• Alan A Stein, Amer F Samdani, Alexander J Schupper, Zan Naseer, Ronit V Shah, Sabrina Zeller, Joshua M Pahys, Solomon Praveen Samuel, Alejandro Quinonez, and Steven W Hwang.
• Department of Neurosurgery, Shriners Children's, Philadelphia, PA.
• Spine. 2024 Nov 15; 49 (22): 154815541548-1554.

Study DesignRetrospective cohort study.ObjectiveTo evaluate the outcomes and reoperation rates in patients with adolescent idiopathic scoliosis undergoing lumbar anterior vertebral body tethering (AVBT).BackgroundAVBT is a viable option for growing children. The benefit of motion preservation must be balanced by a higher reoperation rate. A paucity of reports has addressed lumbar AVBT.Materials And MethodsA single-center retrospective study was conducted to identify all patients who underwent lumbar AVBT (lowest instrumented vertebra L3 or L4) with a minimum of 2 years of follow-up. Clinical and radiographic parameters, including complications and reoperations, were also collected. Statistical analysis was performed using the Student t test for qualitative variables.ResultsFrom a data set of 551 patients, we identified 106 patients (89% female) who underwent a lumbar AVBT (33 lumbar only, 73 bilateral thoracic/lumbar) with a mean follow-up of 4.1 ± 1.6 years at which point 85% (90/106) had reached skeletal maturity. Preoperatively, these patients were skeletally immature (age: 12.8 ± 1.3 yr, Sanders: 3.3 ± 0.8, R = 0.6 ± 0.9) with a lumbar coronal curve angle of 49.6° ± 11.2° which corrected to 19.9° ± 11.2° ( P < 0.0001) at most recent follow-up. At the latest follow-up, 76.4% (81/106) of the patients harbored a coronal curve angle of <30°. Twenty patients (18.9%) underwent 23 reoperations, with overcorrection being the most common (10/23, 43%). Broken tethers led to reoperation in 3 instances (3/23, 13%). Six patients in the cohort needed a posterior spinal fusion (6/106, 5.4%).ConclusionsVertebral body tethering is a viable treatment option for skeletally immature patients with idiopathic scoliosis. This report is the largest to date for lumbar AVBT, highlighting that 84% of patients harbored a curve <35° at the latest follow-up but with an 18.9% reoperation rate.Level Of Evidence3.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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