospital, Denver Colorado. Michael Glotzbecker, MD; Rainbow Children’s Hospital, Cleveland. Michael Kelly, MD; Washington University. Michael Vitale, MD; Columbia University. Michelle Marks, PT, MA; Setting Scoliosis Straight Foundation. Munish Gupta, MD; Washington University. Nicholas Fletcher, MD; Emory University. Patrick Cahill, MD; Children’s Hospital of Philadelphia. Paul Sponseller, MD; Johns Hopkins Hospital. Peter Gabos, MD: Nemours/Alfred I. duPont Hospital for Children. Peter Newton, MD; Rady Children’s Hospital. Peter Sturm, MD; Cincinnati Children’s Hospital. Randal Betz, MD; Institute for Spine & Scoliosis. Stefan Parent, MD: CHU Sainte-Justine. Stephen George, MD; Nicklaus Children's Hospital. Steven Hwang, MD; Shriners Hospitals for Children—Philadelphia. Suken Shah, MD; Nemours/Alfred I. duPont Hospital for Children. Sumeet Garg, MD; Children’s Hospital, Denver Colorado. Tom Errico, MD; Nicklaus Children's Hospital. Vidyadhar Upasani, MD; Rady Children’s Hospital.

Funding

No direct funding was provided for the work presented herein. We did, however, retrospectively assess data from the Harms Study Group, which received external funding from several sources.

Author information

Authors and Affiliations

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

    Daniel G. Hoernschemeyer & Melanie E. Boeyer

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

    Patrick Elliott

  3. Department of Orthopaedic Surgery, The Mount Sinai Hospital, New York, NY, USA

    Baron S. Lonner & Lily Eaker

  4. Missouri Orthopaedic Institute, 1100 Virginia Ave, Columbia, MO, 65212, USA

    Melanie E. Boeyer

Authors
  1. Daniel G. Hoernschemeyer
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  2. Patrick Elliott
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  3. Baron S. Lonner
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  4. Lily Eaker
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Consortia

Harms Study Group

  • Aaron Buckland
  • , Ahmet Alanay
  • , Amer Samdani
  • , Amit Jain
  • , A. Noelle Larson
  • , 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
  • , 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

Daniel G. Hoernschemeyer contributed to the conception, design, data acquisition, data interpretation, revised manuscript, approved final version, and agreed to be accountable; Patrick Elliott assisted in the conception, design, data acquisition, data interpretation, drafted manuscript, approved final version, and agreed to be accountable; Baron S. Lonner was involved in the conception, data acquisition, data interpretation, revised manuscript, approved final version, and agreed to be accountable; Lily Eaker contributed to the conception, data interpretation, revised manuscript, approved final version, and agreed to be accountable; Harms Study Group assisted in the data acquisition, data interpretation, revised manuscript, approved final version, and agreed to be accountable; Melanie E. Boeyer was involved in the conception, design, data analysis, data interpretation, drafted manuscript, revised manuscript, approved final version, and agreed to be accountable.

Corresponding author

Correspondence to Melanie E. Boeyer.

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Conflict of interest

There are several authors of this work that have financial disclosures; however, none are directly related to the work presented herein.

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.

Ethical approval

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

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Hoernschemeyer, D.G., Elliott, P., Lonner, B.S. et al. Bilateral vertebral body tethering: identifying key factors associated with successful outcomes. Eur Spine J 33, 723–731 (2024). https://doi.org/10.1007/s00586-023-08074-9

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