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Vertebral body tethering compared to posterior spinal fusion for skeletally immature adolescent idiopathic scoliosis patients: preliminary results from a matched case–control study

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Abstract

Purpose

Direct comparisons between vertebral body tethering (VBT) and posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) are limited. We aimed to evaluate 2-year results of VBT and PSF to report comparative outcomes.

Methods

26 prospectively enrolled VBT patients were matched 1:1 by age, gender, Risser sign and major curve magnitude with PSF patients. At a minimum 2-year follow-up, surgical results and radiographic outcomes were reviewed.

Results

Operative time, anesthesia time, blood loss, and length of stay were significantly lower in the VBT group (< 0.001, p = 0.003, p < 0.001, p < 0.001, respectively). The major curve at 2 years was corrected by 46% in the VBT group vs. 66% in the PSF (p = 0.0004). Success following VBT, defined as no fusion surgery and Cobb angle < 35° at the 2-year follow-up, was seen in 20 VBT patients (77%) (p = 0.0003) and correlated with mean Cobb angle of < 35° on 3-month imaging. 12 VBT patients (46%) showed curve improvement over time, and those patients had significantly lower mean Cobb angle on the 3-month radiograph than non-modulators (23° vs 31°, p = 0.014). At 2 years, cord breakage occurred in five patients (19%). By 2 years, three VBT patients developed complications (2 pleural effusion and 1 overcorrection needing return to OR). In contrast to PSF, growth continued at T1–T12 (mean 13 mm) and over the instrumented levels (mean 10 mm) following VBT, compared to no growth over instrumented segments in the fusion cohort (p = 0.011, p = 0.0001).

Conclusion

In Sanders stages 3 and 4 patients treated in the USA, Cobb angle < 35° on 3-month imaging was associated with success at the 2-year follow-up. Curve correction was superior in the PSF group with 96% achieving curve correction to < 35° vs. 77% of the VBT patients. Cord breakage was noted in 19% of VBT patients at the 2-year follow-up. Three patients developed complications in both the VBT and PSF cohorts.

Level of evidence

Level II (prospective study with matched retrospective comparison group).

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Funding

Funding for this study was obtained from Orthopedic Research and Education Foundation, Pediatric Orthopedic Society of North America, and Mayo CCaTS-CBD Pilot Award for Team Science.

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Authors and Affiliations

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

    Smitha E. Mathew, Todd A. Milbrandt, Anthony A. Stans, William J. Shaughnessy & A. Noelle Larson

  2. Mayo Clinic Alix School of Medicine, Rochester, MN, USA

    J. Blade Hargiss

Authors
  1. Smitha E. Mathew
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  2. J. Blade Hargiss
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  3. Todd A. Milbrandt
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  4. Anthony A. Stans
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  5. William J. Shaughnessy
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  6. A. Noelle Larson
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Corresponding author

Correspondence to A. Noelle Larson.

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Conflicts of interest

Outside of the study, Dr. Milbrandt reports consulting activities with Orthopediatrics, Medtronic, Zimmer and stock ownership in Viking Scientific. Dr. Larson reports consulting activities with Orthopediatrics, Medtronic, Zimmer, and Globus. Drs. Mathew, Stans, Shaughnessy, and J. Blade Hargiss have no conflicts to report.

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IRB approval was obtained for all aspects of this study, which was performed as part of a surgeon-sponsored investigation device exemption (IRB 17-007801, FDA IDE G18003, NCT03506334) and an institutional registry (IRB 14-004866).

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Mathew, S.E., Hargiss, J.B., Milbrandt, T.A. et al. Vertebral body tethering compared to posterior spinal fusion for skeletally immature adolescent idiopathic scoliosis patients: preliminary results from a matched case–control study. Spine Deform 10, 1123–1131 (2022). https://doi.org/10.1007/s43390-022-00519-3

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  • DOI: https://doi.org/10.1007/s43390-022-00519-3

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