Prospective Follow-up Report on Anterior Vertebral Body Tethering for Idiopathic Scoliosis

• DOI: 10.2106/jbjs.20.01503
• Publication Date: 2021-06-29T19:01:14Z
• Authors: Amer F. Samdani; Joshua M. Pahys; Robert J. Ames; Harsh Grewal; Glenn J. Pelletier; Steven W. Hwang; Randal R. Betz
• Keywords: Male; Reoperation; Adolescent; United States Food and Drug Administration; Thoracoscopy; Bone Screws; Operative Time; Blood Loss, Surgical; Torso; Spine; United States; Respiratory Function Tests; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Scoliosis; Device Approval; Humans; Female; Orthopedic Procedures; Kyphosis; Prospective Studies; Child

Background: Anterior vertebral body tethering (aVBT) has emerged as a novel treatment option for patients with idiopathic scoliosis. We present the results from the first U.S. Food and Drug Administration (FDA) Investigational Device Exemption (IDE) study on aVBT.

Methods: In this prospective review of a retrospective data set, eligible patients underwent aVBT at a single center from August 2011 to July 2015. Inclusion criteria included skeletally immature patients with Lenke type-1A or 1B curves between 30° and 65°. Clinical and radiographic parameters were collected, with the latter measured by an independent reviewer.

Results: Fifty-seven patients (49 girls and 8 boys), with a mean age (and standard deviation) of 12.4 ± 1.3 years (range, 10.1 to 15.0 years), were enrolled in the study. The patients had a mean of 7.5 ± 0.6 levels tethered, the mean operative time was 223 ± 79 minutes, and the mean estimated blood loss was 106 ± 86 mL. The patients were followed for an average of 55.2 ± 12.5 months and had a mean Risser grade of 4.2 ± 0.9 at the time of the latest follow-up. The main thoracic Cobb angle was a mean of 40.4° ± 6.8° preoperatively and was corrected to 18.7° ± 13.4° at the most recent follow-up. In the sagittal plane, T5-T12 kyphosis measured 15.5° ± 10.0° preoperatively, 17.0° ± 10.1° postoperatively, and 19.6° ± 12.7° at the most recent follow-up. Eighty percent of patients had curves of <30° at the most recent follow-up. The most recent Scoliosis Research Society (SRS) scores averaged 4.5 ± 0.4, and scores on the self-image questionnaire averaged 4.4 ± 0.7. No major neurologic or pulmonary complications occurred. Seven (12.3%) of 57 patients had a revision: 5 were done for overcorrection and 2, for adding-on.

Conclusions: Anterior VBT is a promising technique that has emerged as a treatment option for patients with immature idiopathic scoliosis. We present the results from the first FDA-approved IDE study on aVBT, which formed the basis for the eventual Humanitarian Device Exemption approval. The findings affirm the safety and efficacy of this technique and suggest opportunities for improvement, particularly with respect to reoperation rates.

Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.