Anterior Vertebral Body Tethering Compared with Posterior Spinal Fusion for Major Thoracic Curves: A Retrospective Comparison by the Harms Study Group. (21st December 2022)

• Record Type: Journal Article
• Authors: Newton, Peter O.; Parent, Stefan; Miyanji, Firoz; Alanay, Ahmet; Lonner, Baron S.; Neal, Kevin M.; Hoernschemeyer, Daniel G.; Yaszay, Burt; Blakemore, Laurel C.; Shah, Suken A.; Bastrom, Tracey P.
• Other Names: Buckland Aaron author non-byline.; Alanay Ahmet author non-byline.; Samdani Amer author non-byline.; Jain Amit author non-byline.; Lonner Baron author non-byline.; Roye Benjamin author non-byline.; Cho Bob author non-byline.; Yaszay Burt author non-byline.; Yilgor Caglar author non-byline.; Reilly Chris author non-byline.; Hoernschmeyer Dan author non-byline.; Hedequist Daniel author non-byline.; Sucato Daniel author non-byline.; Clements David author non-byline.; Miyanji Firoz author non-byline.; Shufflebarger Harry author non-byline.; Flynn Jack author non-byline.; Mac Thiong Jean Marc author non-byline.; Asghar John author non-byline.; Murphy Josh author non-byline.; Pahys Joshua author non-byline.; Harms Juergen author non-byline.; Bachmann Keith author non-byline.; Neal Kevin author non-byline.; Blakemore Laurel author non-byline.; Haber Lawrence author non-byline.; Lenke Lawrence author non-byline.; Karol Lori author non-byline.; Abel Mark author non-byline.; Erickson Mark author non-byline.; Glotzbecker Michael author non-byline.; Kelly Michael author non-byline.; Vitale Michael author non-byline.; Marks Michelle author non-byline.; Gupta Munish author non-byline.; Fletcher Nicholas author non-byline.; Larson Noelle author non-byline.; Cahill Patrick author non-byline.; Sponseller Paul author non-byline.; Gabos Peter author non-byline.; Newton Peter author non-byline.; Sturm Peter author non-byline.; Betz Randal author non-byline.; Parent Stefan author non-byline.; George Stephen author non-byline.; Hwang Steven author non-byline.; Shah Suken A. author non-byline.; Garg Sumeet author non-byline.; Errico Tom author non-byline.; Upasani Vidyadhar author non-byline.;
• Is Part Of: Journal of bone and joint surgery. Volume 104:Number 24(2022)
• Page Start: 2170
• Page End: 2177
• Publication Date: 2022-12-21
• Subjects: Bones -- Surgery -- Periodicals; Joints -- Surgery -- Periodicals; Orthopedics -- Periodicals; Orthopedics; General Surgery; Bone Diseases; Joint Diseases; Bones -- Surgery; Joints -- Surgery; Orthopedics; Bot (anatomie); Gewrichten; Chirurgie (geneeskunde); Periodicals; Electronic journals; Periodicals; 617.47005
• DOI: 10.2106/JBJS.22.00127
• Languages: English
• ISSNs: 0021-9355

Abstract

Abstract : Background: Anterior vertebral body tethering (AVBT) is an alternative to posterior spinal fusion (PSF) for the surgical treatment of scoliosis. The present study utilized a large, multicenter database and propensity matching to compare outcomes of AVBT to PSF in patients with idiopathic scoliosis. Methods: Patients with thoracic idiopathic scoliosis who underwent AVBT with a minimum 2-year follow-up retrospectively underwent 2 methods of propensity-guided matching to PSF patients from an idiopathic scoliosis registry. Radiographic, clinical, and Scoliosis Research Society 22-Item Questionnaire (SRS-22) data were compared preoperatively and at the ≥2-year follow-up. Results: A total of 237 AVBT patients were matched with 237 PSF patients. In the AVBT group, the mean age was 12.1 ± 1.6 years, the mean follow-up was 2.2 ± 0.5 years, 84% of patients were female, and 79% of patients had a Risser sign of 0 or 1, compared with 13.4 ± 1.4 years, 2.3 ± 0.5 years, 84% female, and 43% Risser 0 or 1 in the PSF group. The AVBT group was younger (p < 0.001), had a smaller mean thoracic curve preoperatively (48 ± 9°; range, 30° to 74°; compared with 53 ± 8°; range, 40° to 78° in the PSF group; p < 0.001), and had less initial correction (41% ± 16% correction to 28° ± 9° compared with 70% ± 11% correction to 16° ± 6° in the PSF group; p < 0.001). Thoracic deformity at the time of the latest follow-up was 27° ± 12° (range, 1° to 61°) for AVBT compared with 20° ± 7° (range, 3° to 42°) for PSF (p < 0.001). A total of 76% of AVBT patients had a thoracic curve of <35° at the latest follow-up compared with 97.4% of PSF patients (p < 0.001). A residual curve of >50° was present in 7 AVBT patients (3%), 3 of whom underwent subsequent PSF, and in 0 PSF patients (0%). Forty-six subsequent procedures were performed in 38 AVBT patients (16%), including 17 conversions to PSF and 16 revisions for excessive correction, compared with 4 revision procedures in 3 PSF patients (1.3%; p < 0.01). AVBT patients had lower median preoperative SRS-22 mental-health component scores (p < 0.01) and less improvement in the pain and self-image scores between preoperatively and the ≥2-year follow-up (p < 0.05). In the more strictly matched analysis (n = 108 each), 10% of patients in the AVBT group and 2% of patients in the PSF group required a subsequent surgical procedure. Conclusions: At a mean follow-up of 2.2 years, 76% of thoracic idiopathic scoliosis patients who underwent AVBT had a residual curve of <35° compared with 97.4% of patients who underwent PSF. A total of 16% of cases in the AVBT group required a subsequent surgical procedure compared with 1.3% in the PSF group. An additional 4 cases (1.3%) in the AVBT group had a residual curve of >50° that may require revision or conversion to PSF. Level of Evidence: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.