Perioperative Outcomes Related to Thoracic and Lumbar Spine Exposure During Vertebral Body Tethering for Adolescent Idiopathic Scoliosis: A Large, Single-institution Retrospective Review

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Levels of evidence: This original article represents a treatment study of Level IV evidence.