Anterior Vertebral Body Tethering: A Single-Center Cohort with 4.3 to 7.4 Years of Follow-up.

IF 4.4 1区医学 Q1 ORTHOPEDICS Journal of Bone and Joint Surgery, American Volume Pub Date : 2024-10-16 Epub Date: 2024-07-05 DOI:10.2106/JBJS.23.01229

Daniel G Hoernschemeyer, Samuel D Hawkins, Nicole M Tweedy, Melanie E Boeyer

{"title":"Anterior Vertebral Body Tethering: A Single-Center Cohort with 4.3 to 7.4 Years of Follow-up.","authors":"Daniel G Hoernschemeyer, Samuel D Hawkins, Nicole M Tweedy, Melanie E Boeyer","doi":"10.2106/JBJS.23.01229","DOIUrl":null,"url":null,"abstract":"Background: Vertebral body tethering (VBT) is a well-recognized, non-fusion alternative for idiopathic scoliosis in children with growth remaining. To date, there have been almost no published outcome studies with postoperative follow-up of >2 years. We aimed to fill this gap by evaluating mid-term outcomes in our first 31 consecutive patients.Methods: We retrospectively assessed additional clinical and radiographic data (mean, 5.7 ± 0.7 years) from our first 31 consecutive patients. Assessments included standard deformity measures, skeletal maturity status, and any additional complications (e.g., suspected broken tethers or surgical revisions). Using the same definition of success (i.e., all residual deformities, instrumented or uninstrumented, ≤30° at maturity; no posterior spinal fusion), we revisited the success rate, revision rate, and suspected broken tether rate.Results: Of our first 31 patients treated with VBT, 29 (of whom 28 were non-Hispanic White and 1 was non-Hispanic Asian; 27 were female and 2 were male) returned for additional follow-up. The success rate dropped to 64% with longer follow-up as deformity measures increased, and the revision rate increased to 24% following 2 additional surgical revisions. Four additional suspected broken tethers were identified, for a rate of 55%, with only 1 occurring beyond 4 years. No additional patients had conversion to a posterior spinal fusion. We observed a mean increase of 4° (range, 2° to 8°) in main thoracic deformity measures and 8° (range, 6° to 12°) in thoracolumbar deformity measures.Conclusions: With >5 years of follow-up, we observed a decrease in postoperative success, as progression of the deformity was observed in most subgroups, and an increase in the revision and suspected broken tether rates. No additional patients had conversion to a posterior spinal fusion, which may indicate long-term survivorship.Level of evidence: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"1857-1865"},"PeriodicalIF":4.4000,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Bone and Joint Surgery, American Volume","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.2106/JBJS.23.01229","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/7/5 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Vertebral body tethering (VBT) is a well-recognized, non-fusion alternative for idiopathic scoliosis in children with growth remaining. To date, there have been almost no published outcome studies with postoperative follow-up of >2 years. We aimed to fill this gap by evaluating mid-term outcomes in our first 31 consecutive patients.

Methods: We retrospectively assessed additional clinical and radiographic data (mean, 5.7 ± 0.7 years) from our first 31 consecutive patients. Assessments included standard deformity measures, skeletal maturity status, and any additional complications (e.g., suspected broken tethers or surgical revisions). Using the same definition of success (i.e., all residual deformities, instrumented or uninstrumented, ≤30° at maturity; no posterior spinal fusion), we revisited the success rate, revision rate, and suspected broken tether rate.

Results: Of our first 31 patients treated with VBT, 29 (of whom 28 were non-Hispanic White and 1 was non-Hispanic Asian; 27 were female and 2 were male) returned for additional follow-up. The success rate dropped to 64% with longer follow-up as deformity measures increased, and the revision rate increased to 24% following 2 additional surgical revisions. Four additional suspected broken tethers were identified, for a rate of 55%, with only 1 occurring beyond 4 years. No additional patients had conversion to a posterior spinal fusion. We observed a mean increase of 4° (range, 2° to 8°) in main thoracic deformity measures and 8° (range, 6° to 12°) in thoracolumbar deformity measures.

Conclusions: With >5 years of follow-up, we observed a decrease in postoperative success, as progression of the deformity was observed in most subgroups, and an increase in the revision and suspected broken tether rates. No additional patients had conversion to a posterior spinal fusion, which may indicate long-term survivorship.

Level of evidence: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

椎体前部系带术：单中心队列，随访 4.3 至 7.4 年。

背景：椎体拴系（VBT）是一种公认的非融合治疗特发性脊柱侧凸的替代方法，适用于发育迟缓的儿童。迄今为止，几乎没有发表过术后随访超过两年的结果研究。我们的目标是通过评估首批 31 例连续患者的中期疗效来填补这一空白：我们回顾性地评估了前 31 例连续患者的其他临床和影像学数据（平均 5.7 ± 0.7 年）。评估内容包括标准畸形测量、骨骼成熟度以及其他并发症（如疑似系带断裂或手术翻修）。采用相同的成功定义（即所有残余畸形、有器械或无器械、成熟度≤30°；无后路脊柱融合），我们重新审查了成功率、翻修率和疑似断裂系带率：在首批接受 VBT 治疗的 31 位患者中，有 29 位（其中 28 位为非西班牙裔白人，1 位为非西班牙裔亚裔；27 位为女性，2 位为男性）返回接受进一步随访。随着畸形程度的增加，随访时间的延长，成功率降至 64%，在进行了两次额外的手术翻修后，翻修率增至 24%。另外还发现了 4 例疑似系带断裂的患者，成功率为 55%，其中只有 1 例患者的系带断裂时间超过了 4 年。没有其他患者转为后路脊柱融合术。我们观察到主要胸椎畸形测量值平均增加了4°（范围为2°至8°），胸腰椎畸形测量值平均增加了8°（范围为6°至12°）：随访超过5年后，我们观察到术后成功率有所下降，因为在大多数亚组中都观察到畸形进展，而且翻修率和疑似系带断裂率有所上升。没有其他患者转为后路脊柱融合术，这可能预示着长期存活率：证据等级：治疗三级。有关证据级别的完整描述，请参阅 "作者须知"。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Journal of Bone and Joint Surgery, American Volume 医学-外科

CiteScore

8.90

自引率

7.50%

发文量

660

审稿时长

1 months

期刊介绍： The Journal of Bone & Joint Surgery (JBJS) has been the most valued source of information for orthopaedic surgeons and researchers for over 125 years and is the gold standard in peer-reviewed scientific information in the field. A core journal and essential reading for general as well as specialist orthopaedic surgeons worldwide, The Journal publishes evidence-based research to enhance the quality of care for orthopaedic patients. Standards of excellence and high quality are maintained in everything we do, from the science of the content published to the customer service we provide. JBJS is an independent, non-profit journal.