Bilateral anterior lumbar vertebral body tethering: a feasibility cohort study

Anterior vertebral body tethering (VBT) is a viable option for children with idiopathic scoliosis. Treating double major curves with bilateral VBT may allow patients to avoid spinal fusion while improving the coronal Cobb angle.

A single center retrospective study was conducted to identify all patients who underwent bilateral VBT (lowest instrumented vertebra L3 or 4) with minimum 2-year follow-up. Clinical and radiographic parameters were collected, including complications and reoperations. Statistical analysis was performed utilizing Students' t-test.

Seventy-three patients (67 female, 91.8%) underwent bilateral VBT with mean follow-up of 4.2 ± 1.5 years. Preoperatively, all patients were skeletally immature (age 12.7 ± 1.2 years with a Sanders score of 3.3 ± 0.8 and Risser grade of 0.6 ± 0.8). The preoperative lumbar Cobb angle was 51.1° ± 7.9° which corrected to 20.7° ± 11.3° at most recent follow-up (p < 0.01) and the thoracic Cobb angle measured 52.3° ± 9.0° which corrected to 27.0° ± 11.3° (p < 0.01) at most recent follow-up. At latest follow-up, 51/73 (69.9%) had a thoracic Cobb angle <30°, 59/73 patients (80.8%) had a lumbar Cobb angle <30°, and 47/73 (64.4%) had both thoracic and lumbar Cobb angles <30°. 15 patients (20.5%) underwent 17 reoperations with overcorrection being the most common indication (8/17, 47.1%). Broken tethers led to reoperation in 3/17 instances (17.6%). Five patients (6.8%) eventually required posterior spinal fusion.

Bilateral VBT is a safe procedure and may be a viable option for patients with double curves, with the majority of curves measuring <30° at most recent follow-up. Surgeons can use these data to help patients and parents make informed decisions regarding treatment options.