The Fate of The Broken Tether: How Do Curves Treated With Vertebral Body Tethering Behave After Tether Breakage?

IF 2.6 2区医学 Q2 CLINICAL NEUROLOGY Spine Pub Date : 2025-03-15 Epub Date: 2024-06-12 DOI:10.1097/BRS.0000000000005072

Tyler A Tetreault, Tiffany N Phan, Tishya A L Wren, Michael J Heffernan, Michelle C Welborn, John T Smith, Ron El-Hawary, Kenneth Cheung, Kenneth D Illingworth, David L Skaggs, Lindsay M Andras

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Abstract

Study design: Retrospective, multicenter.

Objective: The aim of this study was to assess curve progression and occurrence of revision surgery following tether breakage after vertebral body tethering (VBT).

Summary of background data: Tether breakage after VBT is common with rates up to 50% reported. In these cases, it remains unknown whether the curve will progress or remain stable.

Materials and methods: Adolescent and juvenile idiopathic scoliosis patients in a multicenter registry with ≥2-year-follow-up after VBT were reviewed. Broken tethers were listed as postoperative complications and identified by increased screw divergence of >5 degrees on serial radiographs. Revision procedures and curve magnitude at subsequent visits were recorded.

Results: Of 186 patients who qualified for inclusion, 84 (45.2%) patients with tether breakage were identified with a mean age at VBT of 12.4±1.4 years and mean curve magnitude at index procedure of 51.8±8.1 degrees. Tether breakage occurred at a mean of 30.3±11.8 months and mean curve of 33.9±13.2 degrees. Twelve patients (12/84, 14.5%) underwent 13 revision procedures after tether breakage, including six tether revisions and seven conversions to fusion. All tether revisions occurred within 5 months of breakage identification. No patients with curves <35 degrees after breakage underwent revision. Revision rate was greatest in skeletally immature (Risser 0-3) patients with curves ≥35 degrees at time of breakage (Risser 0-3: 9/17, 53% vs. Risser 4-5: 3/23, 13%, P =0.01). Curves increased by 3.1 and 3.7 degrees in the first and second year, respectively. By 2 years, 15/30 (50%) progressed >5 degrees and 8/30 (26.7%) progressed >10 degrees. Overall, 66.7% (40/60) reached a curve magnitude >35 degrees at their latest follow-up, and 14/60 (23.3%) reached a curve magnitude >45 degrees. Skeletal maturity did not affect curve progression after tether breakage ( P >0.26), but time to rupture did ( P =0.048).

Conclusions: While skeletal immaturity and curve magnitude were not independently associated with curve progression, skeletally immature patients with curves ≥35 degrees at time of rupture are most likely to undergo additional surgery. Most patients can expect progression at least 5 degrees in the first 2 years after tether breakage, though longer term behavior remains unknown.

Level of evidence: Level III.

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系带断裂的命运：使用椎体拴系法治疗的曲线在拴系断裂后表现如何？

研究设计多中心回顾性研究：评估椎体拴系术（VBT）后拴系断裂的曲线进展和翻修手术的发生率：背景数据摘要：椎体拴系术后拴系断裂很常见，据报道断裂率高达50%。在这些病例中，曲线是继续发展还是保持稳定仍是未知数：方法：对VBT术后随访≥2年的多中心登记的青少年和幼年特发性脊柱侧凸患者进行回顾。断裂的系带被列为术后并发症，并通过连续X光片上大于5°的螺钉发散度来识别。记录了后续随访中的翻修程序和曲线幅度：在186名符合纳入条件的患者中，有84名（45.2%）患者出现系带断裂，VBT时的平均年龄为12.4±1.4岁，指数手术时的平均曲线幅度为51.8°±8.1°。系带断裂的平均发生时间为 30.3±11.8 个月，平均曲线为 33.9°±13.2°。12名患者（12/84，14.5%）在VBT断裂后接受了13次翻修手术，包括6次系带翻修和7次转为融合术。所有系带翻修手术都发生在断裂确认后的 5 个月内。没有患者的弯曲度为 5°，8/30（26.7%）患者的弯曲度大于 10°。总体而言，66.7%（40/60）的患者在最近一次随访时曲线幅度大于 35°，14/60（23.3%）的患者曲线幅度大于 45°。骨骼成熟度不影响系绳断裂后的曲线发展（P>0.26），但断裂时间影响曲线发展（P=0.048）：结论：虽然骨骼发育不成熟和曲线大小与曲线发展无关，但骨骼发育不成熟且在系带断裂时曲线≥35°的患者最有可能接受额外手术。大多数患者在系带断裂后的头两年内可能会出现至少 5° 的曲线发展，但更长期的情况仍不得而知：证据等级：III。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Spine 医学-临床神经学

CiteScore

5.90

自引率

6.70%

发文量

361

审稿时长

6.0 months

期刊介绍： Lippincott Williams & Wilkins is a leading international publisher of professional health information for physicians, nurses, specialized clinicians and students. For a complete listing of titles currently published by Lippincott Williams & Wilkins and detailed information about print, online, and other offerings, please visit the LWW Online Store. Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of Spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. The Journal does not publish articles reporting material that has been reported at length elsewhere.