Inter-screw index as a novel diagnostic indicator of tether breakage

• Published in: Spine deformity 2023-07, Vol.11 (4), p.887-895
• Main Authors: Wan, Sandra H. T., Guldeniz, Ogulcan, Yeung, Matthew H. Y., Cheung, Jason P. Y., Kwan, Kenny Y. H., Cheung, Kenneth M. C.
• Format: Article
• Language: English
• Subjects: Adolescent; Bone Screws; Case Series; Humans; Kyphosis - surgery; Medicine; Medicine & Public Health; Orthopedics; Radiography; Scoliosis - surgery; Thoracic Vertebrae - surgery
• ISSN: 2212-134X; 2212-1358
• DOI: 10.1007/s43390-023-00679-w

Purpose Tether breakage is the most common complication of Vertebral Body Tethering (VBT) occurring in up to 52% of Adolescent Idiopathic Scoliosis (AIS) patients and risks continued progression and revision. Radiographical diagnosis of tether breakage is commonly defined by a 5° increase in inter-screw angle and associates breakage with loss of correction. However, the sensitivity of this method was 56% only, suggesting that tethers can break without an increase in angulation, which was supported by other studies. To our knowledge, current literature lacks a method merely focusing on the diagnosis of tether breakage radiographically that does not associate the breakages with loss of correction. Methods This was a retrospective review of prospectively collected data of AIS patients who underwent VBT. The “inter-screw index” is defined as the percentage increase in inter-screw distance since post-op, with ≥ 13% increase defined as tether breakage as suggested by our mechanical tests. CTs were reviewed to identify the breakages and compared with inter-screw angle and inter-screw index. Results 94 segments from 13 CTs were reviewed, and 15 tether breakages were identified. Use of inter-screw index correctly identified 14 breakages (93%), whereas ≥ 5° increase in inter-screw angle only identified 12 breakages (80%). Conclusion Use of inter-screw index is proven to be more sensitive than inter-screw angle in identifying tether breakages. Therefore, we propose the use of inter-screw index to diagnose tether breakages radiographically. Tether breakages were not necessarily accompanied by a loss of segmental correction leading to an increase in inter-screw angle, especially after skeletal maturity. Level of evidence Level 3.