JBJS - 2026-03-24 - Journal Article
Outcomes and Complications of Vertebral Body Tethering in Skeletally Immature Patients with Idiopathic Scoliosis.
Imbeault R, Shen J, Alzakri A, Barchi S, Roy-Beaudry M, Turgeon I, Parent S
Topics
Key Takeaway
At mean 63-month follow-up, VBT achieved a final instrumented Cobb angle of 25.7° from a preoperative mean of 47.9°, but 66% had radiographic tether breakage and 21.6% required unplanned return to the OR.
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Summary
This single-center prospective cohort evaluated 5–8-year radiographic outcomes and complications of VBT in 74 skeletally immature patients with idiopathic scoliosis (mean preop Cobb 47.9°). Maximum Cobb angle improved to 17.2° at 2 years but rebounded to 25.7° at ≥5 years, with significant coronal and transverse plane correction maintained (p<0.001 and p=0.006). Tether breakage was suspected in 66% at final follow-up (mean onset 38.1 months), 21.6% required unplanned reoperation, and 13.5% ultimately required posterior spinal fusion.
Key Limitation
Single-center series with no control arm prevents direct comparison of outcomes or complication rates against posterior spinal fusion in the same curve-magnitude population.
Original Abstract
BACKGROUND
Vertebral body tethering (VBT) aims to gradually correct scoliosis using patients' growth while preserving spinal motion. We report 5 to 8-year outcomes and complications in skeletally immature patients.
METHODS
This prospective single-center cohort study included 74 patients who had idiopathic scoliosis and a ≥5-year follow-up. Preoperative, first postoperative visit, 1-year, 2-year, and ≥5-year radiographs were analyzed. A ≥5° increase in the interscrew angle suggested tether breakage.
RESULTS
All 74 patients (5 male and 69 female) were skeletally immature at surgery. The mean age at surgery was 11.8 ± 1.3 years, and the mean follow-up time was 63.4 ± 8.4 months. Of the 74 patients, 68 patients were White, 4 were Black, and 2 were Middle Eastern or North African. VBT was performed on a mean of 7.4 vertebral levels. The maximum Cobb angle was 47.9° ± 9.4° preoperatively, whereas the instrumented Cobb angle measured 17.2° ± 12.3° at 2 years and 25.7° ± 14.0° at ≥5 years postoperatively. An unplanned return to the operating room occurred in 16 patients (21.6%). Forty-nine patients (66%) had a suspected broken tether at the final follow-up. The mean time of the first tether breakage was 38.1 ± 15 months. Forty-nine patients (66%) also had a curve of <40° without an unplanned return to the operating room at a minimum of 5 years postoperatively.
CONCLUSIONS
In our cohort, 66% (49 patients) had a radiographically suspected tether breakage after 5 years and 13.5% (10 patients) required posterior spinal fusion to date. VBT yielded significant correction in the coronal plane (p < 0.001) and transverse plane (p = 0.006) postoperatively, with a reoperation rate of 21.6%.
LEVEL OF EVIDENCE
Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.