Fusionless surgery as a treatment for adolescent idiopathic scoliosis is on the rise after FDA approval in 2019 with an ultimate goal of preserving motion throughout the spine while still being able to prevent progression of scoliosis. Patients and families are interested in having the procedure, and surgeons are interested in performing the surgery. But the procedure is still in its infancy and the short- and long-term outcomes are still being evaluated. Tether breakage is a common complication of the fusionless surgery anterior vertebral body tethering, but we don't fully understand the rate at which it happens and its effect on patient outcomes. A study published in Journal of Pediatric Orthopaedics determined the incidence of tether breakage and its effect on scoliosis correction and the need for revision surgery.

Key Findings

  • Fifty percent of patients who undergo anterior vertebral body tethering are expected to experience tether breakage by three years postoperatively.
  • Patients who sustain a tether breakage experience conversion to posterior spinal fusion more often than those who do not.
  • Patients who sustain a tether breakage have overall less correction of their scoliosis long-term. 

With such a high incidence of tether breakage in anterior vertebral body tethering, the researchers recommend that surgeons should discuss this with patients preoperatively and use standardized measurements and calculations to identify tether breakage postoperatively. For future studies, the researchers hope to expand upon their work by examining a larger set of curve patterns and further elucidate which patients are more at risk for tether breakage in the hopes of modifying factors to decrease the rate of tether breakage in the future, said Brett Lullo, MD, an attending physician in the Division of Orthopaedic Surgery and Sports Medicine at Ann & Robert H. Lurie Children’s Hospital of Chicago and an instructor of orthopaedic surgery at Northwestern University Feinberg School of Medicine. 

Pediatric research at Ann & Robert H. Lurie Children’s is conducted through Stanley Manne Children’s Research Institute. 

Article Citation
Cahill PJ, Miyanji F, Lullo BR, et al. Incidence of Tether Breakage in Anterior Vertebral Body Tethering. Journal of Pediatric Orthopaedics. 2024. 44(4):p e323–e328. DOI: 10.1097/BPO.0000000000002619