Sample Jack W, Curran Brett F, Milbrandt Todd A, Larson A Noelle, Potter D Dean
Department of Surgery, Mayo Clinic, Rochester, MN, USA.
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
J Pediatr Surg. 2025 Feb;60(2):162003. doi: 10.1016/j.jpedsurg.2024.162003. Epub 2024 Oct 12.
Vertebral body tethering (VBT) is a novel non-fusion technique for the management of scoliosis. Despite growing popularity, data concerning complications and thoracic surgery-related outcomes are lacking.
A single-institution retrospective review was conducted of patients who underwent VBT with video-assisted thoracic surgical exposure from 1/1/2015-3/1/2022. Data obtained included demographics, comorbidities, hospital course, and outcomes.
106 patients (81 % female) were identified with a mean age at surgery of 12.7 ± 1.5 (range 9-16). Most patients underwent single curve tethering (n = 93, 87.7 %) with a mean number of vertebral bodies tethered of 8.0 (range 5-13). The mean operative time was 236 ± 96 min (range 129-661) minutes with an estimated blood loss of 165 ± 143 mL (range 20-750) and no patients required allogeneic blood transfusion. The extent of tethering was significantly associated with increased operative time, fluids received, and chest tube output. Excluding instrument-related complications, the complication rate was 13.2 %, mostly occurring within the first 30 days after surgery and pleural effusion being the most common event. Two patients experienced a postoperative hemothorax requiring reoperation. No patients experienced sequelae of spinal cord ischemia secondary to the division of intercostal and/or lumbar vessels during surgical exposure and no deaths occurred.
VBT is a seemingly safe alternative to spinal fusion in skeletally immature adolescents, however, there are notable complications of this procedure related to thoracic exposure. Our experience indicates clinically significant pulmonary complications are uncommon and the extent of vertebral body exposure/tethering was strongly associated with operative duration, fluids, and chest tube output.
This original article represents a treatment study of Level IV evidence.
椎体牵张术（VBT）是一种用于治疗脊柱侧弯的新型非融合技术。尽管其越来越受欢迎，但关于并发症和胸外科手术相关结果的数据却很缺乏。
对2015年1月1日至2022年3月1日期间接受VBT并采用电视辅助胸腔镜手术暴露的患者进行单机构回顾性研究。获取的数据包括人口统计学、合并症、住院过程和结果。
共纳入106例患者（81%为女性），手术平均年龄为12.7±1.5岁（范围9 - 16岁）。大多数患者接受单节段牵张术（n = 93，87.7%），平均牵张椎体数为8.0个（范围5 - 13个）。平均手术时间为236±96分钟（范围129 - 661分钟），估计失血量为165±143毫升（范围20 - 750毫升），无患者需要异体输血。牵张范围与手术时间延长、液体输入量和胸腔引流管引流量显著相关。排除与器械相关的并发症，并发症发生率为13.2%，大多发生在术后30天内，胸腔积液是最常见的事件。2例患者术后发生血胸需要再次手术。手术暴露期间，无患者因肋间和/或腰血管离断继发脊髓缺血后遗症，也无死亡病例。
对于骨骼未成熟的青少年，VBT似乎是脊柱融合术的一种安全替代方法，然而，该手术存在与胸腔暴露相关的显著并发症。我们的经验表明，临床上显著的肺部并发症并不常见，椎体暴露/牵张范围与手术持续时间、液体输入量和胸腔引流管引流量密切相关。
本文为IV级证据的治疗研究。
