Results of posterior spinal fusion after failed anterior vertebral body tethering

Purpose In patients with adolescent idiopathic scoliosis (AIS) undergoing anterior vertebral tethering (AVBT), some will subsequently require posterior spinal fusion (PSF). Limited data exist on clinical and radiographic outcomes of fusion after tether failure. Methods 490 patients who underwent AVB...

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Bibliographic Details
Published in:Spine deformity 2024-03, Vol.12 (2), p.367-373
Main Authors: Samdani, Amer F., Plachta, Stephen M., Pahys, Joshua M., Quinonez, Alejandro, Samuel, Solomon P., Hwang, Stephen W.
Format: Article
Language:English
Subjects:
Adolescent
Case Series
Follow-Up Studies
Humans
Medicine
Medicine & Public Health
Orthopedics
Retrospective Studies
Spinal Fusion - methods
Thoracic Vertebrae - diagnostic imaging
Thoracic Vertebrae - surgery
Treatment Outcome
Vertebral Body
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Summary:Purpose In patients with adolescent idiopathic scoliosis (AIS) undergoing anterior vertebral tethering (AVBT), some will subsequently require posterior spinal fusion (PSF). Limited data exist on clinical and radiographic outcomes of fusion after tether failure. Methods 490 patients who underwent AVBT were retrospectively analyzed. Twenty patients (4.1%) subsequently underwent conversion to PSF. A control group of patients with primary PSF (no previous AVBT) was matched for comparison. Data were compared using paired t-tests and Fisher Exact Tests. Results There was a significant increase in estimated blood loss (EBL) ( p  = 0.002), percent estimated blood volume (%EBV) ( p  = 0.013), operative time ( p  = 0.002), and increased amount of fluoroscopy (mGy) ( p  = 0.04) as well as number of levels fused ( p  = 0.02) in the AVBT conversion group compared to primary fusion. However, no difference was found in implant density ( p  = 0.37), blood transfusions ( p  = 0.11), or intraoperative neuromonitoring events ( p  > 0.99). Both groups attained similar thoracic and lumbar percent correction (major coronal curve angle) from pre-op to the latest follow-up (thoracic p  = 0.507, lumbar p  = 0.952). Conclusion A subset of patients with AVBT will require conversion to PSF. Although technically more challenging, revision surgery can be safely performed with similar clinical and radiographic outcomes to primary PSF. Level of evidence 3.
ISSN:2212-134X
2212-1358
DOI:10.1007/s43390-023-00796-6