Anterior Vertebral Body Tethering Compared with Posterior Spinal Fusion for Major Thoracic Curves A Retrospective Comparison by the Harms Study Group

Background:Anterior vertebral body tethering (AVBT) is an alternative to posterior spinal fusion (PSF) for the surgical treatment of scoliosis. The present study utilized a large, multicenter database and propensity matching to compare outcomes of AVBT to PSF in patients with idiopathic scoliosis.Methods:Patients with thoracic idiopathic scoliosis who underwent AVBT with a minimum 2-year follow-up retrospectively underwent 2 methods of propensity-guided matching to PSF patients from an idiopathic scoliosis registry. Radiographic, clinical, and Scoliosis Research Society 22-Item Questionnaire (SRS-22) data were compared preoperatively and at the >= 2-year follow-up.Results:A total of 237 AVBT patients were matched with 237 PSF patients. In the AVBT group, the mean age was 12.1 +/- 1.6 years, the mean follow-up was 2.2 +/- 0.5 years, 84% of patients were female, and 79% of patients had a Risser sign of 0 or 1, compared with 13.4 +/- 1.4 years, 2.3 +/- 0.5 years, 84% female, and 43% Risser 0 or 1 in the PSF group. The AVBT group was younger (p < 0.001), had a smaller mean thoracic curve preoperatively (48 +/- 9 degrees; range, 30 degrees to 74 degrees; compared with 53 +/- 8 degrees; range, 40 degrees to 78 degrees in the PSF group; p < 0.001), and had less initial correction (41% +/- 16% correction to 28 degrees +/- 9 degrees compared with 70% +/- 11% correction to 16 degrees +/- 6 degrees in the PSF group; p < 0.001). Thoracic deformity at the time of the latest follow-up was 27 degrees +/- 12 degrees (range, 1 degrees to 61 degrees) for AVBT compared with 20 degrees +/- 7 degrees (range, 3 degrees to 42 degrees) for PSF (p < 0.001). A total of 76% of AVBT patients had a thoracic curve of <35 degrees at the latest follow-up compared with 97.4% of PSF patients (p < 0.001). A residual curve of >50 degrees was present in 7 AVBT patients (3%), 3 of whom underwent subsequent PSF, and in 0 PSF patients (0%). Forty-six subsequent procedures were performed in 38 AVBT patients (16%), including 17 conversions to PSF and 16 revisions for excessive correction, compared with 4 revision procedures in 3 PSF patients (1.3%; p < 0.01). AVBT patients had lower median preoperative SRS-22 mental-health component scores (p < 0.01) and less improvement in the pain and self-image scores between preoperatively and the >= 2-year follow-up (p < 0.05). In the more strictly matched analysis (n = 108 each), 10% of patients in the AVBT group and 2% of patients in the PSF group required a subsequent surgical procedure.Conclusions:At a mean follow-up of 2.2 years, 76% of thoracic idiopathic scoliosis patients who underwent AVBT had a residual curve of <35 degrees compared with 97.4% of patients who underwent PSF. A total of 16% of cases in the AVBT group required a subsequent surgical procedure compared with 1.3% in the PSF group. An additional 4 cases (1.3%) in the AVBT group had a residual curve of >50 degrees that may require revision or conversion to PSF.