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Outcomes of vertebral body tethering in the lumbar spine

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Abstract

Purpose

The use of vertebral body tethering (VBT) for the treatment of main thoracic deformities in adolescent idiopathic scoliosis patients is becoming increasingly more common, but limited data exist on its safety and efficacy in thoracolumbar deformities. We aimed to evaluate the postoperative outcomes of patients with thoracolumbar (TL) deformities that were treated with VBT.

Methods

We assessed clinical and radiographic data from twenty-eight consecutive patients that were surgically managed with VBT, all of whom exhibited a TL deformity with at least two years (mean: 44.7 ± 14.5 months) of postoperative follow-up. Standard radiographic parameters were extracted from left hand wrist and standing posterior–anterior and lateral spine radiographs at various timepoints. Outcome variables were assessed based on preoperative Lenke Classification and included: deformity measures, complications, surgical revisions, and postoperative success.

Results

The mean age at the time of instrumentation was 13.4 ± 1.3 years, with an average preoperative Sanders Stage of 4.6 ± 1.4. A significant reduction in preoperative deformities was observed at most postoperative timepoints. A perioperative complication was observed in three patients and surgical revision was required in another four patients. A suspected broken tether was observed in sixteen patients, most of which occurred at the apex of the lumbar deformity. Only one patient required surgical revision due to a suspected broken tether. We observed an overall success rate of 57%, regardless of Lenke Classification.

Conclusions

These data indicate that VBT can successfully correct TL deformity patterns in 57% of patients without an increase in the rate of perioperative complications, suspected broken tethers, or surgical revisions.

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References

  1. Wiggins GC, Shaffrey CI, Abel MF, Menezes AH (2003) Pediatric spinal deformities. Neurosurg Focus 14:1–14. https://doi.org/10.3171/foc.2003.14.1.4

    Article  Google Scholar 

  2. Weinstein SL, Dolan LA, Cheng JC, Danielsson A, Morcuende JA (2008) Adolescent idiopathic scoliosis. Lancet 371:1527–1537. https://doi.org/10.1016/S0140-6736(08)60658-3

    Article  PubMed  Google Scholar 

  3. Nohara A, Kawakami N, Seki K, Tsuji T, Ohara T, Saito T, Kawakami K (2015) The effects of spinal fusion on lumbar disc degeneration in patients with adolescent idiopathic scoliosis: a minimum 10-year follow-up. Spine Deform 3:462–468

    Article  PubMed  Google Scholar 

  4. Tones M, Moss N, Polly DWJ (2006) A review of quality of life and psychosocial issues in scoliosis. Spine 31:3027–3038. https://doi.org/10.1097/01.brs.0000249555.87601.fc

    Article  PubMed  Google Scholar 

  5. Danielsson AJ, Wiklund I, Pehrsson K, Nachemson AL (2001) Health-related quality of life in patients with adolescent idiopathic scoliosis: a matched follow-up at least 20 years after treatment with brace or surgery. Eur Spine J 10:278–288. https://doi.org/10.1007/s005860100309

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Samdani A, Ames R, Kimball J, Pahys J, Grewal H, Pelletier G, Betz R (2014) Anterior vertebral body tethering for idiopathic scoliosis: two-year results. Spine 39:1688–1693

    Article  PubMed  Google Scholar 

  7. Newton P, Kluck D, Saito W, Yaszay B, Bartley C, Bastrom T (2018) Anterior spinal growth tethering for skeletally immature patients with scoliosis: a retrospective look two to four years postoperatively. J Bone Jt Surg Am 100:1691–1697

    Article  Google Scholar 

  8. Hoernschemeyer D, Boeyer M, Robertson M, Loftis C, Worley JR, Tweedy N, Gupta S, Duren D, Holzhauser C, Ramachandran V (2020) Anterior vertebral body tethering for adolescent scoliosis with growth remaining: a retrospective review of 2 to 5-year postoperative results. J Bone Jt Surg Am 102:1169–1176

    Article  Google Scholar 

  9. Samdani AF, Pahys JM, Ames RJ, Grewal H, Pelletier GJ, Hwang SW, Betz RR (2021) Prospective follow-up report on anterior vertebral body tethering for idiopathic scoliosis: interim results from an FDA IDE study. J Bone Jt Surg Am. https://doi.org/10.2106/JBJS.20.01503

    Article  Google Scholar 

  10. Betz R, Ranade A, Samdani A, Chafetz R, D’Andrea L, Gaughan J, Asghar J, Grewal H, Mulcahey M (2010) Vertebral body stapling: a fusionless treatment option for a growing child with moderate idiopathic scoliosis. Spine 35:169–176. https://doi.org/10.1097/BRS.0b013e3181c6dff5

