Can anterior vertebral body tethering provide superior range of motion outcomes compared to posterior spinal fusion in adolescent idiopathic scoliosis? A systematic review

• Published in: European spine journal 2023-09, Vol.32 (9), p.3058-3071
• Main Authors: Wong, Darren Li Liang, Mong, Pak Tung, Ng, Chun Yin, Ong, Chun Kwan, Qian, Zhekai, Shao, Mang Hong, Sin, Ling Kwan Ernest, Wong, Bao Yi, Wong, Chun Ming, Cheung, Jason Pui Yin, To, Michael
• Format: Article
• Language: English
• Subjects: Cadavers; Case reports; Endurance; Medicine; Medicine & Public Health; Muscle strength; Neurosurgery; Quality of life; Range of motion; Review Article; Scoliosis; Surgical Orthopedics; Systematic review; Vertebrae
• ISSN: 0940-6719; 1432-0932
• DOI: 10.1007/s00586-023-07787-1

Purpose Anterior vertebral body tethering (AVBT) was introduced as a fusionless alternative to treating adolescent idiopathic scoliosis (AIS) while preserving range of motion (ROM). This is the first systematic review to compare the ROM outcomes between AVBT and PSF in treating AIS. Methods We conducted a comprehensive search on PubMed, EMBASE, MEDLINE, and Cochrane Library. Inclusion criteria were patients with AIS treated with AVBT or PSF or both, and clearly defined ROM outcomes; exclusion criteria were scoliosis other than AIS, biomechanical or cadaveric studies, non-English publications, case reports, conference summaries, unpublished literature, commentaries, and reviews. Primary outcome was ROM. Secondary outcomes included Cobb angle correction, quality of life (QOL), complications, and muscle strength and endurance. Results Twelve studies were included in this review. We found moderate evidence to support that AVBT results in superior ROM outcomes than PSF while achieving comparable Cobb angle correction with low evidence. The comparison of QOL outcomes between AVBT and PSF remained inconclusive. In addition to the complications noted conventionally in PSF, AVBT could result in over-correction and distal adding-on. We also found very low evidence to support that AIS patients treated with AVBT have superior muscle strength and endurance when compared to those treated with PSF. Conclusions AVBT provides better preservation of ROM and muscle strength postoperatively when compared with PSF, while achieving comparable curve correction. Future studies should explore the spinal growth trajectory to determine the window of opportunity for AVBT in AIS.