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Anterior vertebral body tethering shows clinically comparable shoulder balance outcomes to posterior spinal fusion

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Abstract

Purpose

Posterior spinal fusion (PSF) is the current gold standard in surgical treatment for adolescent idiopathic scoliosis. Vertebral body tethering (VBT) is a fusionless alternative. Shoulder balance is an important metric for outcomes and patient satisfaction. Here we compare shoulder balance outcomes between PSF and VBT.

Methods

In this retrospective review, the pre-operative and post-operative absolute radiographic shoulder height (|RSH|) of 45 PSF patients were compared to 46 VBT patients. Mean values were compared and then collapsed into discrete groups (|RSH| GROUP) and compared. Patients were propensity score matched. Regression models based on pretest–posttest designs were used to compare procedure type on post-operative outcomes.

Results

Pre-operatively there were no differences in |RSH| between PSF and VBT, however, at latest post-operative follow-up PSF maintained a larger |RSH| imbalance compared to VBT (0.91 cm vs 0.63 cm, p = 0.021). In an ANCOVA regression, PSF was associated with a larger |RSH| imbalance compared to VBT, F(1, 88) = 5.76, p = 0.019. An ordinal logistic regression found that the odds ratio of being in a worse |RSH| GROUP for PSF vs VBT is 2.788 (95% CI = 1.099 to 7.075), a statistically significant effect χ2(1) = 4.658, p = 0.031. Results were similar in subgroup analyses of Lenke 1 and Lenke 2 patients, though to less statistical significance.

Conclusion

While PSF was found to be associated with worse |RSH| outcomes, the actual numbers (2–3 mm) are unlikely to be clinically meaningful. Thus, in this analysis, VBT can be said to show comparable shoulder balance outcomes to PSF.

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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.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, 5 E 98th St., 4th Floor, New York, NY, 10029, USA

    James Meyers, Lily Eaker, Michael Herrera, Ashley Wilczek & Baron Lonner

  2. Department of Neurosurgery, Shriners Hospital-Philadelphia, Philadelphia, PA, USA

    Amer Samdani

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

    Firoz Miyanji

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

    Ahmet Alanay & Caglar Yilgor

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

    Daniel Hoernschemeyer

  6. Department of Orthopaedics, Nemours Children’s Hospital, Wilmington, DE, USA

    Suken Shah

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

    Peter Newton

Authors
  1. James Meyers
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Contributions

Made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data: JM, LE, AS, FM, MH, AW, AA, CY, DH, SS, PN, BL. Drafted the work or revised it critically for important intellectual content: JM, LE, AS, FM, MH, AW, AA, CY, DH, SS, PN, BL. Approved the version to be published: JM, LE, AS, FM, MH, AW, AA, CY, DH, SS, PN, BL. 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: JM, LE, AS, FM, MH, AW, AA, CY, DH, SS, PN, BL.

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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Meyers, J., Eaker, L., Samdani, A. et al. Anterior vertebral body tethering shows clinically comparable shoulder balance outcomes to posterior spinal fusion. Spine Deform (2024). https://doi.org/10.1007/s43390-024-00847-6

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