The perioperative complications of vertebral body tethering : prevalence and predictive factors

There is little information in the orthopaedic literature about the rate of perioperative complications of vertebral body tethering (VBT), in the surgical management of patients with adolescent idiopathic scoliosis. The aim of this study was to determine the rate of these complications and to investigate the corresponding predictive factors.

This was a prospective single-centre study involving all patients who underwent VBT between February 2019 and October 2024. A total of 60 patients (51 females and nine males) with 79 instrumented curves were included. The primary outcomes were the rates of various non-implant-related perioperative complications. General complications included: postoperative wound issues (discharge, infection, erythema); bowel dysfunction; thigh pain and paraesthesia; pain in the hip, back, and shoulder; and weakness of hip flexion. Pulmonary complications included pneumothorax, atelectasis, pleural effusion, chylothorax, and a raised hemidiaphragm. Other complications that were investigated included peritoneal perforation, surgical emphysema, superior mesenteric artery syndrome, and screw loosening. Secondary outcomes were the differences in complication rates between types of VBT, the surgical approaches, and the implants. The relationships between pre- and intraoperative factors and complications were assessed using correlation and logistic regression.

A total of 29 operations (36.7%) were associated with at least one pulmonary complication. The rates of pneumothorax, atelectasis, pleural effusion, chylothorax, and raised hemidiaphragm were 30.4%, 12.7%, 12.7%, 3.8%, and 3.8%, respectively. An increased number of instrumented levels significantly predicted postoperative pneumothorax (odds ratio (OR) 2.58 (95% CI 1.27 to 3.51); p = 0.004) and pleural effusion (OR 2.95 (95% CI 1.21 to 7.22); p = 0.019). Thoracic VBT (OR 11.01 (95% CI 1.67 to 72.7); p = 0.012) and the rate of correction (OR 1.06 (95% CI 1.01 to 1.12); p = 0.042) were significant predictors of postoperative atelectasis.

The rate of perioperative complications in this study was higher than has been previously reported, with pneumothorax being the most common pulmonary complication. Thoracic VBTs had significantly more pulmonary complications, but neither the surgical approach, nor the type of implant which was used, was significantly associated with an increased rate of complications. An increased number of instrumented levels, the rate of correction, and instrumentation which included the thoracic spine, were found to be significantly predictive of pulmonary complications.