Natalie A Pulido1, Michael G Vitale2, Stefan Parent3,4, Todd A Milbrandt1, Firoz Miyanji5, Ron El-Hawary6, A Noelle Larson7,8. 1. Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. 2. Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA. 3. Department of Surgery, Université de Montréal, Montreal, QC, Canada. 4. CHU Sainte-Justine, Montreal, QC, Canada. 5. Department of Orthopedics, BC Children's Hospital, Vancouver, BC, Canada. 6. Division of Orthopedic Surgery, Dalhousie University, Halifax, NS, Canada. 7. Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. larson.noelle@mayo.edu. 8. Pediatric Spine Study Group, Valley Forge, PA, USA. larson.noelle@mayo.edu.
Abstract
PURPOSE: Vertebral body tethering (VBT) has been described for patients with idiopathic scoliosis. Results of the technique for non-idiopathic scoliosis have not yet been reported. METHODS: An international multicenter registry was retrospectively queried for non-idiopathic scoliosis patients who underwent VBT with minimum 2-year follow-up. Success at 2 years was defined as Cobb angle < 35 degrees and no fusion surgery. RESULTS: Of the 251 patients treated with VBT, 20 had non-idiopathic scoliosis and minimum 2-year follow-up. Mean age at surgery was 12.4 years (range 10 to 17 years). Mean major Cobb angle at enrollment was 56 degrees. Of those, 18 patients had a major thoracic curve and two had a major lumbar curve. Of the 20 patients, nine met criteria for success (45%). Eight of the 20 patients had poor outcomes (four fusions, four with curve > 50 degrees). Success was associated with smaller preoperative Cobb angle (50 vs. 62 degrees, p = 0.01) and smaller Cobb angle on initial postop imaging (28 degrees vs. 46 degrees, p = 0.0007). All patients with Cobb angle < 35 degrees on 1st postop imaging had a successful result, with the exception of one patient who overcorrected and required fusion. Syndromic vs. neuromuscular patients had a higher likelihood of success (5 of 7, 71%, 2 of 10, 20%, p = 0.03). CONCLUSION: Selected non-idiopathic scoliosis can be successfully treated with VBT, but failure rates are high and were associated with large curves, inadequate intraoperative correction and neuromuscular diagnosis. Achieving a Cobb angle less than 35 degrees on 1st standing radiograph was associated with a successful outcome which was achieved in 45% of patients. LEVEL OF EVIDENCE: Level IV (retrospective review study).
PURPOSE: Vertebral body tethering (VBT) has been described for patients with idiopathic scoliosis. Results of the technique for non-idiopathic scoliosis have not yet been reported. METHODS: An international multicenter registry was retrospectively queried for non-idiopathic scoliosis patients who underwent VBT with minimum 2-year follow-up. Success at 2 years was defined as Cobb angle < 35 degrees and no fusion surgery. RESULTS: Of the 251 patients treated with VBT, 20 had non-idiopathic scoliosis and minimum 2-year follow-up. Mean age at surgery was 12.4 years (range 10 to 17 years). Mean major Cobb angle at enrollment was 56 degrees. Of those, 18 patients had a major thoracic curve and two had a major lumbar curve. Of the 20 patients, nine met criteria for success (45%). Eight of the 20 patients had poor outcomes (four fusions, four with curve > 50 degrees). Success was associated with smaller preoperative Cobb angle (50 vs. 62 degrees, p = 0.01) and smaller Cobb angle on initial postop imaging (28 degrees vs. 46 degrees, p = 0.0007). All patients with Cobb angle < 35 degrees on 1st postop imaging had a successful result, with the exception of one patient who overcorrected and required fusion. Syndromic vs. neuromuscular patients had a higher likelihood of success (5 of 7, 71%, 2 of 10, 20%, p = 0.03). CONCLUSION: Selected non-idiopathic scoliosis can be successfully treated with VBT, but failure rates are high and were associated with large curves, inadequate intraoperative correction and neuromuscular diagnosis. Achieving a Cobb angle less than 35 degrees on 1st standing radiograph was associated with a successful outcome which was achieved in 45% of patients. LEVEL OF EVIDENCE: Level IV (retrospective review study).
Authors: Andrew S Chung; Sean Renfree; Donovan B Lockwood; Judson Karlen; Mohan Belthur Journal: Spine (Phila Pa 1976) Date: 2019-11-15 Impact factor: 3.468
Authors: Alice Baroncini; Per David Trobisch; Christof Birkenmaier; Stephanie Da Paz; Filippo Migliorini Journal: Z Orthop Unfall Date: 2021-04-19 Impact factor: 1.108