Outcomes of Posterior Spinal Fusion and Vertebral Body Tethering in Patients with Adolescent Idiopathic Scoliosis and Evaluation of Quality of Life

INTRODUCTION: Posterior instrumentation and fusion (PEF) is the standard surgical approach and vertebral body tethering (VBT) emerged as an alternative non-fusion technique in the treatment of idiopathic scoliosis. The aim of this study was to compare the correction and health-related life quality of the patients who have undergone PEF and VBT.
METHODS: Matched cohorts were obtained among patients whose curves ranged between 40⁰-70⁰ who had >2 years follow-up. Patients with a lumbar curve included in surgery were excluded. Patients' demographic data, perioperative and follow-up radiographic measurements, and SRS-22 scores were compared.
RESULTS: 16 PEF and 18 VBT patients (30F, 4M) were included. The mean age and follow-up were 13.4 (10-17) years and 25.7 (24–32) months. Preoperative upper thoracic, main thoracic (MT), and thoracolumbar (TL) curves were similar among groups. The surgical correction percentage in the MT curve was greater in the PEF group (84%–53%, p<0.001), while the overall correction percentage at two years was similar (80–76%, p=0.616). There was an improvement in self-image and subtotal scores at two years in PEF and VBT groups (p<0.001–p=0.037 and p<0.001–p=0.016). In the PEF group, function scores at six months and two years (p=0.027), pain and sub-total scores at two years (p=0.020, p=0.036) were found to be lower compared to VBT.
DISCUSSION AND CONCLUSION: Following PEF and VBT surgeries, a similar improvement was observed in MT and TL curves. While similar improvement is achieved in SRS22 scores, this improvement is dynamically progressed in VBT. Whether SRS22 scores are better in the VBT group should be examined in larger patient series with longer follow-up.

Adölesan Ýdiyopatik Skolyozlu Hastalarda Posterior Spinal Füzyon ve Vertebra Cisim Gerdirme Cerrahisinin Sonuçlarýnýn ve Yaþam Kalitesinin Deðerlendirilmesi

GÝRÝÞ ve AMAÇ: Adölesan idiopatik skolyoz’un (AIS) cerrahi tedavisinde standart yaklaþýmý posterior enstrümentasyon ve füzyon (PEF) oluþturur. Tedaviye alternatif, füzyonsuz cerrahi yöntem olan vertebra cisim gerdirme (VBT) ise giderek daha sýk kullanýlmaktadýr. Bu çalýþmayla, PEF ve VBT yöntemleri ile ameliyat edilmiþ AIS hastalarýnýn düzelme miktarlarý ve yaþam kalitelerinin karþýlaþtýrýlmasý amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Eþleþmiþ kohortlar, 2 yýl takipli 40⁰-70⁰ eðriliði olan AIS hastalarý incelenerek elde edildi. Lomber eðriliðin cerrahiye dahil edildiði hastalar çalýþmadan çýkartýldý. Hastalarýn demografik verileri, perioperatif ve takip radyografik ölçümleri ve hasta tarafýndan bildirilen SRS-22 skorlarý karþýlaþtýrýldý.
BULGULAR: Çalýþmaya, 16 PEF ve 18 VBT hastasý (30K, 4E) dahil edildi. Kohortun ortalama yaþý 13,4 (10-17) yýl ve takip süresi 25,7 (24–32) aydý. Gruplarýn preoperatif üst torasik, ana torasik (MT) ve torakolomber (TL) skolyoz açýlarý benzerdi. PEF grubunda MT eðrilikte cerrahi düzelme oraný daha fazla (%84–%53, p<0,001) iken, 2. yýlda toplam düzelme oranlarý gruplarda benzerdi (%80–%76, p=0,616). 2. yýlda PEF ve VBT gruplarýnda kendi imaj/görüþünde ve ara toplamda anlamlý iyileþme olduðu saptandý (p<0,001–p=0,037 ve p<0,001–p=0,016). PEF grubunda, fonksiyon/ aktivite alt baþlýðýndaki skorlar 6. ayda ve 2. yýlda (p=0,027) ve aðrý, ara-toplam skorlarý 2. yýlda, VBT grubuna göre düþüktü (p=0,020, p=0,036).
TARTIÞMA ve SONUÇ: PEF ve VBT cerrahisi takibinde MT ve TL eðriliklerde 2. yýlda benzer oranda düzelme görülmektedir. SRS22 skorlarýnda iki cerrahi ile benzer iyileþme elde edilirken, VBT’de bu iyileþme dinamik olarak seyretmektedir. Ýki grup arasýnda fonksiyon/aktivite, ara-toplam ve aðrý skorlarýnýn VBT grubunda erken dönem ve takipte füzyona kýyasla daha iyi olmasý, daha uzun takipli geniþ hasta serilerinde incelenmelidir.