• Per David Trobisch and Alice Baroncini.
• Department of Spine Surgery, Eifelklinik St. Brigida, Simmerath, Germany.
• Eur Spine J. 2021 Dec 1; 30 (12): 3570-3576.

IntroductionAim of this study was to analyze the rate of tether breakages after lumbar vertebral body tethering (VBT) and to study the effects and possible benefits of the use of a 2-tether construct. Tether breakage is a known mechanical complication after VBT. However, the literature only refers to thoracic VBT, and no data on the breakage rate or 2-tether construct after lumbar VBT are available.Materials And MethodsPatients who underwent lumbar VBT with lowest instrumented vertebra at L3 or L4 and had a 1-year follow-up were included. Radiologic data were obtained preoperatively, at the 1st standing X-ray and at the 1-year follow-up to study breakage rate, loss of correction and lumbar lordosis in 1- and 2-tether constructs.ResultsData from 30 patients (mean age 14.7 ± 1.8) were available, 12 with double tether. Double tether did not decrease lumbar lordosis. The breakage rate was 24% in segments instrumented with a single tether and 16% in segments instrumented with a double tether (OR 1.6, p = 0.4). Lumbar loss of correction was 10° ± 6.8° in the entire cohort and 12.1° ± 5.4° in patients with a breakage (p = 0.2). Revision rate was 10%, due to tether breakage and loss of correction.ConclusionBreakage rate after lumbar VBT is high, but was improved with the use of a 2-tether construct. Despite tether breakage, loss of correction was limited and the revision rate low. The use of a double tether does not have a kyphotic effect on the lumbar spine.© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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