Stamiris Stavros, Sofos Cornelius, Sarridimitriou Athanasios, Kakoulidis Panagiotis, Christidis Panagiotis, Stamiris Dimitrios, Anestiadou Elissavet, Cheva Angeliki, Chatzianestiadou Christiana, Christodoulou Pavlos, Karampalis Christos
Department of Orthopaedics, 424 General Military Hospital, West Ring Road, Nea Efkarpia, 56429, Thessaloniki, Greece.
3rd Academic Department of Orthopaedics, Faculty of Medicine, Aristotle University of Thessaloniki, West Ring Road, Nea Efkarpia, 56429, Thessaloniki, Greece.
Spine Deform. 2025 Jun 8. doi: 10.1007/s43390-025-01113-z.
Although posterior spinal fusion (PSF) is considered the gold standard for the treatment of idiopathic scoliosis, it has been associated with several limitations. Vertebral body tethering (VBT) offers a motion-preserving alternative, with growing evidence supporting its clinical efficacy.
A comprehensive search of PubMed, Cochrane, Web of Science and Scopus databases was performed to identify comparative studies between VBT and PSF in patients with idiopathic scoliosis. Primary outcomes included major curve correction and postoperative major and minor curve angles. Secondary outcomes included radiographic parameters (shoulder height difference, spinal height gain, coronal balance, thoracic kyphosis, lumbar lordosis), perioperative metrics [length of stay (LOS), estimated blood loss (EBL), operative time, instrumented levels], patient-reported outcomes [Scoliosis Research Society-22 Questionnaire (SRS-22)], complication and revision rates.
Seventeen studies met the inclusion criteria. VBT patients required shorter instrumentations (p < 0.00001). PSF achieved lower postoperative major (p < 0.00001) and minor curve angles (p = 0.00001), better coronal balance (p = 0.005) and superior major curve correction from baseline (p < 0.00001), but with questionable clinical significance. VBT demonstrated greater lumbar flexion capacity (p < 0.00001), superior shoulder balance (p < 0.00001) and better outcomes in SRS-22 pain (p = 0.02), satisfaction (p = 0.03) and function (p = 0.02) at two-year follow-up. VBT also had shorter operation times (p = 0.0007), less blood loss (p < 0.00001), but higher complication (p = 0.0002) and revision rates (p < 0.00001). No difference detected in lumbar lordosis (p = 0.08), thoracic kyphosis (p = 0.15), SRS-22 self-image (p = 0.20) and total (p = 0.12), lumbar side bending (p = 0.81), axial rotation (p = 0.43) and hospital stay (p = 0.7).
PSF demonstrates superior coronal spinal alignment, along with lower complication and revision rates. In contrast, VBT offers better preservation of spinal motion, improved shoulder balance, enhanced early quality of life, and reduced blood loss and operative time, while requiring shorter instrumentations. Treatment decisions should be individualized, taking into account patient-specific factors. Long-term outcome data are needed to guide clinical practice.
尽管后路脊柱融合术（PSF）被认为是治疗特发性脊柱侧凸的金标准，但它存在一些局限性。椎体牵张术（VBT）提供了一种保留运动功能的替代方法，越来越多的证据支持其临床疗效。
对PubMed、Cochrane、科学引文索引和Scopus数据库进行全面检索，以确定VBT与PSF治疗特发性脊柱侧凸患者的比较研究。主要结局包括主弯矫正以及术后主弯和次弯角度。次要结局包括影像学参数（肩高差异、脊柱高度增加、冠状面平衡、胸椎后凸、腰椎前凸）、围手术期指标[住院时间（LOS）、估计失血量（EBL）、手术时间、固定节段数]、患者报告结局[脊柱侧凸研究学会-22问卷（SRS-22）]、并发症和翻修率。
17项研究符合纳入标准。VBT患者所需的固定节段数更少（p < 0.00001）。PSF术后主弯（p < 0.00001）和次弯角度更低（p = 0.00001），冠状面平衡更好（p = 0.005），与基线相比主弯矫正效果更好（p < 0.00001），但临床意义存疑。VBT在两年随访时显示出更大的腰椎前屈能力（p < 0.00001）、更好的肩部平衡（p < 0.00001）以及SRS-22疼痛（p = 0.02）、满意度（p = 0.03）和功能（p = 0.02）方面更好的结局。VBT的手术时间也更短（p = 0.0007），失血量更少（p < 0.00001），但并发症（p = 0.0002）和翻修率更高（p < 0.00001）。在腰椎前凸（p = 0.08）、胸椎后凸（p = 0.15）、SRS-22自我形象（p = 0.20）和总分（p = 0.12）、腰椎侧屈（p = 0.81）、轴向旋转（p = 0.43）和住院时间（p = 0.7）方面未检测到差异。
PSF显示出更好的冠状面脊柱排列，以及更低的并发症和翻修率。相比之下，VBT能更好地保留脊柱运动功能，改善肩部平衡，提高早期生活质量，并减少失血量和手术时间，同时所需的固定节段数更少。治疗决策应个体化，考虑患者的具体因素。需要长期结局数据来指导临床实践。