    Article  PubMed  Google Scholar 

  11. Pehlivanoglu T, Oltulu I, Erdag Y, Akturk UD, Korkmaz E, Yildirim E, Sarioglu E, Ofluoglu E, Aydogan M (2021) Comparison of clinical and functional outcomes of vertebral body tethering to posterior spinal fusion in patients with adolescent idiopathic scoliosis and evaluation of quality of life: preliminary results. Spine Deform. https://doi.org/10.1007/s43390-021-00323-5

    Article  PubMed  Google Scholar 

  12. Yucekul A, Akpunarli B, Durbas A, Zulemyan T, Havlucu I, Ergene G, Senay S, Yalinay Dikmen P, Turgut Balci S, Karaarslan E, Yavuz Y, Yilgor C, Alanay A (2021) Does vertebral body tethering cause disc and facet joint degeneration? A preliminary MRI study with minimum 2-years follow-up. Spine J. https://doi.org/10.1016/j.spinee.2021.05.020

    Article  PubMed  Google Scholar 

  13. Newton P, Bartley C, Bastrom T, Kluck D, Saito W, Yaszay B (2020) Anterior spinal growth modulation in skeletally immature patients with idiopathic scoliosis: a comparison with posterior spinal fusion at 2 to 5 years postoperatively. J Bone Jt Surg Am 102:769–777

    Article  Google Scholar 

  14. Alanay A, Yucekul A, Abul K, Ergene G, Senay S, Ay B, Cebeci BO, Yalinay Dikmen P, Zulemyan T, Yavuz Y, Yilgor C (2020) Thoracoscopic vertebral body tethering for adolescent idiopathic scoliosis: follow-up curve behavior according to sanders skeletal maturity staging. Spine 45:E1483. https://doi.org/10.1097/BRS.0000000000003643

    Article  PubMed  Google Scholar 

  15. Baroncini A, Trobisch P, Migliorini F (2020) Learning curve for vertebral body tethering: analysis on 90 consecutive patients. Spine Deform 9:141–147

  16. Lenke LG, Betz RR, Clements D, Merola A, Haher T, Lowe T, Newton P, Bridwell KH, Blanke K (2002) Curve prevalence of a new classification of operative adolescent idiopathic scoliosis: does classification correlate with treatment? Spine 27:604–611

    Article  PubMed  Google Scholar 

  17. Baker C, Kiebzak G, Neal K (2020) Anterior vertebral body tethering shows mixed results at 2-year follow-up. Spine Deform 9:481–489

  18. Pehlivanoglu T, Oltulu I, Erdag Y, Korkmaz E, Sarioglu E, Ofluoglu E, Aydogan M (2021) Double-sided vertebral body tethering of double adolescent idiopathic scoliosis curves: radiographic outcomes of the first 13 patients with 2 years of follow-up. Eur Spine J. https://doi.org/10.1007/s00586-021-06745-z

    Article  PubMed  Google Scholar 

  19. Stein-Wexler R, Wootton-Gorges SL, Ozonoff MB (2014) Pediatric orthopedic imaging. Springer, Berlin

    Google Scholar 

  20. Skaggs DL, Kocher M (2015) Master techniques in orthopaedic surgery: pediatrics. Lippincott Williams & Wilkins, Philadelphia

    Google Scholar 

  21. Weinstein SL, Dolan LA, Spratt KF, Peterson KK, Spoonamore MJ, Ponseti IV (2003) Health and function of patients with untreated idiopathic scoliosis: a 50-year natural history study. JAMA 289:559–567. https://doi.org/10.1001/jama.289.5.559

    Article  PubMed  Google Scholar 

  22. Samdani A, Ames R, Kimball J, Pahys J, Grewal H, Pelletier G, Betz R (2015) Anterior vertebral body tethering for immature adolescent idiopathic scoliosis: one-year results on the first 32 patients. Eur Spine J 24:1533–1539

    Article  PubMed  Google Scholar 

  23. Parent S, Shen J (2020) Anterior vertebral body growth-modulation tethering in idiopathic scoliosis: surgical technique. J Am Acad Orthop Surg 28:693–699. https://doi.org/10.5435/JAAOS-D-19-00849

    Article  PubMed  Google Scholar 

  24. Buyuk AF, Milbrandt TA, Mathew SE, Potter DD, Larson AN (2021) Does preoperative and intraoperative imaging for anterior vertebral body tethering predict postoperative correction? Spine Deform 9:743–750. https://doi.org/10.1007/s43390-020-00267-2

