Safety and efficacy of anterior vertebral body tethering in the treatment of idiopathic scoliosis

AimsSpinal fusion remains the gold standard in the treatment of idiopathic scoliosis. However, anterior vertebral body tethering (AVBT) is gaining widespread interest, despite the limited data on its efficacy. The aim of our study was to determine the clinical efficacy of AVBT in skeletally immature patients with idiopathic scoliosis.MethodsAll consecutive skeletally immature patients with idiopathic scoliosis treated with AVBT enrolled in a longitudinal, multicentre, prospective database between 2013 and 2016 were analyzed. All patients were treated by one of two surgeons working at two independent centres. Data were collected prospectively in a multicentre database and supplemented retrospectively where necessary. Patients with a minimum follow-up of two years were included in the analysis. Clinical success was set a priori as a major corona) Cobb angle of < 35 degrees at the most recent follow-up.ResultsA total of 57 patients were included in the study. Their mean age was 12.7 years (SD 1.5; 8.2 to 16.7), with 95% being female. The mean preoperative Sanders score and Risser grade was 3.3 (SD 1.2), and 0.05 (0 to 3), respectively. The majority were thoracic tethers (96.5%) and the mean follow-up was 40.4 months (SD 9.3). The mean preoperative major curve of 51 degrees (SD 10.9 degrees; 31 degrees to 81 degrees) was significantly improved to a mean of 24.6 degrees (SD 11.8 degrees; 0 degrees to 57 degrees) at the first postoperative visit (45.6% (SD 17.6%; 7% to 107%); p < 0.001)) with further significant correction to a mean of 16.3 degrees (SD 12.8 degrees; -12 to 55; p < 0.001) at one year and a significant correction to a mean of 23 degrees (SD 15.4 degrees; -18 degrees to 57 degrees) at the final follow-up (42.9% (-16% to 147%); p < 0.001). Clinical success was achieved in 44 patients (77%). Most patients reached skeletal maturity, with a mean Risser score of 4.3 (SD 1.02), at final follow-up. The complication rate was 28.1% with a 15.8% rate of unplanned revision procedures.ConclusionAVBT is associated with satisfactory correction of deformity and an acceptable complication rate when used in skeletally immature patients with idiopathic scoliosis. Improved patient selection and better implant technology may improve the 15.8% rate of revision surgery in these patients. Further scrutiny of the true effectiveness and long-term risks of this technique remains critical

Anterior Vertebral Body Tethering (AVBT) for Treatment Of Idiopathic Scoliosis in the Skeletally Immature

Prospective case series. OBJECTIVE. Determine the efficacy of anterior vertebral body tethering (AVBT) in skeletally immature patients. SUMMARY OF BACKGROUND DATA. The value of AVBT is currently unclear given the paucity of available data. METHODS. Consecutive skeletally immature patients with idiopathic scoliosis were treated with AVBT between 2012 and 2018 by one of two surgeons working at two independent centers and followed up for >2 years. Data were collected prospectively and supplemented retrospectively where necessary. Outcomes were measured preoperatively, at first erect radiograph (FE), 1-year postoperatively and at most recent follow up (FU). RESULTS. One hundred twelve patients underwent 116 primary tethering procedures (108 thoracic and eight lumbar tethers). Four patients had primary tethering of both lumbar and thoracic curves. At surgery mean age was 12.7 ± 1.4 years (8.2–16.7) and Risser 0.5 ± 0.9 (0–3). Follow up was mean 37 ± 9 months (15–64). Preoperative mean coronal Cobb angle of the 130 tethered curves was 50.8° ± 10.2 (31–81) and corrected significantly to 26.6° ± 10.1 (−3–61) at FE radiograph (P < 0.001). Further significant improvement was seen from FE to 1-year, to mean 23.1° ± 12.4 (−37–57) (P < 0.001). There was a small but significant increase between 1-year and FU to 25.7° ± 16.3 (−32–58) (P < 0.001), which appeared to reflect tether breakage. Untethered minor curves were corrected from 31.0° ± 9.5 (3–57) to 20.3° ± 10.3 (0–52) at FU (P < 0.001). Rib hump was corrected from 14.1 ± 4.8 (0–26) to 8.8° ± 5.4 (0–22) at FU (P < 0.01). Twenty-five patients (22%) had 28 complications. Fifteen patients (13%) requiring 18 revision operations including six completed and one awaited fusions. CONCLUSION. AVBT of immature cases is associated with satisfactory deformity correction in the majority of cases. However, complication and revision rates suggest the need for improved implants and patient selection. Long-term follow-up remains crucial to establish the true efficacy of this procedure. Level of Evidence:

