Eifelklinik St. Brigida, Simmerath, Germany.
Eur Spine J. 2022 Apr;31(4):1045-1050. doi: 10.1007/s00586-021-07107-5. Epub 2022 Jan 8.
Vertebral body tethering (VBT) has shown promising results but also a high tether breakage rate, which has been reported in up to 48% of patients. Tether breakages can lead to loss of correction, and the most used definition for tether breakage is a loss of segmental correction of > 5°. However, there may also be some breakages that do not have a negative influence on curve correction. Analyzing the real breakage rate was the aim of this study.
All patients who underwent anterior revision surgery after VBT were included in this retrospective study. Real (intraoperatively confirmed) tether breakages were compared to preoperatively suspected tether breakages. The definition for a suspected tether breakage was an angular change of more than 5° between an early and the latest radiograph.
Ten patients who received 11 revision surgeries with a total of 15 revised curves were analyzed. Of the 80 analyzed segments, 36 were found to have a breakage. Of these 36 segments, 20 were suspected to be broken preoperatively. Sixteen breakages were not identified on preoperative radiographs (44%). One suspected broken tether was intraoperatively found to be intact.
By using the > 5° rule, only 56% of the tether breakages could be diagnosed. On the other hand, many tether breakages will not result in a loss of correction.
椎体拴系（VBT）已显示出良好的效果，但也存在较高的拴系断裂率，据报道高达 48%的患者会出现这种情况。拴系断裂可导致矫正丢失，最常用的拴系断裂定义是节段矫正丢失超过 5°。然而，也可能存在一些不会对曲线矫正产生负面影响的断裂。本研究旨在分析实际的断裂率。
本回顾性研究纳入了所有接受 VBT 后行前路翻修手术的患者。将术中证实的真正（术中证实）拴系断裂与术前疑似拴系断裂进行比较。疑似拴系断裂的定义为早期和最新的影像学检查中角度变化超过 5°。
分析了 10 名接受 11 次翻修手术共 15 次翻修曲线的患者。在 80 个分析节段中，发现 36 个节段有断裂。在这 36 个节段中，20 个节段术前被怀疑有断裂。术前影像学检查未发现 16 个断裂（44%）。术中发现 1 个疑似断裂的拴系实际上是完整的。
使用>5°规则，只能诊断出 56%的拴系断裂。另一方面，许多拴系断裂不会导致矫正丢失。
