Orthopaedics Department, Queensland Children's Hospital, South Brisbane, Australia.
Biomechanics and Spine Research Group (BSRG), Centre for Children's Health Research, Queensland University of Technology (QUT), Brisbane, Australia.
Spine Deform. 2023 Nov;11(6):1297-1307. doi: 10.1007/s43390-023-00723-9. Epub 2023 Jul 11.
Vertebral body tethering (VBT) is a recent procedure to correct and reduce spinal curves in skeletally immature patients with adolescent idiopathic scoliosis (AIS). The purpose of this systematic review and meta-analysis is to determine the expected curve reduction and potential complications for adolescent patients after VBT.
PubMed, Embase, Google Scholar and Cochrane databases were searched until February 2022. Records were screened against pre-defined inclusion and exclusion criteria. Data sources were prospective and retrospective studies. Demographics, mean differences in Cobb angle, surgical details and complication rates were recorded. Meta-analysis was conducted using a random-effects model.
This systematic review includes 19 studies, and the meta-analysis includes 16 of these. VBT displayed a statistically significant reduction in Cobb angle from pre-operative to final (minimum 2 years) measurements. The initial mean Cobb angle was 47.8° (CI 95% 42.9-52.7°) and decreased to 22.2° (CI 95% 19.9-24.5°). The mean difference is - 25.8° (CI 95% - 28.9-22.7) (p < 0.01). The overall complication rate was 23% (CI 95% 14.4-31.6%), the most common complication was tether breakage 21.9% (CI 95% 10.6-33.1%). The spinal fusion rate was 7.2% (CI 95% 2.3-12.1%).
VBT results in a significant reduction of AIS at 2 years of follow-up. Overall complication rate was relatively high although the consequences of the complications are unknown. Further research is required to explore the reasons behind the complication rate and determine the optimal timing for the procedure. VBT remains a promising new procedure that is effective at reducing scoliotic curves and preventing spinal fusion in the majority of patients.
Systematic review of Therapeutic Studies with evidence level II-IV.
椎体束缚术（VBT）是一种治疗青少年特发性脊柱侧凸（AIS）的新方法，用于矫正和减少骨骼未成熟患者的脊柱曲线。本系统评价和荟萃分析的目的是确定 VBT 后青少年患者的预期曲线减少和潜在并发症。
检索 PubMed、Embase、Google Scholar 和 Cochrane 数据库，截至 2022 年 2 月。根据预先确定的纳入和排除标准筛选记录。数据来源为前瞻性和回顾性研究。记录人口统计学、Cobb 角的平均差异、手术细节和并发症发生率。使用随机效应模型进行荟萃分析。
本系统评价包括 19 项研究，荟萃分析包括其中的 16 项。VBT 显示 Cobb 角从术前到最终（至少 2 年）测量值有统计学显著降低。初始平均 Cobb 角为 47.8°（95%CI 42.9-52.7°），降至 22.2°（95%CI 95%19.9-24.5°）。平均差异为-25.8°（95%CI 95%-28.9-22.7）（p<0.01）。总体并发症发生率为 23%（95%CI 95%14.4-31.6%），最常见的并发症是系绳断裂 21.9%（95%CI 95%10.6-33.1%）。脊柱融合率为 7.2%（95%CI 95%2.3-12.1%）。
VBT 在 2 年随访时可显著降低 AIS。总体并发症发生率相对较高，尽管并发症的后果尚不清楚。需要进一步研究以探讨并发症发生率的原因，并确定该手术的最佳时机。VBT 仍然是一种有前途的新方法，可有效减少脊柱侧凸曲线并防止大多数患者的脊柱融合。
治疗性研究的系统评价，证据水平 II-IV。