Anterior Vertebral Body Tethering for Treatment of Idiopathic Scoliosis in the Skeletally Immature: Results of 112 Cases

Study Design. Prospective case series.Objective. Determine the efficacy of anterior vertebral body tethering (AVBT) in skeletally immature patients.Summary of Background Data. The value of AVBT is currently unclear given the paucity of available data.Methods. Consecutive skeletally immature patients with idiopathic scoliosis were treated with AVBT between 2012 and 2018 by one of two surgeons working at two independent centers and followed up for &gt;2 years. Data were collected prospectively and supplemented retrospectively where necessary. Outcomes were measured preoperatively, at first erect radiograph (FE), 1-year postoperatively and at most recent follow up (FU).Results. One hundred twelve patients underwent 116 primary tethering procedures (108 thoracic and eight lumbar tethers). Four patients had primary tethering of both lumbar and thoracic curves. At surgery mean age was 12.7 +/- 1.4 years (8.2-16.7) and Risser 0.5 +/- 0.9 (0-3). Follow up was mean 37 +/- 9 months (15-64). Preoperative mean coronal Cobb angle of the 130 tethered curves was 50.8 degrees +/- 10.2 (31-81) and corrected significantly to 26.6 degrees +/- 10.1 (-3-61) at FE radiograph (P&lt;0.001). Further significant improvement was seen from FE to 1-year, to mean 23.1 degrees +/- 12.4 (-37-57) (P&lt;0.001). There was a small but significant increase between 1-year and FU to 25.7 degrees +/- 16.3 (-32-58) (P&lt;0.001), which appeared to reflect tether breakage. Untethered minor curves were corrected from 31.0 degrees +/- 9.5 (3-57) to 20.3 degrees +/- 10.3 (0-52) at FU (P&lt;0.001). Rib hump was corrected from 14.1 +/- 4.8 (0- 26) to 8.8 degrees +/- 5.4 (0-22) at FU (P&lt;0.01). Twenty-five patients (22%) had 28 complications. Fifteen patients (13%) requiring 18 revision operations including six completed and one awaited fusions.Conclusion. AVBT of immature cases is associated with satisfactory deformity correction in the majority of cases. However, complication and revision rates suggest the need for improved implants and patient selection. Long-term follow-up remains crucial to establish the true efficacy of this procedure

The reliability of the Aospine thoracolumbar spine injury classification system in children : An international validation study

Publisher Copyright: © 2021, British Editorial Society of Bone and Joint Surgery. All rights reserved.Purpose To evaluate the AOSpine Thoracolumbar Spine Injury Classification System and if it is reliable and reproducible when applied to the paediatric population globally. Methods A total of 12 paediatric orthopaedic surgeons were asked to review MRI and CT imaging of 25 paediatric patients with thoracolumbar spine traumatic injuries, in order to determine the classification of the lesions observed. The evaluators classified injuries into primary categories: A, B and C. Interobserver reliability was assessed for the initial reading by Fleiss’s kappa coefficient (kF) along with 95% confidence intervals (CI). For A and B type injuries, sub-classification was conducted including A0-A4 and B1-B2 subtypes. Interobserver reliability across subclasses was assessed using Krippendorff’s alpha (αk) along with bootstrapped 95% CIs. A second round of classification was performed one-month later. Intraobserver reproducibility was assessed for the primary classifications using Fleiss’s kappa and sub-classification reproducibility was assessed by Krippendorff’s alpha (αk) along with 95% CIs. Results In total, 25 cases were read for a total of 300 initial and 300 repeated evaluations. Adjusted interobserver reliability was almost perfect (kF = 0.74; 95% CI 0.71 to 0.78) across all observers. Sub-classification reliability was substantial (αk=0.67; 95% CI 0.51 to 0.81), Adjusted intraobserver reproducibility was almost perfect (kF = 0.91; 95% CI 0.83 to 0.99) for both primary classifications and for sub-classifications (αk =0.88; 95% CI 0.83 to 0.93). Conclusion The interand intraobserver reliability for the AOSpine Thoracolumbar Spine Injury Classification System was high amongst paediatric orthopaedic surgeons. The AOSpine Thoracolumbar Spine Injury Classification System is a promising option as a uniform fracture classification in children.Peer reviewe