JBJS - 2026-09-16 - 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% of patients had suspected 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 (mean age 11.8 years) with idiopathic scoliosis and mean preoperative Cobb angle of 47.9°. Instrumented Cobb angle improved to 17.2° at 2 years but rebounded to 25.7° at final follow-up, with 66% showing suspected tether breakage at a mean of 38.1 months postoperatively. Sixty-six percent maintained curves <40° without unplanned reoperation at 5 years, while 13.5% required conversion to posterior spinal fusion.
Key Limitation
The absence of a concurrent posterior spinal fusion control group prevents direct comparison of reoperation rates, curve correction durability, and patient-reported outcomes between VBT and the current surgical standard of care.
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.