Non-fusion surgical correction of thoracic idiopathic scoliosis using a novel, braided vertebral body tethering device: Minimum follow-up of 4 years

Abstract

Background: Anterior vertebral body tethering to effect scoliosis correction in a growing spine has been shown to work with varying degrees of success. This report describes the mid-term results of this technique using a new device composed of a braided ultra-high molecular weight polyethylene (UHMWPE) cord anchored to bone screws applied without segmental compression. Methods: This was a single-center prospective observational study of an investigational device. Five female patients aged 9 to 12 years with thoracic scoliosis underwent thoracoscopic insertion of the UHMWPE tether. Radiographs and magnetic resonance imaging (MRI) were performed, and the Scoliosis Research Society (SRS)-22 was administered, preoperatively and at regular intervals after surgery, with a minimum of 4 years of follow-up. Results: All tethering devices spanning the end vertebrae (range, 7 to 8 vertebrae) were implanted successfully. Mean blood loss was 136 mL, and the mean operative time was 205 minutes. The mean preoperative main thoracic Cobb angle was 40.1°. Curve correction of the tethered segment ranged from 0% to 133.3% at 4 years. We observed greater correction in 2 patients with open triradiate cartilage (TRC), achieving full scoliosis correction at 2 years and 121.5% at 4 years. MRI showed improvement in periapical disc wedging morphology and 55% improvement of rotation at 3 years. There were 20 adverse events, of which 16 were mild and 4 were moderate in severity. The 4 moderate events of pneumonia, distal decompensation, curve progression, and overcorrection occurred in 3 patients, 2 of whom required fusion. Conclusions: Anterior vertebral body tethering resulted in scoliosis deformity correction in the coronal and axial planes, with preservation of curve flexibility. Actual correction by growth modulation was noted only in patients with open TRC, whereas curve stabilization was noted in patients with closed TRC. Overcorrection, curve progression, and distal decompensation are problems with this technique. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. © 2019 The Authors. Published by The Journal of Bone and Joint Surgery, Incorporated. All rights reserved. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.