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Double major curvature treated with vertebral body tethering of both curves: how do outcomes compare to posterior spinal fusion?

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Abstract

Purpose

Vertebral body tethering (VBT) is a non-fusion alternative to posterior spinal fusion (PSF). There have been few reports on VBT of two curvatures. We aim to compare the radiographic outcomes between VBT and PSF in patients with double curvatures in which both curves were instrumented.

Methods

29 AIS patients matched by Lenke, age (± 2 years), triradiate cartilage closure status, major Cobb angle (± 8°), and T5–T12 kyphosis (± 10°). Variables were compared using Wilcoxon rank-sum tests, Student’s t tests, and chi-Square. Clinical success was defined as major curve < 35°.

Results

Group baseline demographics were similar. Major thoracic (T) curve types had significantly better major (VBT 51.5 ± 7.9° to 31.6 ± 12.0° [40%] vs. PSF 54.3 ± 7.4° to 17.4 ± 6.5° [68%]; p = 0.0002) and secondary curve correction in the PSF group. 71% of major T VBT patients were clinically successful versus 100% of PSF. Major thoracolumbar (TL) curve types experienced comparable major (VBT 52.3 ± 7.0° to 18.3 ± 11.4° (65%) vs. PSF 53.0 ± 5.2° to 23.8 ± 10.9° (56%); p = 0.2397) and secondary curve correction. 92% of major TL VBT patients were clinically successful versus 75% in the PSF group. There was no difference in T5–12 kyphosis or lumbar lordosis between groups for any curve type. There were 4 patients (13.8%) with major complications in the VBT group compared to 0 (0%) in the PSF.

Conclusion

Patients with double major AIS who underwent VBT with major T curve types had less correction than PSF; however, those with major TL curves experienced similar radiographic outcomes regardless of procedure. Complications were greater for VBT.

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Code availability

Not applicable.

Data availability

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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Funding

Funding was received from Setting Scoliosis Straight Foundation.

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Authors and Affiliations

  1. Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, Mount Sinai Spine, 5 E 98th St., New York, NY, 10029, USA

    Baron Lonner, Lily Eaker, Jessica Zhang & Ashley Wilczek

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

    Daniel Hoernschemeyer, Patrick Elliot & Melanie E. Boeyer

  3. Department of Orthopaedics, Children’s Healthcare of Atlanta, Atlanta, GA, USA

    Nicholas D. Fletcher

  4. Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey

    Ahmet Alanay & Caglar Yilgor

  5. Department of Orthopaedics, Rady Children’s Hospital, San Diego, CA, USA

    Peter Newton

  6. Department of Orthopedics, British Columbia Children’s Hospital, Vancouver, BC, Canada

    Firoz Miyanji

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  1. Baron Lonner
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Contributions

Made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data: BL, LE, DH, JZ, AW, PE, MB, NF, AA, CY, PN, FM, HNG. Drafted the work or revised it critically for important intellectual content: BL, LE, DH, JZ, AW, PE, MB, NF, AA, CY, PN, FM, HNG. Approved the version to be published: BL, LE, DH, JZ, AW, PE, MB, NF, AA, CY, PN, FM, HNG. Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: BL, LE, DH, JZ, AW, PE, MB, NF, AA, CY, PN, FM, HNG.

Corresponding author

Correspondence to Baron Lonner.

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Conflict of interest

Dr. Lonner reports personal fees, royalty fees, and research grant support from ZimVie Spine 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, other from Paradigm Spine, non-financial support and other from Spine Search, other from Setting Scoliosis Straight Foundation, outside the submitted work.

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

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Lonner, B., Eaker, L., Hoernschemeyer, D. et al. Double major curvature treated with vertebral body tethering of both curves: how do outcomes compare to posterior spinal fusion?. Spine Deform 12, 651–662 (2024). https://doi.org/10.1007/s43390-023-00803-w

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