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Complications, Reoperations, and Mid-Term Outcomes Following Anterior Vertebral Body Tethering Versus Posterior Spinal Fusion: A Meta-Analysis
Anterior vertebral body tethering (AVBT) is a growth-modulation technique theorized to correct adolescent idiopathic scoliosis (AIS) without the postoperative stiffness imposed by posterior spinal fusion. However, data are limited to small series examining short-term outcomes. To assess AVBT’s poten...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Journal of Bone and Joint Surgery, Inc.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8225360/ https://www.ncbi.nlm.nih.gov/pubmed/34179678 http://dx.doi.org/10.2106/JBJS.OA.21.00002 |
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author | Shin, Max Arguelles, Gabriel R. Cahill, Patrick J. Flynn, John M. Baldwin, Keith D. Anari, Jason B. |
author_facet | Shin, Max Arguelles, Gabriel R. Cahill, Patrick J. Flynn, John M. Baldwin, Keith D. Anari, Jason B. |
author_sort | Shin, Max |
collection | PubMed |
description | Anterior vertebral body tethering (AVBT) is a growth-modulation technique theorized to correct adolescent idiopathic scoliosis (AIS) without the postoperative stiffness imposed by posterior spinal fusion. However, data are limited to small series examining short-term outcomes. To assess AVBT’s potential as a viable alternative to posterior spinal fusion (PSF), a comprehensive comparison is warranted. The purpose of this meta-analysis was to compare postoperative outcomes between patients with AIS undergoing PSF and AVBT. Our primary objective was to compare complication and reoperation rates at available follow-up times. Secondary objectives included comparing mid-term Scoliosis Research Society (SRS)-22 scores, and coronal and sagittal-plane Cobb angle corrections. METHODS: We performed a systematic review of outcome studies following AVBT and/or PSF procedures. The inclusion criteria included the following: AVBT and/or PSF procedures; Lenke 1 or 2 curves; an age of 10 to 18 years for >90% of the patient population; <10% non-AIS scoliosis etiology; and follow-up of ≥1 year. A single-arm, random-effects meta-analysis was performed. Deformity corrections, complication and reoperation rates, and postoperative SRS-22 scores were recorded. RESULTS: Ten AVBT studies (211 patients) and 14 PSF studies (1,069 patients) were included. The mean follow-up durations were similar for both groups. Pooled complication rates were 26% for AVBT versus 2% for PSF, and reoperation rates were 14.1% for AVBT versus 0.6% for PSF with nonoverlapping confidence intervals (CIs). The pooled reoperation rate among studies with follow-up times of ≥36 months was 24.7% in AVBT versus 1.8% in PSF. Deformity correction, clinical outcomes, and mid-term SRS-22 scores were similar. CONCLUSIONS: Our study showed greater rates of complications and reoperations with AVBT compared with PSF. Reoperation rates were significantly greater in AVBT studies with longer follow-up (≥36 months). Deformity correction, clinical outcomes, and mid-term SRS-22 scores were similar. While a potential fusionless treatment for AIS merits excitement, clinicians should consider AVBT with caution. Future long-term randomized prospective studies are needed. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. |
format | Online Article Text |
id | pubmed-8225360 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Journal of Bone and Joint Surgery, Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-82253602021-06-25 Complications, Reoperations, and Mid-Term Outcomes Following Anterior Vertebral Body Tethering Versus Posterior Spinal Fusion: A Meta-Analysis Shin, Max Arguelles, Gabriel R. Cahill, Patrick J. Flynn, John M. Baldwin, Keith D. Anari, Jason B. JB JS Open Access Scientific Articles Anterior vertebral body tethering (AVBT) is a growth-modulation technique theorized to correct adolescent idiopathic scoliosis (AIS) without the postoperative stiffness imposed by posterior spinal fusion. However, data are limited to small series examining short-term outcomes. To assess AVBT’s potential as a viable alternative to posterior spinal fusion (PSF), a comprehensive comparison is warranted. The purpose of this meta-analysis was to compare postoperative outcomes between patients with AIS undergoing PSF and AVBT. Our primary objective was to compare complication and reoperation rates at available follow-up times. Secondary objectives included comparing mid-term Scoliosis Research Society (SRS)-22 scores, and coronal and sagittal-plane Cobb angle corrections. METHODS: We performed a systematic review of outcome studies following AVBT and/or PSF procedures. The inclusion criteria included the following: AVBT and/or PSF procedures; Lenke 1 or 2 curves; an age of 10 to 18 years for >90% of the patient population; <10% non-AIS scoliosis etiology; and follow-up of ≥1 year. A single-arm, random-effects meta-analysis was performed. Deformity corrections, complication and reoperation rates, and postoperative SRS-22 scores were recorded. RESULTS: Ten AVBT studies (211 patients) and 14 PSF studies (1,069 patients) were included. The mean follow-up durations were similar for both groups. Pooled complication rates were 26% for AVBT versus 2% for PSF, and reoperation rates were 14.1% for AVBT versus 0.6% for PSF with nonoverlapping confidence intervals (CIs). The pooled reoperation rate among studies with follow-up times of ≥36 months was 24.7% in AVBT versus 1.8% in PSF. Deformity correction, clinical outcomes, and mid-term SRS-22 scores were similar. CONCLUSIONS: Our study showed greater rates of complications and reoperations with AVBT compared with PSF. Reoperation rates were significantly greater in AVBT studies with longer follow-up (≥36 months). Deformity correction, clinical outcomes, and mid-term SRS-22 scores were similar. While a potential fusionless treatment for AIS merits excitement, clinicians should consider AVBT with caution. Future long-term randomized prospective studies are needed. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. Journal of Bone and Joint Surgery, Inc. 2021-06-23 /pmc/articles/PMC8225360/ /pubmed/34179678 http://dx.doi.org/10.2106/JBJS.OA.21.00002 Text en Copyright © 2021 The Authors. Published by The Journal of Bone and Joint Surgery, Incorporated. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. |
spellingShingle | Scientific Articles Shin, Max Arguelles, Gabriel R. Cahill, Patrick J. Flynn, John M. Baldwin, Keith D. Anari, Jason B. Complications, Reoperations, and Mid-Term Outcomes Following Anterior Vertebral Body Tethering Versus Posterior Spinal Fusion: A Meta-Analysis |
title | Complications, Reoperations, and Mid-Term Outcomes Following Anterior Vertebral Body Tethering Versus Posterior Spinal Fusion: A Meta-Analysis |
title_full | Complications, Reoperations, and Mid-Term Outcomes Following Anterior Vertebral Body Tethering Versus Posterior Spinal Fusion: A Meta-Analysis |
title_fullStr | Complications, Reoperations, and Mid-Term Outcomes Following Anterior Vertebral Body Tethering Versus Posterior Spinal Fusion: A Meta-Analysis |
title_full_unstemmed | Complications, Reoperations, and Mid-Term Outcomes Following Anterior Vertebral Body Tethering Versus Posterior Spinal Fusion: A Meta-Analysis |
title_short | Complications, Reoperations, and Mid-Term Outcomes Following Anterior Vertebral Body Tethering Versus Posterior Spinal Fusion: A Meta-Analysis |
title_sort | complications, reoperations, and mid-term outcomes following anterior vertebral body tethering versus posterior spinal fusion: a meta-analysis |
topic | Scientific Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8225360/ https://www.ncbi.nlm.nih.gov/pubmed/34179678 http://dx.doi.org/10.2106/JBJS.OA.21.00002 |
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