Systematic Reviews
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. May 18, 2022; 13(5): 481-493
Published online May 18, 2022. doi: 10.5312/wjo.v13.i5.481
Anterior vertebral body tethering for idiopathic scoliosis in growing children: A systematic review
Davide Bizzoca, Andrea Piazzolla, Lorenzo Moretti, Giovanni Vicenti, Biagio Moretti, Giuseppe Solarino
Davide Bizzoca, Andrea Piazzolla, UOSD Spinal Deformity Centre, AOU Consorziale Policlinico di Bari, Bari 70124, Italy
Davide Bizzoca, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Bari 70124, Italy
Lorenzo Moretti, Orthopaedic and Trauma Unit, AUO Consorziale Policlinico di Bari, Bari 70124, Italy
Giovanni Vicenti, Biagio Moretti, Giuseppe Solarino, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic and Trauma Unit, University of Bari “Aldo Moro”, Bari 70124, Puglia, Italy
Author contributions: Bizzoca D and Piazzolla A performed the research and drafted the manuscript; Solarino G and Moretti B revised the work critically; Moretti L and Vicenti G made substantial contributions to data interpretation, and all the authors approved the version to be published.
Conflict-of-interest statement: The authors declared no potential conflicts of interest concerning the research, authorship, and/or publication of this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Giuseppe Solarino, MD, PhD, Associate Professor, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic and Trauma Unit, University of Bari “Aldo Moro”, Piazza Giulio Cesare, 11, Bari 70124, Puglia, Italy. giuseppe.solarino@uniba.it
Received: February 21, 2021
Peer-review started: February 21, 2021
First decision: July 28, 2021
Revised: August 1, 2021
Accepted: April 8, 2022
Article in press: April 8, 2022
Published online: May 18, 2022
ARTICLE HIGHLIGHTS
Research background

Anterior vertebral body tethering (AVBT) was originally described in 2010 by Crawford and Lenke[16], who reported the first case of an 8-year-old child, with a 40° right thoracic curve successfully managed with this growth-friendly technique. In 2019, the US Food and Drug Administration approved the first instrumentation system for AVBT, under a Humanitarian Device Exception, for skeletally immature patients with curves having a Cobb angle between 35° and 65°. However, some controversies still exist in this emerging surgical technique.

Research motivation

This systematic review was designed to summarise current evidence about the efficacy and safety of AVBT in the management of idiopathic scoliosis in skeletally immature patients.

Research objectives

The objectives of this systematic review were: (1) To assess the success of AVBT at a minimum 24-mo follow-up; (2) To identify the rate of perioperative complications, re-interventions and conversions to posterior spinal fusion (PSF), in patients who underwent AVBT; and (3) To identify the correct indications for AVBT.

Research methods

The search of electronic databases was performed to identify relevant clinical studies, dealing with AVBT, for further analysis. A total of 107 studies were identified, but only seven of these were included in the present review.

Research results

The pooled data of seven studies with 163 patients showed that AVBT was successful only in 117 patients (71.8%). Moreover, 23 patients (14.11%) required unplanned revision surgery and 18 (11%) needed conversion to PSF within the follow-up period. A postoperative complication rate of 17.8% was also observed.

Research conclusions

AVBT is a promising growth-friendly technique for the treatment of idiopathic scoliosis in growing patients. However, AVBT has a moderate success rate has perioperative complications, revision and conversion to PSF.

Research perspectives

Future studies should confirm the surgical criteria for AVBT, prove tethering long-term effectiveness and safety, focus on patient-reported outcomes measures, and propose strategies to avoid perioperative complications and long-term implant failures. A more durable, fatigue-resistant cable should be developed to prevent the high number of broken tethers observed in the published studies.