Spine · 2024
Lumbar Vertebral Body Tethering: Single Center Outcomes and Reoperations in a Consecutive Series of 106 Patients.
СтатьяНазвание и аннотация: Перевод в очереди
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Stein Alan A, Samdani Amer F, Schupper Alexander J, Naseer Zan, Shah Ronit V, Zeller Sabrina, Pahys Joshua M, Samuel Solomon Praveen, Quinonez Alejandro, Hwang Steven W
Аннотация
STUDY DESIGN: Retrospective cohort study.
OBJECTIVE: To evaluate the outcomes and reoperation rates in patients with adolescent idiopathic scoliosis undergoing lumbar anterior vertebral body tethering (AVBT).
BACKGROUND: AVBT is a viable option for growing children. The benefit of motion preservation must be balanced by a higher reoperation rate. A paucity of reports has addressed lumbar AVBT.
MATERIALS AND METHODS: A single-center retrospective study was conducted to identify all patients who underwent lumbar AVBT (lowest instrumented vertebra L3 or L4) with a minimum of 2 years of follow-up. Clinical and radiographic parameters, including complications and reoperations, were also collected. Statistical analysis was performed using the Student t test for qualitative variables.
RESULTS: From a data set of 551 patients, we identified 106 patients (89% female) who underwent a lumbar AVBT (33 lumbar only, 73 bilateral thoracic/lumbar) with a mean follow-up of 4.1 ± 1.6 years at which point 85% (90/106) had reached skeletal maturity. Preoperatively, these patients were skeletally immature (age: 12.8 ± 1.3 yr, Sanders: 3.3 ± 0.8, R = 0.6 ± 0.9) with a lumbar coronal curve angle of 49.6° ± 11.2° which corrected to 19.9° ± 11.2° ( P < 0.0001) at most recent follow-up. At the latest follow-up, 76.4% (81/106) of the patients harbored a coronal curve angle of <30°. Twenty patients (18.9%) underwent 23 reoperations, with overcorrection being the most common (10/23, 43%). Broken tethers led to reoperation in 3 instances (3/23, 13%). Six patients in the cohort needed a posterior spinal fusion (6/106, 5.4%).
CONCLUSIONS: Vertebral body tethering is a viable treatment option for skeletally immature patients with idiopathic scoliosis. This report is the largest to date for lumbar AVBT, highlighting that 84% of patients harbored a curve <35° at the latest follow-up but with an 18.9% reoperation rate.
LEVEL OF EVIDENCE: 3.
OBJECTIVE: To evaluate the outcomes and reoperation rates in patients with adolescent idiopathic scoliosis undergoing lumbar anterior vertebral body tethering (AVBT).
BACKGROUND: AVBT is a viable option for growing children. The benefit of motion preservation must be balanced by a higher reoperation rate. A paucity of reports has addressed lumbar AVBT.
MATERIALS AND METHODS: A single-center retrospective study was conducted to identify all patients who underwent lumbar AVBT (lowest instrumented vertebra L3 or L4) with a minimum of 2 years of follow-up. Clinical and radiographic parameters, including complications and reoperations, were also collected. Statistical analysis was performed using the Student t test for qualitative variables.
RESULTS: From a data set of 551 patients, we identified 106 patients (89% female) who underwent a lumbar AVBT (33 lumbar only, 73 bilateral thoracic/lumbar) with a mean follow-up of 4.1 ± 1.6 years at which point 85% (90/106) had reached skeletal maturity. Preoperatively, these patients were skeletally immature (age: 12.8 ± 1.3 yr, Sanders: 3.3 ± 0.8, R = 0.6 ± 0.9) with a lumbar coronal curve angle of 49.6° ± 11.2° which corrected to 19.9° ± 11.2° ( P < 0.0001) at most recent follow-up. At the latest follow-up, 76.4% (81/106) of the patients harbored a coronal curve angle of <30°. Twenty patients (18.9%) underwent 23 reoperations, with overcorrection being the most common (10/23, 43%). Broken tethers led to reoperation in 3 instances (3/23, 13%). Six patients in the cohort needed a posterior spinal fusion (6/106, 5.4%).
CONCLUSIONS: Vertebral body tethering is a viable treatment option for skeletally immature patients with idiopathic scoliosis. This report is the largest to date for lumbar AVBT, highlighting that 84% of patients harbored a curve <35° at the latest follow-up but with an 18.9% reoperation rate.
LEVEL OF EVIDENCE: 3.