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Who are the best candidates? Factors predicting success and failure of vertebral body tethering
Dustin Kress1,2, Eddie Geagea3, Taghi Ramazanian1
1Nemours Children's Health, 807 Children's Way, Jacksonville, FL, 32207, USA.
Purpose:
Vertebral body tethering (VBT) is a fusionless alternative for adolescent idiopathic scoliosis (AIS), but predictors of long-term success remain unclear. We aimed to report outcomes 2-8 years following VBT and identify factors associated with revision surgery.
Methods:
Single institution retrospective review of a prospectively collected AIS database.
Inclusion Criteria:
VBT between 2015-2022, skeletal maturity (Risser 5 or Risser 4 with Sanders 7) at follow-up, and minimum 2-year follow-up or revision surgery. Patients were classified as not requiring revision surgery (NRS) or requiring revision surgery (RS).
Results:
Forty-one patients were included: 21 (51%) NRS and 20 (49%) RS. Mean follow-up was 4.3 years (NRS) and 3.6 years (RS). Compared with RS, NRS patients had lower preoperative curve magnitude (46° vs. 52°, p = 0.03) and higher Sanders stage (3.4 vs. 2.4, p = 0.01). Sanders <3 (OR = 9.2, 95% CI 1.3-67.3, p = 0.03) and preoperative curve magnitude (OR = 2.7 per 10°, 95% CI 1.1-6.8, p = 0.04) were independent predictors of revision surgery. Double curves had higher revision rates (86% vs. 41%); 30% of RS patients had double curves versus 5% of NRS. Immediate correction to <35° was achieved in 67% (NRS) vs. 25% (RS) (p = 0.01). Final Cobb angle was 25° (NRS) vs. 34° (RS) (p = 0.003).
Conclusions:
VBT patients not requiring revision surgery had preoperative curves <50° and more advanced skeletal maturity (Sanders 3.4 vs. 2.4). These patients were more likely to achieve immediate correction to <35° and maintain correction at follow-up. These factors should be considered when selecting patients for fusionless techniques and inform preoperative counseling regarding revision risk.