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
{"title":"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？","authors":"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","doi":"10.1097/BRS.0000000000005072","DOIUrl":null,"url":null,"abstract":"<p><strong>Study design: </strong>Retrospective, multicenter.</p><p><strong>Objective: </strong>The aim of this study was to assess curve progression and occurrence of revision surgery following tether breakage after vertebral body tethering (VBT).</p><p><strong>Summary of background data: </strong>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.</p><p><strong>Materials and methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"405-411"},"PeriodicalIF":2.6000,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The Fate of The Broken Tether: How Do Curves Treated With Vertebral Body Tethering Behave After Tether Breakage?\",\"authors\":\"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\",\"doi\":\"10.1097/BRS.0000000000005072\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Study design: </strong>Retrospective, multicenter.</p><p><strong>Objective: </strong>The aim of this study was to assess curve progression and occurrence of revision surgery following tether breakage after vertebral body tethering (VBT).</p><p><strong>Summary of background data: </strong>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.</p><p><strong>Materials and methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p><p><strong>Level of evidence: </strong>Level III.</p>\",\"PeriodicalId\":22193,\"journal\":{\"name\":\"Spine\",\"volume\":\" \",\"pages\":\"405-411\"},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2025-03-15\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Spine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/BRS.0000000000005072\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/6/12 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Spine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/BRS.0000000000005072","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/6/12 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
The Fate of The Broken Tether: How Do Curves Treated With Vertebral Body Tethering Behave After Tether Breakage?
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.
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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.
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