ArticleSpine deformity2026
Complications and unplanned return to the operating room (UPROR) at five years post-operative vertebral body tethering for idiopathic scoliosis.
Article in Spine deformity, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeThe purpose of this study was to determine the potential long-term morbidity, and risk of unplanned return to the operating room (UPROR) at five years postoperative vertebral body tethering (VBT) surgery for idiopathic scoliosis.
methodA total of 120 patients treated with VBT with five years of follow-up were included in this study. Prospectively collected clinical and radiographic data were analyzed retrospectively. Primary outcomes included radiographic Cobb angle and sagittal parameters, which were analyzed preoperatively, immediately post-operatively, and at 1, 2, and 5 years after surgery. Radiographically identified and clinical complications were categorized and reported using the modified Clavien-Dindo system (mCDS).
resultsPreoperatively, the mean patient age was 12.6 years (95% CI 12.4-12.8), and Risser stages ranged from 0 to 3. The mean main thoracic scoliosis was 51.2° (95% CI 49.7-52.7°). All patients underwent thoracoscopic VBT, with an immediate post-operative improvement to 26.9° (95% CI 25.3-28.5°; p < 0.01). This correction was maintained at the 1-year follow-up at 23.0° (p < 0.01 vs. immediate post-op) and the 2-year follow-up at 27.5° (p = 0.64 vs. immediate post-op). However, mean scoliosis increased by the 5-year follow-up to 33.5° (95% CI 30.4-36.6°; p < 0.01 vs. immediate post-op). Preoperative global kyphosis was 28.5° (95% CI 26.4-30.6°), which remained stable at the 1-year (28.7°; 95% CI 26.5-31.0°) and 2-year (29.2°; 95% CI 26.6-31.8°) post-operative follow-ups. However, global kyphosis increased by 5 years post-operatively to 42.2° (95% CI 38.3-46.0°; p < 0.01 vs. preoperative). According to the modified Clavien-Dindo-Sink classification, there were 38 Grade 0 occurrences, consisting of radiographically suspected tether breakages without associated curve progression or unplanned return to the operating room (UPROR). There were 4 Grade I, 8 Grade II, 20 Grade IIIb, and 2 Grade IVa complications; no Grade IIIa, IVb, or V complications were observed. The minor complication rate (mCDS I and II) was 10%, and the major complication rate (mCDS III and IV) was 18.3%. The overall complication rate was 60% (28.3% if suspected radiographic tether breakages are excluded). The UPROR rate was 15.8%.
conclusionThe 5-year complication rate was 60%, which decreased to 28.3% if suspected radiographic tether breakages were excluded. The UPROR rate was 15.8% at 5 years. While global thoracic kyphosis remained stable during the first two years, it increased significantly by the 5-year follow-up.
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