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Anterior Vertebral Body Tethering for Treatment of Idiopathic Scoliosis in the Skeletally Immature: Results of 112 Cases

Prospective case series. OBJECTIVE. Determine the efficacy of anterior vertebral body tethering (AVBT) in skeletally immature patients. SUMMARY OF BACKGROUND DATA. The value of AVBT is currently unclear given the paucity of available data. METHODS. Consecutive skeletally immature patients with idiop...

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Autores principales: Rushton, Paul R.P., Nasto, Luigi, Parent, Stefan, Turgeon, Isabelle, Aldebeyan, Sultan, Miyanji, Firoz
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8500278/
https://www.ncbi.nlm.nih.gov/pubmed/34091563
http://dx.doi.org/10.1097/BRS.0000000000004061
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author Rushton, Paul R.P.
Nasto, Luigi
Parent, Stefan
Turgeon, Isabelle
Aldebeyan, Sultan
Miyanji, Firoz
author_facet Rushton, Paul R.P.
Nasto, Luigi
Parent, Stefan
Turgeon, Isabelle
Aldebeyan, Sultan
Miyanji, Firoz
author_sort Rushton, Paul R.P.
collection PubMed
description Prospective case series. OBJECTIVE. Determine the efficacy of anterior vertebral body tethering (AVBT) in skeletally immature patients. SUMMARY OF BACKGROUND DATA. The value of AVBT is currently unclear given the paucity of available data. METHODS. Consecutive skeletally immature patients with idiopathic scoliosis were treated with AVBT between 2012 and 2018 by one of two surgeons working at two independent centers and followed up for >2 years. Data were collected prospectively and supplemented retrospectively where necessary. Outcomes were measured preoperatively, at first erect radiograph (FE), 1-year postoperatively and at most recent follow up (FU). RESULTS. One hundred twelve patients underwent 116 primary tethering procedures (108 thoracic and eight lumbar tethers). Four patients had primary tethering of both lumbar and thoracic curves. At surgery mean age was 12.7 ± 1.4 years (8.2–16.7) and Risser 0.5 ± 0.9 (0–3). Follow up was mean 37 ± 9 months (15–64). Preoperative mean coronal Cobb angle of the 130 tethered curves was 50.8° ± 10.2 (31–81) and corrected significantly to 26.6° ± 10.1 (−3–61) at FE radiograph (P < 0.001). Further significant improvement was seen from FE to 1-year, to mean 23.1° ± 12.4 (−37–57) (P < 0.001). There was a small but significant increase between 1-year and FU to 25.7° ± 16.3 (−32–58) (P < 0.001), which appeared to reflect tether breakage. Untethered minor curves were corrected from 31.0° ± 9.5 (3–57) to 20.3° ± 10.3 (0–52) at FU (P < 0.001). Rib hump was corrected from 14.1 ± 4.8 (0–26) to 8.8° ± 5.4 (0–22) at FU (P < 0.01). Twenty-five patients (22%) had 28 complications. Fifteen patients (13%) requiring 18 revision operations including six completed and one awaited fusions. CONCLUSION. AVBT of immature cases is associated with satisfactory deformity correction in the majority of cases. However, complication and revision rates suggest the need for improved implants and patient selection. Long-term follow-up remains crucial to establish the true efficacy of this procedure. Level of Evidence: 3
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spelling pubmed-85002782021-10-13 Anterior Vertebral Body Tethering for Treatment of Idiopathic Scoliosis in the Skeletally Immature: Results of 112 Cases Rushton, Paul R.P. Nasto, Luigi Parent, Stefan Turgeon, Isabelle Aldebeyan, Sultan Miyanji, Firoz Spine (Phila Pa 1976) Deformity Prospective case series. OBJECTIVE. Determine the efficacy of anterior vertebral body tethering (AVBT) in skeletally immature patients. SUMMARY OF BACKGROUND DATA. The value of AVBT is currently unclear given the paucity of available data. METHODS. Consecutive skeletally immature patients with idiopathic scoliosis were treated with AVBT between 2012 and 2018 by one of two surgeons working at two independent centers and followed up for >2 years. Data were collected prospectively and supplemented retrospectively where necessary. Outcomes were measured preoperatively, at first erect radiograph (FE), 1-year postoperatively and at most recent follow up (FU). RESULTS. One hundred twelve patients underwent 116 primary tethering procedures (108 thoracic and eight lumbar tethers). Four patients had primary tethering of both lumbar and thoracic curves. At surgery mean age was 12.7 ± 1.4 years (8.2–16.7) and Risser 0.5 ± 0.9 (0–3). Follow up was mean 37 ± 9 months (15–64). Preoperative mean coronal Cobb angle of the 130 tethered curves was 50.8° ± 10.2 (31–81) and corrected significantly to 26.6° ± 10.1 (−3–61) at FE radiograph (P < 0.001). Further significant improvement was seen from FE to 1-year, to mean 23.1° ± 12.4 (−37–57) (P < 0.001). There was a small but significant increase between 1-year and FU to 25.7° ± 16.3 (−32–58) (P < 0.001), which appeared to reflect tether breakage. Untethered minor curves were corrected from 31.0° ± 9.5 (3–57) to 20.3° ± 10.3 (0–52) at FU (P < 0.001). Rib hump was corrected from 14.1 ± 4.8 (0–26) to 8.8° ± 5.4 (0–22) at FU (P < 0.01). Twenty-five patients (22%) had 28 complications. Fifteen patients (13%) requiring 18 revision operations including six completed and one awaited fusions. CONCLUSION. AVBT of immature cases is associated with satisfactory deformity correction in the majority of cases. However, complication and revision rates suggest the need for improved implants and patient selection. Long-term follow-up remains crucial to establish the true efficacy of this procedure. Level of Evidence: 3 Lippincott Williams & Wilkins 2021-11-01 2021-06-04 /pmc/articles/PMC8500278/ /pubmed/34091563 http://dx.doi.org/10.1097/BRS.0000000000004061 Text en Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. 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 (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. http://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/)
spellingShingle Deformity
Rushton, Paul R.P.
Nasto, Luigi
Parent, Stefan
Turgeon, Isabelle
Aldebeyan, Sultan
Miyanji, Firoz
Anterior Vertebral Body Tethering for Treatment of Idiopathic Scoliosis in the Skeletally Immature: Results of 112 Cases
title Anterior Vertebral Body Tethering for Treatment of Idiopathic Scoliosis in the Skeletally Immature: Results of 112 Cases
title_full Anterior Vertebral Body Tethering for Treatment of Idiopathic Scoliosis in the Skeletally Immature: Results of 112 Cases
title_fullStr Anterior Vertebral Body Tethering for Treatment of Idiopathic Scoliosis in the Skeletally Immature: Results of 112 Cases
title_full_unstemmed Anterior Vertebral Body Tethering for Treatment of Idiopathic Scoliosis in the Skeletally Immature: Results of 112 Cases
title_short Anterior Vertebral Body Tethering for Treatment of Idiopathic Scoliosis in the Skeletally Immature: Results of 112 Cases
title_sort anterior vertebral body tethering for treatment of idiopathic scoliosis in the skeletally immature: results of 112 cases
topic Deformity
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8500278/
https://www.ncbi.nlm.nih.gov/pubmed/34091563
http://dx.doi.org/10.1097/BRS.0000000000004061
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