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Changing Complication Trends After Anterior Vertebral Body Tethering: Ten-Year Experience.
Taemin Oh1, Cleopatra Nehme, Amer F Samdani
1Shriners Children's Philadelphia, Philadelphia, PA.
Spine
|May 30, 2025
Summary
Over a decade, anterior vertebral body tethering (VBT) complications shifted from overcorrection to increased tether breakages. This study highlights evolving VBT techniques and outcomes in pediatric spinal deformity.
Area of Science:
- Spinal surgery
- Pediatric orthopedics
- Biomechanical engineering
Background:
- Anterior vertebral body tethering (VBT) is a surgical technique used to correct spinal deformities in skeletally immature patients.
- VBT is associated with potential complications, including overcorrection, undercorrection, and device failure (tether breakage).
- Understanding the evolution of complication profiles over time is crucial for refining VBT surgical techniques and improving patient outcomes.
Purpose of the Study:
- To analyze changes in complication profiles following anterior vertebral body tethering (VBT) over a 10-year period.
- To investigate the trend of specific complications such as overcorrection and tether breakage.
- To identify factors influencing the shift in complication patterns.
Main Methods:
- A single-center retrospective study reviewed patients who underwent VBT between 2011 and 2020 with a minimum two-year follow-up.
- Patients were stratified into three treatment epochs: 2011-2015, 2016-2017, and 2018-2020.
- Complications were categorized (tether breakage, overcorrection, adding-on, curve progression, miscellaneous), and radiographic parameters were compared across epochs.
Main Results:
- Over 50% of patients experienced radiographic complications, with 19% requiring revision surgery.
- A significant decrease in overcorrection rates was observed over time (13% to 2%), while tether breakage incidence increased (49% to 59%).
- Age at surgery, curve magnitude, and skeletal maturity increased, with a trend towards more lumbar curves and lumbar tether breakages.
Conclusions:
- The 10-year experience with VBT demonstrates a significant evolution in complication patterns.
- Surgical learning and technique modifications have led to a reduction in overcorrection.
- There has been a subsequent rise in tether breakages, necessitating further research into device integrity and surgical strategies.
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