Outcomes after vertebral body tethering for Lenke type 5 scoliosis continue to improve: analysis of different surgical techniques.

Purpose: Vertebral Body Tethering (VBT) is a motion-preserving surgical technique for treating adolescent idiopathic scoliosis (AIS), particularly for thoracolumbar (TL) curves. While the technique has demonstrated potential benefits, its outcomes remain less predictable compared to posterior spinal fusion (PSF), with complications, such as tether breakages and revision surgeries. This study evaluates the impact of surgical experience and implant modifications on the outcomes of TL VBT for Lenke type 5 curves.

Methods: A retrospective analysis was performed on all consecutive AIS patients who underwent TL VBT from 2017 to 2022. The cohort was divided into three groups based on surgical technique and implant evolution: Group 1 (single-tether), Group 2 (double-tether), and Group 3 (advanced experience with 2nd generation implants). Radiographic outcomes, success rates (defined as a postoperative Cobb angle ≤ 30°), and complications were analysed at 1- and 2-year follow-ups.

Results: 30 patients were included. Average correction rates were 53.7%, 62.6%, 71.2% for groups 1, 2, and 3. Group 3 had a 100% success rate at 2 years, compared to 42.9% in Group 1 and 40% in Group 2 (P = 0.010). Early tether breakage rate (at 1 year) significantly correlated with experience (85.7% vs. 40% vs. 12.5%). Revision rate was 28.6% for Group 1 and 0 for groups 2 and 3.

Conclusions: These findings suggest that advanced surgical techniques and improved implants are key to achieving superior radiological outcomes and reducing revision rates.