Analysis of tether breakages during revision after failed thoracolumbar double-row vertebral body tethering

Vertebral Body Tethering (VBT) yields improving postoperative results. However, tether breakage remains a common complication, especially in thoracolumbar (TL) curves, and can negatively impact the outcome. The pathomechanism behind TL tether breakages is not well understood, yet this knowledge is essential for improving surgical planning. Therefore, the study aimed to investigate the timing and location of tether breakage in double-row (TL) revision cases.

This study performed a descriptive analysis of consecutively explanted double-row implants in TL VBT patients who underwent revision due to tether breakage and for whom photographic documentation was available. A > 5° increase in the interscrew angle on consecutive radiographs suggested tether breakage.

Data from 50 instrumented levels in ten patients were available. The UIV ranged from T9 to T11 and the LIV from L3 to L4. Revision surgery was performed, on average, 35 months after the index surgery. The study showed that the > 5° rule identified a higher percentage of segments with both tethers broken (68%) than segments with only one broken tether (54%). There was no difference in the occurrence of anterior (61%) and posterior (62%) tether breakage. The anterior tether broke in the distal segment in all ten cases, while the posterior tether broke in the distal segment in nine out of ten cases.

This study showed that the distal segment of the lumbar spine is prone for tether breakage. Fewer breakages were observed in the thoracic segments. Additionally, no clear breakage pattern in relation to implant standing time was observed.