Anterior vertebral body tethering for idiopathic scoliosis in growing children: A systematic review

Table 2 Perioperative complications, number of tether revisions and conversion to posterior spinal fusion and instrumentation of anterior vertebral body tethering procedures in the included studies

Ref.	Patients (n)	Perioperative complications		Tether revision			Conversion to PSF
		Type of complication	n of cases (%)	Causes	n of cases (%)	n of revisions (%)	Causes	n of cases (%)
Miyanji et al[14], 2020	57	Pulmonary. Atelectasis. Pneumonia. Superficial wound infection. Hip and shoulder pain. Numbness in the arm and breast	3 (5.26). 1 (1.75). 1 (1.75). 1 (1.75). 1 (1.75)	Overcorrection (loosening tether). Tether breakage (replaced). Adding on (extension of tether)	1 (1.75). 1 (1.75). 1 (1.75)	1 (1.75). 1 (1.75). 1 (1.75)	Insufficient correction of tethered curve and progression of the deformity. Adding on	5 (8.77). 1 (1.75)
Baker et al[17], 2020	17	N/A	N/A	Broken tether. Other complications	9 (52.94). 3 (17.7)	1 (5.88). 3 (17.7)	Overcorrection. Progression of the untethered thoracic curve in a patient with lumbar AVBT	1 (5.88). 1 (5.88)
Hoernschemeyer et al[20], 2020	29	Recurrent pneumothorax. Syncopal episodes (decompression of a Chiari 1 malformation, diagnosed after AVBT)	1 (3.45). 1 (3.45)	Broken tether. Overcorrection. Adding on	14 (48.275). 2 (6.9). 1 (3.45)	3 (10.3): 1 revisio. 2 PSF. 2 (6.9). 1 (3.45)	Progression of the tethered curve after broken tether	2 (6.9)
Pehlivanoglu et al[21], 2020	21	Chylothorax (conservatively managed)	1 (4.76)	Broken tether	1 (4.76)	1 (4.76)	-	-
Newton et al[22], 2020	23	Atelectasis with pulmonary oedema (treated with positive airway pressure that resolved by postoperative day 6). Pain radiating down the leg (3 yr postop resolved with physical therapy). Horner syndrome (withasymmetric pupils remaining)	1 (4.35). 1 (4.35). 1 (4.35)	Broken tether (revision for curve progression). Overcorrection (tether removal, tether replaced with less tension). Progression of the untethered curve. Second revision (broken tether with progression, progression)	12. 3. 2. 2	2 (8.7). 2 (8.7). 1 (4.35). 2 (8.7). 1 (4.35). 1 (4.35)	Curve progression (converted to PSF, indication to PSF, but not yet undergone)	3 (13). 3 (13)
Wong et al[23], 2019	5	Fever. Postop. Nausea. Postop. Vomiting. Postop. Haematuria. Reactive airways. Right pneumothorax. Left/dependent lung pleural effusion. Pneumonia. Conjunctivitis. Trunk listing	5 (100). 1 (20). 1 (20). 1 (20). 1 (20). 2 (40). 1 (20). 1 (20). 1 (20). 1 (20)	-	-	-	Overcorrection. Curve progression/distal decompensation	1 (20). 1 (20)
Samdani et al[24], 2014	11	Persistent atelectasis (bronchoscopy)	1 (9.1)	Overcorrection	2 (18.2)	2 (18.2)	-	-

AVBT: Anterior vertebral body tethering; PSF: Posterior spinal fusion.