Pain After Anterior Vertebral Body Tethering: Incidence, Risk Factors, and Timing

• Published in: Spine (Philadelphia, Pa. 1976) Pa. 1976), 2023-10, Vol.48 (20), p.1464-1471
• Main Authors: Yang, Michael J., Samdani, Amer F., Pahys, Joshua M., Quinonez, Alejandro, McGarry, Maureen, Toll, Brandon, Grewal, Harsh, Hwang, Steven W.
• Format: Article
• Language: English
• ISSN: 0362-2436; 1528-1159
• DOI: 10.1097/BRS.0000000000004779

Retrospective case series. To examine the incidence and risk factors for postoperative pain following anterior vertebral body tethering (AVBT) for adolescent idiopathic scoliosis (AIS). Up to 78% of patients with AIS report preoperative pain; it is the greatest patient concern surrounding surgery. Pain significantly decreases following posterior spinal fusion, but pain following AVBT is poorly understood. We retrospectively reviewed 279 patients with 2-year follow-up after AVBT for AIS. We collected demographic, radiographic, and clinical data pertinent to postoperative pain at each time interval of preoperative and postoperative visits (6 weeks, 6 mo, 1 y, and annually thereafter). Within our cohort, 68.1% of patients reported preoperative pain. Older age (P=0.014) and greater proximal (P=0.013) and main thoracic (P=0.002) coronal curve magnitudes were associated with preoperative pain. Pain at any time point > 6 weeks postoperatively was reported in 41.6% of patients; it was associated with female gender (P=0.032), need for revision surgery (P=0.019), and greater lateral displacement of the apical lumbar vertebrae (P=0.028). The association between preoperative and postoperative pain trended toward significance (P=0.07). At 6 months postoperatively, 91.8% had pain resolution; the same number remained pain-free at the time of last follow-up. The presence of a postoperative complication was associated with new-onset postoperative pain that resolved (P=0.009). Only 8.2% had persistent pain, although no risk factors were found to be associated with persistent pain. In our cohort of 279 patients with minimum 2-year follow-up after AVBT, 68.1% reported preoperative pain. Nearly 42% reported postoperative pain at any time point, but only 8.2% had persistent pain. Postoperative pain after AVBT was associated with female gender, revision surgery, and Lenke lumbar modifier. AVBT is associated with a significant reduction in pain, and few patients report long-term postoperative pain. 4.