Newton Peter O, Parent Stefan, Miyanji Firoz, Alanay Ahmet, Lonner Baron S, Neal Kevin M, Hoernschemeyer Daniel G, Yaszay Burt, Blakemore Laurel C, Shah Suken A, Bastrom Tracey P
Division of Orthopedics & Scoliosis, Rady Children's Hospital, San Diego, California.
Department of Orthopaedics, CHU Sainte-Justine, Montreal, Québec, Canada.
J Bone Joint Surg Am. 2022 Dec 21;104(24):2170-2177. doi: 10.2106/JBJS.22.00127. Epub 2022 Oct 20.
Anterior vertebral body tethering (AVBT) is an alternative to posterior spinal fusion (PSF) for the surgical treatment of scoliosis. The present study utilized a large, multicenter database and propensity matching to compare outcomes of AVBT to PSF in patients with idiopathic scoliosis.
Patients with thoracic idiopathic scoliosis who underwent AVBT with a minimum 2-year follow-up retrospectively underwent 2 methods of propensity-guided matching to PSF patients from an idiopathic scoliosis registry. Radiographic, clinical, and Scoliosis Research Society 22-Item Questionnaire (SRS-22) data were compared preoperatively and at the ≥2-year follow-up.
A total of 237 AVBT patients were matched with 237 PSF patients. In the AVBT group, the mean age was 12.1 ± 1.6 years, the mean follow-up was 2.2 ± 0.5 years, 84% of patients were female, and 79% of patients had a Risser sign of 0 or 1, compared with 13.4 ± 1.4 years, 2.3 ± 0.5 years, 84% female, and 43% Risser 0 or 1 in the PSF group. The AVBT group was younger (p < 0.001), had a smaller mean thoracic curve preoperatively (48 ± 9°; range, 30° to 74°; compared with 53 ± 8°; range, 40° to 78° in the PSF group; p < 0.001), and had less initial correction (41% ± 16% correction to 28° ± 9° compared with 70% ± 11% correction to 16° ± 6° in the PSF group; p < 0.001). Thoracic deformity at the time of the latest follow-up was 27° ± 12° (range, 1° to 61°) for AVBT compared with 20° ± 7° (range, 3° to 42°) for PSF (p < 0.001). A total of 76% of AVBT patients had a thoracic curve of <35° at the latest follow-up compared with 97.4% of PSF patients (p < 0.001). A residual curve of >50° was present in 7 AVBT patients (3%), 3 of whom underwent subsequent PSF, and in 0 PSF patients (0%). Forty-six subsequent procedures were performed in 38 AVBT patients (16%), including 17 conversions to PSF and 16 revisions for excessive correction, compared with 4 revision procedures in 3 PSF patients (1.3%; p < 0.01). AVBT patients had lower median preoperative SRS-22 mental-health component scores (p < 0.01) and less improvement in the pain and self-image scores between preoperatively and the ≥2-year follow-up (p < 0.05). In the more strictly matched analysis (n = 108 each), 10% of patients in the AVBT group and 2% of patients in the PSF group required a subsequent surgical procedure.
At a mean follow-up of 2.2 years, 76% of thoracic idiopathic scoliosis patients who underwent AVBT had a residual curve of <35° compared with 97.4% of patients who underwent PSF. A total of 16% of cases in the AVBT group required a subsequent surgical procedure compared with 1.3% in the PSF group. An additional 4 cases (1.3%) in the AVBT group had a residual curve of >50° that may require revision or conversion to PSF.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
椎体前路栓系术（AVBT）是脊柱后路融合术（PSF）治疗脊柱侧弯的一种替代方法。本研究利用一个大型多中心数据库和倾向匹配法，比较特发性脊柱侧弯患者中AVBT与PSF的治疗效果。
对接受AVBT且至少随访2年的胸段特发性脊柱侧弯患者，回顾性地采用2种倾向引导匹配方法，与特发性脊柱侧弯登记处的PSF患者进行匹配。对术前及随访≥2年时的影像学、临床和脊柱侧弯研究学会22项问卷（SRS - 22）数据进行比较。
共237例AVBT患者与237例PSF患者匹配。AVBT组患者的平均年龄为12.1±1.6岁，平均随访时间为2.2±0.5年，84%为女性，79%的患者Risser征为0或1；PSF组患者的平均年龄为13.4±1.4岁，平均随访时间为2.3±0.5年，84%为女性，43%的患者Risser征为0或1。AVBT组患者年龄更小（p<0.001），术前平均胸弯更小（48±9°；范围30°至74°；PSF组为53±8°；范围40°至78°；p<0.001），初始矫正程度更低（矫正41%±16%至28°±9°，而PSF组矫正70%±11%至16°±6°；p<0.001）。最新随访时，AVBT组的胸段畸形为27°±12°（范围1°至61°），PSF组为20°±7°（范围3°至42°）（p<0.001）。最新随访时，76%的AVBT患者胸弯<35°，而PSF患者为97.4%（p<0.001）。7例AVBT患者（3%）存在>50°的残留弯，其中3例随后接受了PSF手术，PSF组无患者（0%）出现这种情况。38例AVBT患者（16%）进行了46次后续手术，包括17例转为PSF手术和16例因过度矫正进行的翻修手术，而PSF组3例患者（1.3%）进行了4次翻修手术（p<0.01）。AVBT组患者术前SRS - 22心理健康成分评分中位数较低（p<0.01），术前至随访≥2年时疼痛和自我形象评分改善较少（p<0.05）。在更严格匹配分析（每组n = 108）中，AVBT组10%的患者和PSF组2%的患者需要进行后续手术。
平均随访2.2年时，接受AVBT的胸段特发性脊柱侧弯患者中，76%的患者残留弯<35°，而接受PSF的患者为97.4%。AVBT组16%的病例需要进行后续手术，而PSF组为1.3%。AVBT组另有4例（1.3%）患者残留弯>50°，可能需要翻修或转为PSF手术。
治疗性III级。有关证据水平的完整描述，请参阅作者指南。
