Lumbar Vertebral Body Tethering: Outcomes and Reoperations in a Consecutive Series of 106 patients

Sunday, May 5, 2024

4:09 PM – 4:13 PM CT

Location: S405b

Presenting Author(s)

Alan Stein, MD

Resident
Shriners Hospital for Children
Valhalla, NY, US

Co-Author(s)

SH

Steven Hwang, MD

Staff Physician
Shriners Children’s-Philadelphia
Philadelphia, Pennsylvania, United States
TI

Terrence Ishmael, MD

Faculty
Shriners Hospital for Children, United States
ZN

Zan Naseer, MD

Resident
Shriners Hospital for Children, United States
EN

Emily Nice, BS

Student
Shriners Hospital for Children, United States
JP

Joshua Pahys, MD

Faculty
Shrin
Philadelphia, Pennsylvania, United States
Amer Samdani, MD

Faculty
Shriners Hospital for Children
Philadelphia, Pennsylvania, United States
Alexander J. Schupper, MD

Resident
Mount Sinai Health System
New York, NY, US

Disclosure(s):

Alan Stein, MD: No financial relationships to disclose

Introduction: Anterior vertebral body tethering (aVBT) is a viable option for children with idiopathic scoliosis. However, the promise of motion preservation offsets with the known increased reoperation rate. Maintenance of lumbar motion offers significant benefit over VBT for the thoracic region. However, a paucity of reports have addressed lumbar VBT.

Methods: A retrospectively collected dataset was queried for all patients who underwent lumbar VBT (LIV 3 or 4) with minimum 2 years of follow-up. Clinical and radiographic parameters were collected including radiographic parameters and reoperations. Statistical analysis was performed utilizing students t test.

Results: From a dataset of 551 patients, we identified 106 patients (89% female) who underwent a lumbar aVBT (33 lumbar only, 73 bilateral thoracic/lumbar) with mean follow up of 4.1±1.6 yrs at which point 85% (90/106) reached skeletal maturity. Preoperatively, these patients were skeletally immature (age=12.8± 1.3 yrs, Sanders=3.3 ± 0.8, R=0.6 ± 0.9) with a lumbar cobb angle of 49.6° ± 11.2 which corrected to 19.9° ± 11.2 (p < 0.0001) at most recent follow-up. At latest follow-up, 84%( 89/106) of patients harbored a cobb angle less than 35°. Twenty patients (18.9%) underwent 23 reoperations with over correction being the most common (10/23=43%). Broken tethers led to reoperation in three instances (3/23=13%). Six patients in the cohort needed a PSF (5.4%=6/106).

Conclusion : Vertebral body tethering has emerged as a viable treatment option for skeletally immature idiopathic scoliosis. The high reoperation rate must be balanced with motion preservation, significance of which is paramount in the lumbar spine. This report is the largest for lumbar aVBT highlighting 84% of patients harboring a curve less than 35 degrees at latest follow up, but with a 18.9% reoperation rate. Surgeons can use this data to ensure patients make an informed decision when deciding between their options for treatment.