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Coronal decompensation following thoracic vertebral body tethering in idiopathic scoliosis

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Abstract

Purpose

Post-operative coronal decompensation (CD) continues to be a challenge in the treatment of adolescent idiopathic scoliosis (AIS). CD following selective spinal fusion has been studied. However, there is currently little information regarding CD following Vertebral Body Tethering (VBT). Thus, the goal of this study is to better understand the incidence and risk factors for CD after VBT.

Methods

Retrospective review of a prospective multicenter database was used for analysis. Inclusion criteria were patients undergoing thoracic VBT, a minimum 2-year follow-up, LIV was L1 or above, skeletally immature (Risser ≤ 1), and available preoperative and final follow-up AP and lateral upright radiographs. Radiographic parameters including major and minor Cobb angles, curve type, LIV tilt/translation, L4 tilt, and coronal balance were measured. CD was defined as the distance between C7PL and CSVL > 2 cm. Multiple logistic regression model was used to identify significant predictors of CD.

Results

Out of 136 patients undergoing VBT, 94 patients (86 female and 6 male) met the inclusion criteria. The mean age at surgery was 12.1 (9–16) and mean follow-up period was 3.4 years (2–5 years). Major and minor curves, AVR, coronal balance, LIV translation, LIV tilt, L4 tilt were significantly improved after surgery. CD occurred in 11% at final follow-up. Lenke 1A-R (24%) and 1C (26%) had greater incidence of CD compared to 1A-L (4%), 2 (0%), and 3 (0%). LIV selection was not associated with CD. Multivariate logistic regression analysis yielded 1A-R and 1C curves as a predictor of CD with the odds ratio being 17.0.

Conclusion

CD occurred in 11% of our thoracic VBT patients. Lenke 1A-R and 1C curve types were predictors for CD in patients treated with VBT. There were no other preoperative predictors associated with CD.

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Data availability

The data that support the findings of this study are available on request from the corresponding author, (MCW).

Code availability

Statistical analysis was conducted using SPSS Statistics 26 (IBM Corp., Armonk, NY).

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Funding

There was no funding for this study.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan

    Yoji Ogura

  2. Department of Pediatric Orthopedic Surgery, Mayo Clinic College of Medicine and Science, Rochester, MN, USA

    A. Noelle Larson

  3. Department of Pediatric Orthopaedic Surgery, Pediatric Specialists of Virginia, Merrifield, VA, USA

    Laurel Blakemore

  4. Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada

    Firoz Miyanji

  5. Department of Pediatric Orthopedic Surgery, Children’s Hospital of Los Angeles, Los Angeles, CA, USA

    Lindsay M. Andras

  6. Department of Orthopaedic Surgery, Hospital Ste-Justine (HSJ), Montreal, QC, Canada

    Stefan Parent

  7. Department of Orthopaedic Surgery, IWK Health Centre, Halifax, NS, Canada

    Ron El-Hawary

  8. Shriners Hospital for Children Portland, 3101 SW Sam Jackson Park Road, Portland, OR, 97229, USA

    Michelle Cameron Welborn

Authors
  1. Yoji Ogura
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  2. A. Noelle Larson
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  3. Laurel Blakemore
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  4. Firoz Miyanji
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  5. Lindsay M. Andras
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  6. Stefan Parent
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  7. Ron El-Hawary
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  8. Michelle Cameron Welborn
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Consortia

Pediatric Spine Study Group

Contributions

YO, ANL, LB, FM, LA, SP, REH: data acquisition, analysis, interpretation, drafted/ revised work, approved final version. MW: conception/design, data acquisition, analysis, interpretation, drafted/revised work, approved final version.

Corresponding author

Correspondence to Michelle Cameron Welborn.

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Conflict of interest

Yoji Ogura reports no financial conflict of interest. Dr. Larson reports consulting with Orthopediatrics, Medtronics, Depuy Synthes, ZimVie with funds directed to Mayo orthopedic research. In addition, Dr. Larson has royalties with Globus and a patent with Mayo. Dr. Blakemore reports personal fees from Stryker Spine, other from Pediatric Spine Foundation, other from Spine Deformity Journal, outside the submitted work; In addition, Dr. Blakemore has a patent U.S. Patent Application 10,548,639 pending to Stryker Spine, and a patent.US Patent Application 17/091773 pending to Stryker Spine. Dr. Miyanji reports personal fees from Depuy Synthes, personal fees from Stryker, personal fees and other from ZimVie, personal fees from Orthopaediatrics, grants from Setting Scoliosis Straight Foundation, other from AO Fracture, Tumour, Deformity Expert Group outside the submitted work. Lindsay Andras, reports grants from POSNA during the conduct of the study; stocks/shareholder of Eli Lilly, personal fees from Medtronic, personal fees from Nuvasive, personal fees from Orthopediatrics, personal fees from Orthobullets 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, other from DePuy Synthes, other from Medtronic, other from Orthopaediatrics, outside the submitted work. Dr. El-Hawary reports grants and personal fees from Medtronic Canada, grants and personal fees from Depuy Synthes Spine, personal fees and other from Orthopediatrics, grants from ZimVie, grants from Scoliosis Research Society, grants from Pediatric Orthopaedic Society of North America outside the submitted work. Dr. Welborn reports grants from POSNA, grants from Shriners Hospital for Children, during the conduct of the study; personal fees and other from Depuy Synthes, personal fees from Nuvasive, personal fees from Stryker/K2M, personal fees from Orthopediatrics, Personal fees from AstraZenica outside the submitted work.

Ethical approval (IRB)

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Western Institutional Review Board, Panel 5 Study # 20160128) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Ogura, Y., Larson, A.N., Blakemore, L. et al. Coronal decompensation following thoracic vertebral body tethering in idiopathic scoliosis. Spine Deform (2024). https://doi.org/10.1007/s43390-024-00855-6

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