Siu Jeremy W, Wu Hao-Hua, Saggi Satvir, Allahabadi Sachin, Katyal Toshali, Diab Mohammad
University of California San Francisco School of Medicine.
Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA.
J Pediatr Orthop. 2023 Mar 1;43(3):143-150. doi: 10.1097/BPO.0000000000002320. Epub 2022 Dec 6.
Correcting adolescent idiopathic scoliosis (AIS) without fusion can be achieved with anterior vertebral body tethering (AVBT). However, little is known about the perioperative outcomes, pain control, and clinical outcomes in patients undergoing AVBT compared with instrumented posterior spinal fusion (IPSF).
In this retrospective cohort study, we compared pediatric patients with AIS who underwent either AVBT or IPSF. Inclusion criteria were based on the AVBT group, which included primary thoracic idiopathic scoliosis, Risser ≤1, curve magnitude 40 to 70 degrees, age 9 to 15, no prior spine surgery, index surgery between 2014 and 2019, and minimum 2-year follow-up. Patient demographics, perioperative metrics, pain visual analog scale scores, opiate morphine equivalent usage, cost data, and radiographic outcomes were compared.
We identified 23 patients who underwent AVBT and 24 matched patients in the IPSF group based on inclusion criteria. Patients undergoing AVBT and PSF were similar in age (12±1 y vs. 13±1 y, P =0.132) and average follow-up time (3.8±1.6 y vs. 3.3±1.4 y, P =0.210). There were 23 female patients (87%) in the AVBT group and 24 female (92%) patients in the IPSF group. Intraoperatively, estimated blood loss (498±290 vs. 120±47 mL, P <0.001) and procedure duration (419±95 vs. 331±83 min, P =0.001) was significantly greater in the IPSF group compared with AVBT. Length of stay was lower in the AVBT group compared with PSF (4±1 vs. 5±2 d, P =0.04). PSF patients had significantly greater total postoperative opiate morphine equivalent use compared with AVBT (2.2±1.9 vs. 5.6±3.4 mg/kg, P <0.001). Overall direct costs following PSF and AVBT were similar ($47,655+$12,028 vs. $50,891±$24,531, P =0.58). Preoperative radiographic parameters were similar between both the groups, with a major thoracic curve at 51±10 degrees for AVBT and 54±9 degrees for IPSF ( P =0.214). At the most recent follow-up, IPSF patients had greater curve reduction to a mean major thoracic curve of 11±7 degrees (79%) compared with 19±10 degrees (63%) in AVBT patients ( P =0.002). Nine patients (39%) required revision surgery following AVBT compared with 4 patients(17%) following IPSF ( P =0.09).
In a select cohort of patients, AVBT offers decreased surgical time, blood loss, length of stay, and postoperative opiate usage compared with IPSF. Although IPSF resulted in greater deformity correction at 2-year follow-up, the majority of patients who underwent AVBT had ≤35 major curves and avoided fusion. There is optimism for AVBT as a treatment option for select AIS patients, but long-term complications are still being understood, and the risk for revision surgeries remains high.
Level III.
前路椎体拴系术（AVBT）可实现不融合矫正青少年特发性脊柱侧凸（AIS）。然而，与后路器械脊柱融合术（IPSF）相比，AVBT患者的围手术期结果、疼痛控制和临床结果知之甚少。
在这项回顾性队列研究中，我们比较了接受AVBT或IPSF的AIS儿科患者。纳入标准基于AVBT组，包括原发性胸段特发性脊柱侧凸、Risser≤1、侧弯度数40至70度、年龄9至15岁、既往无脊柱手术史、2014年至2019年的索引手术以及至少2年的随访。比较了患者的人口统计学、围手术期指标、疼痛视觉模拟量表评分、阿片类吗啡当量使用情况、成本数据和影像学结果。
根据纳入标准，我们确定了23例接受AVBT的患者和24例IPSF组的匹配患者。接受AVBT和PSF的患者年龄相似（12±1岁对13±1岁，P =0.132），平均随访时间相似（3.8±1.6年对3.3±1.4年，P =0.210）。AVBT组有23例女性患者（87%），IPSF组有24例女性患者（92%）。术中，IPSF组的估计失血量（498±290对120±47 mL，P <0.001）和手术时间（419±95对331±83分钟，P =0.001）明显高于AVBT组。AVBT组的住院时间低于PSF组（4±1对5±2天，P =0.04）。与AVBT相比，PSF患者术后阿片类吗啡当量总使用量明显更高（2.2±1.9对5.6±3.4 mg/kg，P <0.001）。PSF和AVBT后的总体直接成本相似（47,655 +12,028美元对50,891±24,531美元，P =0.58）。两组术前影像学参数相似，AVBT组主要胸弯为51±10度，IPSF组为54±9度（P =0.214）。在最近的随访中，IPSF患者的侧弯矫正程度更大，平均主要胸弯为11±7度（79%），而AVBT患者为19±10度（63%）（P =0.002）。AVBT后9例患者（39%）需要翻修手术，而IPSF后为4例患者（17%）（P =0.09）。
在特定队列的患者中，与IPSF相比，AVBT可减少手术时间、失血量、住院时间和术后阿片类药物使用。尽管IPSF在2年随访时导致更大的畸形矫正，但大多数接受AVBT的患者主要弯度≤35度且避免了融合。对于特定的AIS患者，AVBT作为一种治疗选择令人乐观，但长期并发症仍有待了解，翻修手术的风险仍然很高。
三级。
