Learning curve for vertebral body tethering: analysis on 90 consecutive patients

Area of Science:

• Spine surgery
• Orthopedic surgery
• Pediatric orthopedics

Background:

• Vertebral body tethering (VBT) is an emerging surgical technique for adolescent idiopathic scoliosis (AIS).
• Many spinal surgeons lack experience with the anterior surgical approaches required for VBT.
• There is limited published data on the learning curve associated with VBT procedures.

Purpose of the Study:

• To evaluate the learning curve for vertebral body tethering (VBT) in the treatment of adolescent idiopathic scoliosis (AIS).
• To identify key surgical metrics that demonstrate improvement with increasing surgeon experience.
• To provide data on the initial outcomes of VBT at an institution.

Main Methods:

• Retrospective analysis of 90 consecutive patients undergoing VBT for AIS.
• Data collected included intubation time, surgical duration, estimated blood loss per screw, and hospitalization length.
• Statistical analysis used linear regression and Pearson correlation to assess trends with experience.

Main Results:

• Significant decreases were observed in intubation time (r=-0.57), surgical duration (r=-0.55), and estimated blood loss per screw (r=-0.66) with increasing patient numbers.
• Hospitalization length also showed a decrease (r=-0.32) as surgeons gained experience.
• No intraoperative complications were reported during the study period.

Conclusions:

• Vertebral body tethering (VBT) exhibits a rapid learning curve for spinal surgeons.
• Expected improvements with experience include a 60% decrease in blood loss, over 50% reduction in intubation and surgical times, and a 32% decrease in hospitalization length per patient.
• VBT is a feasible and safe procedure with a demonstrable learning curve.