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Vertebral body tethering for non-idiopathic scoliosis: initial results from a multicenter retrospective study

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Abstract

Purpose

Vertebral body tethering (VBT) has been described for patients with idiopathic scoliosis. Results of the technique for non-idiopathic scoliosis have not yet been reported.

Methods

An international multicenter registry was retrospectively queried for non-idiopathic scoliosis patients who underwent VBT with minimum 2-year follow-up. Success at 2 years was defined as Cobb angle < 35 degrees and no fusion surgery.

Results

Of the 251 patients treated with VBT, 20 had non-idiopathic scoliosis and minimum 2-year follow-up. Mean age at surgery was 12.4 years (range 10 to 17 years). Mean major Cobb angle at enrollment was 56 degrees. Of those, 18 patients had a major thoracic curve and two had a major lumbar curve. Of the 20 patients, nine met criteria for success (45%). Eight of the 20 patients had poor outcomes (four fusions, four with curve > 50 degrees). Success was associated with smaller preoperative Cobb angle (50 vs. 62 degrees, p = 0.01) and smaller Cobb angle on initial postop imaging (28 degrees vs. 46 degrees, p = 0.0007). All patients with Cobb angle < 35 degrees on 1st postop imaging had a successful result, with the exception of one patient who overcorrected and required fusion. Syndromic vs. neuromuscular patients had a higher likelihood of success (5 of 7, 71%, 2 of 10, 20%, p = 0.03).

Conclusion

Selected non-idiopathic scoliosis can be successfully treated with VBT, but failure rates are high and were associated with large curves, inadequate intraoperative correction and neuromuscular diagnosis. Achieving a Cobb angle less than 35 degrees on 1st standing radiograph was associated with a successful outcome which was achieved in 45% of patients.

Level of evidence

Level IV (retrospective review study).

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Funding

Funding for this study was obtained from Pediatric Spine Study Group.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Natalie A. Pulido, Todd A. Milbrandt & A. Noelle Larson

  2. Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA

    Michael G. Vitale

  3. Department of Surgery, Université de Montréal, Montreal, QC, Canada

    Stefan Parent

  4. CHU Sainte-Justine, Montreal, QC, Canada

    Stefan Parent

  5. Department of Orthopedics, BC Children’s Hospital, Vancouver, BC, Canada

    Firoz Miyanji

  6. Division of Orthopedic Surgery, Dalhousie University, Halifax, NS, Canada

    Ron El-Hawary

  7. Pediatric Spine Study Group, Valley Forge, PA, USA

    A. Noelle Larson

Authors
  1. Natalie A. Pulido
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  2. Michael G. Vitale
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  3. Stefan Parent
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  4. Todd A. Milbrandt
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  5. Firoz Miyanji
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  6. Ron El-Hawary
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  7. A. Noelle Larson
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Consortia

Pediatric Spine Study Group

Corresponding author

Correspondence to A. Noelle Larson.

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Conflict of interest

Ms. Pulido and Pediatric Spine Study Group have no conflicts to report. Outside of the study, Dr. Milbrandt reports consulting activities with Orthopediatrics, Medtronic, Zimmer and stock ownership in Viking Scientific. Outside of study, Dr. Larson reports consulting activities with Orthopediatrics, Medtronic, Zimmer, and Globus. Outside of study, Dr. El-Hawary reports grants and personal fees from Medtronic, grants and personal fees from Depuy Synthes Spine, other from Orthopediatrics, grants from Zimmer Biomet. Outside the submitted work, Dr. Vitale reports research grants from OSRF, Pediatric Spine Foundation, POSNA, Setting Scoliosis Straight Foundation, consulting activities with Stryker, Biomet, and NuVasive, and positions in a company (CSF, President, Board of Directors; POSNA: Former President 2020; IPOS: Board Member, Chair Emeritus,’17-present, Chair’15- ‘16, C4K, Board of Directors). Outside the submitted work, Dr. Parent reports personal fees from EOS-imaging, personal fees from Spinologics, personal fees from K2M, personal fees from EOS-imaging, personal fees from DePuy Synthes Spine, other from Academic Research chair in spine deformities of the CHU Sainte-Justine (DePuy), grants from DePuy Synthes Spine, grants from Canadian Institutes of Health Research, grants from Pediatric Orthopaedic Society of North America, grants from Scoliosis Research Society, grants from EOS imaging, grants from Canadian Foundation for Innovation, grants from Setting Scoliosis Straight Foundation, grants from Natural Sciences and Engineering Council of Canada, grants from Fonds de recherche Québec—Santé, grants and other from Orthopaedic Research and Education Foundation, fellowship support from DePuy Synthes, Medtronic, and Orthopaediatrics. Outside the submitted work, Dr. Miyanji reports committee membership at POSNA and SRS, personal fees and other from Zimmer, personal fees from Depuy, Orthopediatrics, Stryker, Zimmer.

Ethical approval

IRB approval was obtained for all aspects of this study, which was performed as part of a multicenter study conducted through the Pediatric Spine Study Group.

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Pulido, N.A., Vitale, M.G., Parent, S. et al. Vertebral body tethering for non-idiopathic scoliosis: initial results from a multicenter retrospective study. Spine Deform 11, 139–144 (2023). https://doi.org/10.1007/s43390-022-00575-9

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  • DOI: https://doi.org/10.1007/s43390-022-00575-9

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