Analysis of the risk factors for tether breakage after two-row vertebral body tethering (2RVBT) in adolescent idiopathic scoliosis (AIS).

IF 1.8 Q3 CLINICAL NEUROLOGY

Spine deformity Pub Date : 2025-07-14 DOI:10.1007/s43390-025-01142-8

Abel De Varona-Cocero, Djani Robertson, Fares Ani, Camryn Myers, Constance Maglaras, Tina Raman, Themistocles Protopsaltis, Juan C Rodriguez-Olaverri

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引用次数: 0

Abstract

Purpose: Vertebral body tethering (VBT) offers a fusion-less alternative for adolescent idiopathic scoliosis (AIS) patients, with tether breakage being a common concern, particularly in single-row VBT. Limited data exist on double-row VBT's impact on tether breakage. This study evaluates a two-row vertebral body tethering (2RVBT) technique, comparing cases with and without broken tethers in patients with over 2 year follow-up.

Methods: A single-center, retrospective review (2019-2022) included AIS patients who underwent mini-open thoracoscopic-assisted 2RVBT. Inclusion criteria were idiopathic scoliosis < 65° flexible curves, residual post-operative curves < 30°, and ≥ 2 year follow-up. Patients were divided into broken-tether (BT) and non-broken-tether (NBT) groups. Radiographic measures included thoracic (T) and thoracolumbar (TL) Cobb angles, coronal balance, L5 tilt, and sagittal parameters. Tether breakage was defined by > 5° change in screw angulation, with or without associated loss of correction.

Results: Among 109 patients (NBT = 94, BT = 15), the overall tether breakage rate was 13.7%. The BT group had significantly larger pre-operative TL Cobb angles (53.4 ± 14.0° vs 43.7 ± 13.8°, p = 0.02), greater TL correction (- 36.2 ± 9.1° vs -2 3.7 ± 15.9°, p = 0.002), and higher post-operative coronal imbalance (21.2 ± 14.6 mm vs 11.9 ± 9.4 mm, p = 0.049). They also had significantly lower skeletal maturity (mean Risser stage 2.0 ± 1.1 vs 3.2 ± 1.3, p = 0.019; Sanders 4.0 ± 1.5 vs 5.4 ± 2.0, p = 0.019). Most broken tethers did not require revision, but some cases underwent re-tethering or fusion.

Conclusion: Double tether constructs may reduce the rate of tether breakage following VBT. The main risk factors for tether breakage following double tether VBT are residual post-operative coronal imbalance, larger corrections in the lumbar spine, large rigid thoracic curves, and skeletal immaturity. Furthermore, most broken tethers did not require revision, which may indicate that curves maintained appropriate correction post-breakage due to the functional lifespan of double tether constructs. Although these are preliminary findings that must be supported with further multicenter studies that include single-tether constructs, these findings should be taken into consideration when indicating patients for VBT.

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青少年特发性脊柱侧凸（AIS）两排椎体系扎术（2RVBT）后系索断裂危险因素分析。

目的：椎体系留（VBT）为青少年特发性脊柱侧凸（AIS）患者提供了一种无融合的替代方法，系留断裂是一个常见的问题，特别是单排VBT。关于双排VBT对系索断裂影响的研究数据有限。本研究评估了两排椎体系扎术（2RVBT）技术，比较了2年多随访的患者系扎断和未系扎断的病例。方法：一项单中心回顾性研究（2019-2022），纳入了接受微创胸腔镜辅助2RVBT的AIS患者。纳入标准为特发性脊柱侧凸，螺钉角度改变5°，伴或不伴矫正缺失。结果：109例患者（NBT = 94, BT = 15）中，总系索断裂率为13.7%。BT组术前TL Cobb角较大（53.4±14.0°vs 43.7±13.8°，p = 0.02）， TL矫正度较大（- 36.2±9.1°vs -2 3.7±15.9°，p = 0.002），术后冠状不平衡较大（21.2±14.6 mm vs 11.9±9.4 mm, p = 0.049）。他们的骨骼成熟度也明显较低(平均Risser期2.0±1.1 vs 3.2±1.3,p = 0.019；桑德斯4.0±1.5 vs 5.4±2.0,p = 0.019)。大多数断裂的系索不需要修复，但有些病例需要重新系索或融合。结论：双系索装置可降低VBT术后系索断裂的发生率。双系索VBT后系索断裂的主要危险因素是术后残留的冠状不平衡、腰椎较大的矫正、较大的刚性胸椎弯曲和骨骼不成熟。此外，大多数断裂的系绳不需要修复，这可能表明由于双系绳结构的功能寿命，弯曲在断裂后保持适当的矫正。虽然这些是初步的发现，必须得到进一步的多中心研究的支持，包括单系绳结构，但在指示患者进行VBT时，这些发现应该被考虑在内。

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 deformity

CiteScore

3.20

自引率

18.80%

发文量

167

期刊介绍： Spine Deformity the official journal of the?Scoliosis Research Society is a peer-refereed publication to disseminate knowledge on basic science and clinical research into the?etiology?biomechanics?treatment?methods and outcomes of all types of?spinal deformities. The international members of the Editorial Board provide a worldwide perspective for the journal's area of interest.The?journal?will enhance the mission of the Society which is to foster the optimal care of all patients with?spine?deformities worldwide. Articles published in?Spine Deformity?are Medline indexed in PubMed.? The journal publishes original articles in the form of clinical and basic research. Spine Deformity will only publish studies that have institutional review board (IRB) or similar ethics committee approval for human and animal studies and have strictly observed these guidelines. The minimum follow-up period for follow-up clinical studies is 24 months.