Department of Orthopaedics, Stanford Medicine Children's Health, Palo Alto, CA.
Department of Orthopaedics, The Children's Hospital of Philadelphia.
J Pediatr Orthop. 2024;44(5):e389-e393. doi: 10.1097/BPO.0000000000002653. Epub 2024 Mar 8.
Anterior vertebral body tethering (AVBT) is increasingly popular as an option for surgical treatment of idiopathic scoliosis (IS). While the technology remains new, it is important for families and patients to be able to compare it to the current standard of care, posterior spinal fusion (PSF). The purpose of this study is to describe the complication rate of AVBT in IS using the mCDS and to compare it to the recently reported complication rate of PSF in IS.
A multicenter pediatric spine deformity database was queried for all idiopathic scoliosis patients who underwent vertebral body tethering. There were 171 patients with a minimum 9-month follow-up included in this study. Complications were retrospectively graded by 2 attending pediatric spine surgeons using the mCDS classification system.
Data from 171 patients with idiopathic scoliosis was available for analysis, with 156/171 (91%) of patients being female and an average age of 12.2 years old at surgery. There were 156 thoracic tethers (1 with an LIV below L2), 5 lumbar tethers, 9 staged double tethers, and only 1 patient with same-day double tether. Fifty-five (55) (32%) patients experienced a total of 69 complications. The most common complication type for VBT by mCDS was Grade IIIb, encompassing 29/69 (42%) of complications. The second most frequent complication grade was Grade I at 23/69 (33%). Thirty-four (34) out of 69 (49%) of the VBT complications reported required either procedural/surgical intervention or admission to the ICU.
This is the first study to directly compare the complication profile of VBT to PSF using the mCDS. Forty-nine percent (49%) of the VBT complications reported were at least Grade III, while only 7% of complications in the control PSF cohort from the literature were Grade III or higher. The mCDS complication classification brings light to the early learning experience of a new technique compared to the widely accepted standard of PSF for IS.
III - Retrospective comparative study.
前路椎体拴系术（AVBT）作为特发性脊柱侧凸（IS）的一种手术治疗选择，越来越受到欢迎。虽然这项技术还很新，但对于患者及其家属来说，能够将其与目前的标准治疗方法——后路脊柱融合术（PSF）进行比较是很重要的。本研究的目的是使用 mCDS 描述 IS 中 AVBT 的并发症发生率，并将其与最近报道的 IS 中 PSF 的并发症发生率进行比较。
对多中心小儿脊柱畸形数据库中所有接受椎体拴系术的特发性脊柱侧凸患者进行了检索。本研究共纳入 171 例至少有 9 个月随访的患者。并发症由 2 位主治小儿脊柱外科医生使用 mCDS 分类系统进行回顾性分级。
共分析了 171 例特发性脊柱侧凸患者的数据，其中 156/171（91%）为女性，手术时的平均年龄为 12.2 岁。有 156 个胸椎体拴系（1 个位于 L2 以下的 LIV），5 个腰椎体拴系，9 个分期双拴系，只有 1 个患者进行了同日双拴系。55（32%）例患者共发生 69 种并发症。mCDS 中 VBT 最常见的并发症类型为 IIIb 级，占 69 种并发症中的 29 种（42%）。其次是 I 级，有 23 种（33%）。69 种 VBT 并发症中有 34 种（49%）需要手术干预或入住 ICU。
这是第一项使用 mCDS 直接比较 VBT 和 PSF 并发症谱的研究。报告的 49%（49%）的 VBT 并发症至少为 III 级，而文献中对照 PSF 队列中只有 7%的并发症为 III 级或更高级别。mCDS 并发症分类使我们能够了解新技术的早期学习经验，与 IS 的广泛接受的标准 PSF 相比。
III-回顾性比较研究。