    Article  PubMed  Google Scholar 

  25. RStudio Team (2021) RStudio: integrated development environment for R

  26. Rathbun JR, Hoernschemeyer DS, Wakefield MR, Malm-Buatsi EA, Murray KS, Ramachandran V (2019) Ureteral injury following vertebral body tethering for adolescent idiopathic scoliosis. J Pediatr Surg Case Rep 46:101219. https://doi.org/10.1016/j.epsc.2019.101219

    Article  Google Scholar 

  27. Miyanji F, Pawelek J, Nasto LA, Rushton P, Simmonds A, Parent S (2020) Safety and efficacy of anterior vertebral body tethering in the treatment of idiopathic scoliosis. Bone Jt J 102-B:1703–1708. https://doi.org/10.1302/0301-620X.102B12.BJJ-2020-0426.R1

    Article  Google Scholar 

  28. Samdani AF, Pahys JM, Ames RJ, Grewal H, Pelletier GJ, Hwang SW, Betz RR (2021) Prospective follow-up report on anterior vertebral body tethering for idiopathic scoliosis: interim results from an FDA IDE study. JBJS 103:1611–1619. https://doi.org/10.2106/JBJS.20.01503

    Article  Google Scholar 

  29. Hoernschemeyer DG, Boeyer ME, Tweedy NM, Worley JR, Crim JR (2021) A preliminary assessment of intervertebral disc health and pathoanatomy changes observed two years following anterior vertebral body tethering. Eur Spine J. https://doi.org/10.1007/s00586-021-06972-4

    Article  PubMed  Google Scholar 

  30. Mathew SE, Milbrandt TA, Larson AN (2022) Measurable lumbar motion remains 1 year after vertebral body tethering. J Pediatr Orthop 42:e861. https://doi.org/10.1097/BPO.0000000000002202

    Article  PubMed  Google Scholar 

  31. Buyuk AF, Milbrandt TA, Mathew SE, Larson AN (2021) Measurable thoracic motion remains at 1 year following anterior vertebral body tethering, with sagittal motion greater than coronal motion. JBJS 103:2299–2305. https://doi.org/10.2106/JBJS.20.01533

    Article  Google Scholar 

  32. Newton P, Bartley C, Bastrom T, Kluck D, Saito W, Yaszay B (2020) Anterior spinal growth modulation in skeletally immature patients with idiopathic scoliosis: a comparison with posterior spinal fusion at 2 to 5 years postoperatively. JBJS 102:769–777. https://doi.org/10.2106/JBJS.19.01176

    Article  Google Scholar 

  33. Trobisch PD, Baroncini A (2021) Preliminary outcomes after vertebral body tethering (VBT) for lumbar curves and subanalysis of a 1- versus 2-tether construct. Eur Spine J. https://doi.org/10.1007/s00586-021-07009-6

    Article  PubMed  Google Scholar 

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Acknowledgements

This work was supported by an Investigator Initiated Research Grant from Zimmer Biomet to Daniel G. Hoernschemeyer and Melanie E. Boeyer.

Funding

This work was funded by Zimmer Biomet (Grant no. IRU2019-43S).

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Missouri, 204 N. Keene Street #102, Columbia, MO, 65201, USA

    Melanie E. Boeyer & Daniel G. Hoernschemeyer

  2. Missouri Orthopaedic Institute, Columbia, MO, USA

    Melanie E. Boeyer & Daniel G. Hoernschemeyer

  3. School of Medicine, University of Missouri, Columbia, MO, USA

    Sophi Farid

  4. Division of Thoracic Surgery, Department of Surgery, University of Missouri, Columbia, MO, USA

    Sebastian Wiesemann

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Contributions

MEB: conception, design, data analysis, data interpretation, drafted manuscript, revised manuscript, approved final version, and agreed to be accountable. DGH: conception, design, data acquisition, data interpretation, drafted manuscript, revised manuscript, approved final version, and agreed to be accountable. SF: data analysis, data interpretation, drafted manuscript, revised manuscript, approved final version, and agreed to be accountable. SW: design, data interpretation, drafted manuscript, revised manuscript, approved final version, and agreed to be accountable.

Corresponding author

Correspondence to Daniel G. Hoernschemeyer.

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Conflict of interest

Melanie E. Boeyer: ZimVie—Research Support. Daniel G. Hoernschemeyer: ZimVie—Research Support, Consultant Orthopaediatrics—IP Royalties, Paid Consultant, Stock or Stock Options Biomarin—Paid Presenter or Speaker, Research Support. Sophi Farid: None. Sebastian Wiesemann: None.

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The procedures outlined were approved by the University of Missouri’s Institutional Review Board (project number: 2024965).

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Boeyer, M.E., Farid, S., Wiesemann, S. et al. Outcomes of vertebral body tethering in the lumbar spine. Spine Deform 11, 909–918 (2023). https://doi.org/10.1007/s43390-023-00662-5

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