Bizzoca Davide, Piazzolla Andrea, Moretti Lorenzo, Vicenti Giovanni, Moretti Biagio, Solarino Giuseppe
UOSD Spinal Deformity Centre, AOU Consorziale Policlinico di Bari, Bari 70124, Italy.
Orthopaedic and Trauma Unit, AUO Consorziale Policlinico di Bari, Bari 70124, Italy.
World J Orthop. 2022 May 18;13(5):481-493. doi: 10.5312/wjo.v13.i5.481.
The management of idiopathic scoliosis (IS) in skeletally immature patients should aim at three-dimensional deformity correction, without compromising spinal and chest growth. In 2019, the US Food and Drug Administration approved the first instrumentation system for anterior vertebral body tethering (AVBT), under a Humanitarian Device Exception, for skeletally immature patients with curves having a Cobb angle between 35° and 65°.
To summarize current evidence about the efficacy and safety of AVBT in the management of IS in skeletally immature patients.
From January 2014 to January 2021, Ovid Medline, Embase, Cochrane Library, Scopus, Web of Science, Google Scholar and PubMed were searched to identify relevant studies. The methodological quality of the studies was evaluated and relevant data were extracted.
Seven clinical trials recruiting 163 patients were included in the present review. Five studies out of seven were classified as high quality, whereas the remaining two studies were classified as moderate quality. A total of 151 of 163 AVBT procedures were performed in the thoracic spine, and the remaining 12 tethering in the lumbar spine. Only 117 of 163 (71.8%) patients had a nonprogressive curve at skeletal maturity. Twenty-three of 163 (14.11%) patients required unplanned revision surgery within the follow-up period. Conversion to posterior spinal fusion (PSF) was performed in 18 of 163 (11%) patients.
AVBT is a promising growth-friendly technique for treatment of IS in growing patients. However, it has moderate success and perioperative complications, revision and conversion to PSF.
骨骼未成熟患者特发性脊柱侧凸（IS）的治疗应旨在进行三维畸形矫正，同时不影响脊柱和胸廓的生长。2019年，美国食品药品监督管理局在人道主义器械豁免下，批准了首个用于椎体前路拴系（AVBT）的器械系统，用于治疗Cobb角在35°至65°之间的骨骼未成熟曲线患者。
总结关于AVBT治疗骨骼未成熟患者IS的疗效和安全性的现有证据。
检索2014年1月至2021年1月期间的Ovid Medline、Embase、Cochrane图书馆、Scopus、科学网、谷歌学术和PubMed，以识别相关研究。评估研究的方法学质量并提取相关数据。
本综述纳入了7项招募163例患者的临床试验。7项研究中有5项被归类为高质量，其余2项研究被归类为中等质量。163例AVBT手术中，有151例在胸椎进行，其余12例在腰椎进行拴系。163例患者中只有117例（71.8%）在骨骼成熟时曲线未进展。163例患者中有23例（14.11%）在随访期内需要进行计划外翻修手术。163例患者中有18例（11%）转为后路脊柱融合（PSF）。
AVBT是一种有前景的、对生长有益的技术，用于治疗生长中的患者的IS。然而，它的成功率中等，且存在围手术期并发症、翻修以及转为PSF的情况。
