ArticleSpine deformity2026
Who are the best candidates? Factors predicting success and failure of vertebral body tethering.
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
purposeVertebral body tethering (VBT) is a fusionless alternative for adolescent idiopathic scoliosis (AIS), but predictors of long-term success remain unclear. We aimed to report outcomes 2-8 years following VBT and identify factors associated with revision surgery.
methodsSingle institution retrospective review of a prospectively collected AIS database. INCLUSION CRITERIA: VBT between 2015-2022, skeletal maturity (Risser 5 or Risser 4 with Sanders 7) at follow-up, and minimum 2-year follow-up or revision surgery. Patients were classified as not requiring revision surgery (NRS) or requiring revision surgery (RS).
resultsForty-one patients were included: 21 (51%) NRS and 20 (49%) RS. Mean follow-up was 4.3 years (NRS) and 3.6 years (RS). Compared with RS, NRS patients had lower preoperative curve magnitude (46° vs. 52°, p = 0.03) and higher Sanders stage (3.4 vs. 2.4, p = 0.01). Sanders <3 (OR = 9.2, 95% CI 1.3-67.3, p = 0.03) and preoperative curve magnitude (OR = 2.7 per 10°, 95% CI 1.1-6.8, p = 0.04) were independent predictors of revision surgery. Double curves had higher revision rates (86% vs. 41%); 30% of RS patients had double curves versus 5% of NRS. Immediate correction to <35° was achieved in 67% (NRS) vs. 25% (RS) (p = 0.01). Final Cobb angle was 25° (NRS) vs. 34° (RS) (p = 0.003).
conclusionsVBT patients not requiring revision surgery had preoperative curves <50° and more advanced skeletal maturity (Sanders 3.4 vs. 2.4). These patients were more likely to achieve immediate correction to <35° and maintain correction at follow-up. These factors should be considered when selecting patients for fusionless techniques and inform preoperative counseling regarding revision risk.
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