• Eur Spine J · Feb 2023

    Operative differences for posterior spinal fusion after vertebral body tethering: Are we fusing more levels in the end?

    • Melanie E Boeyer, Andrew Groneck, Ahmet Alanay, Kevin M Neal, A Noelle Larson, Stefan Parent, Peter Newton, Firoz Miyanji, Lawrence Haber, Harms Study Group, and Daniel G Hoernschemeyer.
    • Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA.
    • Eur Spine J. 2023 Feb 1; 32 (2): 625633625-633.

    PurposeLittle is known about the perioperative characteristics associated with a posterior spinal fusion (PSF) in adolescent idiopathic scoliosis patients previously treated with vertebral body tethering (VBT). We aimed to determine if operative time, estimated blood loss, postoperative length of stay, instrumentation type, and implant density differed in patients that received a PSF (i.e., PSF-Only) or a PSF following a failed VBT (i.e., PSF-VBT).MethodsWe retrospectively assessed matched cohort data (PSF-VBT = 22; PSF-Only = 22) from two multi-center registries. We obtained: (1) operative time, (2) estimated blood loss, (3) postoperative length of stay, (4) instrumentation type, and (5) implant density. Theoretical fusion levels prior to the index procedure were obtained for PSF-VBT and compared to the actual levels fused.ResultsWe observed no difference in operative time, estimated blood loss, or postoperative length of stay. Instrumentation type was all-screw in PSF-Only and varied in PSF-VBT with nearly 25% of patients exhibiting a hybrid construct. There was no added benefit to removing anterior instrumentation prior to fusion; however, implant density was higher in PSF-Only (1.9 ± 0.2) than when compared to PSF-VBT (1.7 ± 0.3). An additional two levels were fused in 50% of PSF-VBT patients, most of which were added to the distal end of the construct.ConclusionsWe found that operative time, estimated blood loss, and postoperative length of stay were similar in both cohorts; however, the length of the fusion construct in PSF-VBT is likely to be two levels longer when a failed VBT is converted to a PSF.© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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