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

Autor: Sample JW; Department of Surgery, Mayo Clinic, Rochester, MN, USA., Curran BF; Department of Surgery, Mayo Clinic, Rochester, MN, USA., Milbrandt TA; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA., Larson AN; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA., Potter DD; Division of Pediatric Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA. Electronic address: potter.d@mayo.edu.
Jazyk: angličtina
Zdroj: Journal of pediatric surgery [J Pediatr Surg] 2024 Oct 12; Vol. 60 (2), pp. 162003. Date of Electronic Publication: 2024 Oct 12.
DOI: 10.1016/j.jpedsurg.2024.162003
Abstrakt: 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.
Competing Interests: Conflicts of interest A. Noelle Larson is a consultant for Highridge, Orthopediatrics, DePuy Synthes, Medtronic, and Pacira with all funds directed to Mayo Clinic. A. Noelle Larson and Mayo Clinic receive royalties from Globus. Dr. Milbrandt is a consultant to Medtronic with all funds directed to Mayo Clinic. Mayo Clinic has received research funding from Orthopediatrics and Medtronic. Dr. Potter is a consultant to Medtronic. This was in an educational capacity only. The contributing authors have no conflict of interests or competing interests to declare. No funding was received to assist with the preparation of this manuscript.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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