Abstract
Anterior Scoliosis Correction (ASC) with anterior longitudinal ligament and annular disc complex (intervertebral) de-tethering releases is the authors’ multi-year advancement of their original mini-open vertebral body tethering technique to include a dual screw-line construct and multi-level intervertebral de-tethering releases. The study included patients diagnosed with early onset scoliosis, aged 5-10 years of age, Sanders stage 2 or less, Risser sign of 0, open triradiate cartilages, and a minimum of 2 years of follow-up. Within a database encompassing 840 patients treated by ASC, 15 patients (17 curves) met the inclusion criteria. The average duration of follow-up for this cohort was 48.3 months (range 25 to 86 months). The mean age at the time of surgery was 8 years (range 5.7 to 10.1 years). Preoperative scoliosis curves averaged 81° (range 58° to 100°). At the most recent follow-up, the instrumented curves improved to an average of 22° (range -15° to 68°) and mean correction of 75%. Preoperative 3-D kyphosis, calculated as an average of -6° (range -23° to +20°), was improved to an average of + 28° (range ‑1° to +59°) at latest follow-up. As may be anticipated with early onset scoliosis, 11 of the 15 patients underwent a secondary surgical procedure an average of 43 months following the index procedure. Of these 11, lengthening was necessary for overcorrection in 3 patients (20%), revision or subsequent stage ASC was done for additional correction adjustment in 6 patients (40%), and spinal fusion was performed in 2 patients (13%). In conclusion, a cohort of 15 patients aged 5-10 years with early onset scoliosis treated by ASC with intervertebral de-tethering releases (initial average curve of 81°) demonstrated a substantial mean correction of 75% in the instrumented curve. Although 2/15 patients (13%) subsequently underwent posterior spinal fusion, these early outcomes suggest a potential alternative to traditional posterior growing rod system approaches and posterior spinal fusion for these young patients.