Lumbar, thoracic, and bilateral vertebral body tethering: do surgical outcomes differ?

Area of Science:

• Spine surgery
• Pediatric orthopedics
• Adolescent idiopathic scoliosis management

Background:

• Vertebral body tethering (VBT) is increasingly utilized for adolescent idiopathic scoliosis (AIS) to preserve spinal mobility.
• Limited evidence exists comparing outcomes across different VBT surgical approaches (thoracic, lumbar, bilateral).

Purpose of the Study:

• To comprehensively assess complications and outcomes of single thoracic (T), single lumbar/thoracolumbar (TL/L), and bilateral (B) VBT in pediatric AIS patients.
• To hypothesize similar curve correction, surgical outcomes, and rates of major complications and reoperations among the three VBT approaches.

Main Methods:

• Retrospective review of 133 consecutive AIS patients undergoing VBT (2015-2022) by a single surgical team.
• Data analysis included preoperative, first erect, and final follow-up (minimum 2 years).
• Suspected tether breakage was assessed using inter-screw angles via a deep-learning model.

Main Results:

• No significant differences in suspected tether breakage (31.2% T, 40% B, 45% TL/L), major complications (3.2% T, 10% B, 5% TL/L), or reoperations (10.8% T, 10% B, 5% TL/L) were observed.
• TL/L approach showed superior initial curve correction (23° vs. 31° T, 28° B) at first erect.
• Final curve magnitudes were similar across all groups (T: 28°, B: 28°, TL/L: 23°). Bilateral VBT had the longest operative time.

Conclusions:

• All three VBT approaches (T, B, TL/L) demonstrate comparable safety and efficacy for AIS treatment.
• While TL/L offers better initial correction and bilateral requires longer surgery, final outcomes and complication rates are similar.
• The findings support the use of all assessed VBT strategies in pediatric scoliosis management.