De Varona-Cocero Abel, Ani Fares, Kim Nathan, Robertson Djani, Myers Camryn, Ashayeri Kimberly, Maglaras Constance, Protopsaltis Themistocles, Rodriguez-Olaverri Juan C
Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY.
Clin Spine Surg. 2025 Apr 1;38(3):E186-E192. doi: 10.1097/BSD.0000000000001697. Epub 2024 Oct 11.
Single-center retrospective cohort study.
To compare the correction of fractional curve and L5 tilt in 2RVBT versus PSF with LIV in the lumbar spine.
Vertebral body tethering, an AIS fusion-alternative, avoids rigid constructs, allowing for lower instrumented vertebra (LIV) selection. Single-tether constructs break, but mini-open thoracoscopic assistant double-row vertebral body tethering (2RVBT) reduces this. Limited comparative studies exist with posterior spinal fusion (PSF).
Retrospective analysis of AIS correction surgeries with lumbar LIV using preoperative and minimum 2-year postoperative imaging. Patients were divided into 2RVBT or PSF groups. Data included age, Riser, UIV, LIV, instrumented levels, and revision rates. Radiographic analyses included preoperative and postoperative main curve Cobb (MCC), secondary curve Cobb (SCC), fractional curve Cobb (FCC), and L5 tilt.
Ninety-nine patients participated (49 in 2RVBT, 50 in PSF). Preoperatively, secondary CC differed significantly (2RVBT: 44.6±10.4 degrees vs. PSF: 39.5±11.8 degrees, P =0.026), but not L5 tilt, MCC, or FCC. Postoperatively, MCC (2RVBT: 25.7±12.3 degrees vs. PSF: 19.5±7.4 degrees, P =0.003) and SCC (2RVBT: 18.0±8.4 degrees vs. PSF: 14.5±6.6 degrees, P =0.012) varied. Preoperative to postoperative changes in MCC (2RVBT: -32.0±11.3 degrees vs. PSF: -37.2±13.3 degrees, P =0.044) and L5 tilt (-13.8±9.0 degrees vs. PSF: -8.1±6.8 degrees, P =0.001) differed. Revision rates were similar (2RVBT: 2.0%, PSF: 4.0%, P =0.57). In 2RVBT, 3 tethers broke, 1 revision occurred for a broken tether, and 1 pleural effusion needed thoracocentesis. In PSF, 1 superficial infection needed surgery, and 1 revision was for add-on phenomenon. After PSM for Lenke classification, 54 patients remained (27 in each group). At 2 years, 2RVBT showed less MCC correction (-30.8±11.8 degrees vs. -38.9±11.9 degrees, P =0.017), but greater L5 tilt correction (-14.6±10.0 degrees vs. -7.5±6.0 degrees, P =0.003).
This study with a minimum 2-year radiographic follow-up demonstrates that 2RVBT results in greater L5 tilt correction when compared with posterior spinal fusion after PSM for Lenke classification and similar rates of revision surgery.
Level III.
单中心回顾性队列研究。
比较腰椎双棒椎体牵张术（2RVBT）与后路脊柱融合术（PSF）联合下终椎（LIV）对分数曲线和L5倾斜度的矫正效果。
椎体牵张术是一种青少年特发性脊柱侧弯（AIS）融合替代方法，避免了刚性固定结构，允许选择下固定椎（LIV）。单棒固定结构会断裂，但微创胸腔镜辅助双排椎体牵张术（2RVBT）可减少这种情况。与后路脊柱融合术（PSF）的对比研究有限。
对采用LIV的AIS矫正手术进行回顾性分析，使用术前及术后至少2年的影像学资料。将患者分为2RVBT组或PSF组。数据包括年龄、Riser、上终椎（UIV）、LIV、固定节段及翻修率。影像学分析包括术前及术后主弯Cobb角（MCC）、次弯Cobb角（SCC）、分数曲线Cobb角（FCC）及L5倾斜度。
99例患者参与研究（2RVBT组49例，PSF组50例）。术前，次弯CC有显著差异（2RVBT组：44.6±10.4度 vs. PSF组：39.5±11.8度，P =0.026），但L5倾斜度、MCC或FCC无差异。术后，MCC（2RVBT组：25.7±12.3度 vs. PSF组：19.5±7.4度，P =0.003）和SCC（2RVBT组：18.0±8.4度 vs. PSF组：14.5±6.6度，P =0.012）有所不同。术前至术后MCC（2RVBT组：-32.0±11.3度 vs. PSF组：-37.2±13.3度，P =0.044）和L5倾斜度（-13.8±9.0度 vs. PSF组：-8.1±6.8度，P =0.001）的变化存在差异。翻修率相似（2RVBT组：2.0%，PSF组：4.0%，P =0.57）。在2RVBT组，3根牵张棒断裂，1例因牵张棒断裂进行翻修，1例胸腔积液需胸腔穿刺。在PSF组，1例浅表感染需手术治疗，1例翻修是因为附加现象。根据Lenke分类进行倾向评分匹配（PSM）后，剩余54例患者（每组27例）。2年时，2RVBT组MCC矫正较小（-30.8±11.8度 vs. -38.9±11.9度，P =0.017），但L5倾斜度矫正较大（-14.6±10.0度 vs. -7.5±6.0度，P =0.003）。
这项至少有2年影像学随访的研究表明，在根据Lenke分类进行PSM后与后路脊柱融合术相比，2RVBT可导致更大的L5倾斜度矫正，且翻修手术率相似。
III级。
