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Vertebral body tethering for Lenke 1A curves: the lumbar modifier predicts less optimal outcomes

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Abstract

Introduction

The addition of the L4 “AR” and “AL” lumbar modifier for Lenke 1A idiopathic scoliosis (IS) has been shown to direct treatment in posterior spinal fusion; however, its utility in vertebral body tethering (VBT) has yet to be evaluated.

Methods

A review of a prospective, multicenter database for VBT in IS was performed for patients with Lenke 1A deformities and a minimum of 2 years follow-up. Patients were categorized by their lumbar modifier (AR vs AL). Less optimal VBT outcome (LOVO) was defined as a final coronal curve > 35°, lumbar adding-on, or revision surgery for deformity progression or adding-on.

Results

Ninety-nine patients met inclusion criteria (81% female, mean 12.6 years), with 55.6% being AL curves. Overall, there were 23 instances of tether breakage (23.3%) and 20 instances of LOVO (20.2%). There was a higher rate of LOVO in AR curves (31.8% vs 10.9%, P = 0.01). Patients with LOVO had greater preoperative deformity, greater apical translation, larger coronal deformity on first erect radiographs, and less coronal deformity correction. Failure to correct the deformity < 30° on first erect was associated with LOVO, as was LIV selection short of the last touch vertebra (TV). Independent risk factors for LOVO included AR curves (OR 3.4; P = 0.04) and first erect curve magnitudes > 30 degrees (OR 6.0; P = 0.002).

Discussion

There is a 20.2% rate of less optimal VBT following VBT for Lenke 1A curves. AR curves are independently predictive of less optimal outcomes following VBT and require close attention to LIV selection. Surgeons should consider achieving an initial coronal correction < 30 degrees and extending the LIV to at least the TV to minimize the risk of LOVO.

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Data availability

Data is available for review upon appropriate request.

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Funding

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Authors and Affiliations

  1. Department of Pediatric Orthopaedic Surgery, Children’s Mercy Kansas City, Kansas City, MO, USA

    K. Aaron Shaw

  2. Department of Orthopaedic Surgery, BC Children’s Hospital, Vancouver, BC, Canada

    Firoz Miyanji

  3. Department of Orthopaedic Surgery, Rady’s Children’s Hospital, San Diego, CA, USA

    Tracey Bryan & Peter O. Newton

  4. Department of Orthopaedic Surgery, University of Montreal, Montreal, QC, Canada

    Stefan Parent

  5. Department of Pediatric Orthopaedic Surgery, CPG–Orthopaedics, Children’s Healthcare of Atlanta Scottish Rite, Atlanta, GA, USA

    Joshua S. Murphy

Authors
  1. K. Aaron Shaw
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  2. Firoz Miyanji
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  3. Tracey Bryan
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  4. Stefan Parent
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  5. Peter O. Newton
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  6. Joshua S. Murphy
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Consortia

Harms Study Group

Contributions

KAS: study design, data interpretation, manuscript drafting, manuscript approval, and accountable. B: data analysis, data interpretation, manuscript editing, manuscript approval, and accountable. FM, SP, and PON: study design, data interpretation, manuscript editing and approval, and accountable. JSM: study design, data analysis, manuscript editing, manuscript approval, and accountable.

Corresponding author

Correspondence to Joshua S. Murphy.

Ethics declarations

Conflict of interest

Dr. Shaw is a committee member for NASS, POSNA, and AAOS; Dr. Miyanji is a consultant for OrthoPediatrics, Depuy, Zimmer, and Stryker, receives royalities from Zimmer, and research support from DePuy; Ms. Bryan reports no conflicts; Dr. Parent is a consultant for Depuy Synthes, EOS Imaging, Spinologics, receives Royalties from Rodin 4D, stock options from Spinologics, Research Support from Setting Scoliosis Straight and EOS Imaging, paid presenter for DePuy, and board/committee member for POSNA, Canadian Spine Society; Dr. Newton is consultant for Globus, Pacira, Stryke, Depuy, Mirus and receives Royalties from DePuy, Stryker, and Thieme, Research support from Depuy, EOS Imaging, Medtronic, Nuvasive, Stryker, and Zimmer, Paid presenter for Medtronic, and board/committee member for IPOP, Harms Study Group, SRS, Setting Scoliosis Straight; Dr. Murphy is a committee member on POSNA, reviewer for Journal of Pediatric Orthopaedics and Spine Deformity, and Consultant for Orthopediatrics, Depuy Synthes Spine, and ATEC Spine.

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Approved.

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Not applicable.

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From: Children’s Healthcare of Atlanta Scottish Rite.

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Shaw, K.A., Miyanji, F., Bryan, T. et al. Vertebral body tethering for Lenke 1A curves: the lumbar modifier predicts less optimal outcomes. Spine Deform 12, 663–670 (2024). https://doi.org/10.1007/s43390-023-00815-6

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  • DOI: https://doi.org/10.1007/s43390-023-00815-6

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