Does preoperative and intraoperative imaging for anterior vertebral body tethering predict postoperative correction?



Anterior vertebral body tethering (AVBT) is an emerging approach for idiopathic scoliosis. However, overcorrection and under-correction are common causes of revision surgery, and intraoperative tensioning of the cord is one key component to achieve appropriate curve correction. We sought to determine whether preoperative flexibility radiographs or intraoperative radiographs would predict correction at first erect imaging for scoliosis patients undergoing anterior vertebral body tethering (AVBT).


Single-center retrospective review. Fifty-one patients with a diagnosis of idiopathic scoliosis underwent anterior body tethering. Preoperative flexibility films and intraoperative radiographs were compared to first erect standing radiographs to determine if there was a correlation in Cobb angle.


Preoperative major Cobb angle measured 52° ± 9°. Major Cobb angle on bending films was 24° ± 8°. Intraoperative imaging showed correction to a mean of 17° ± 8°. Postoperative first erect standing radiographs showed correction to a mean of 26° ± 10°. The mean difference in major Cobb angle between intraoperative radiograph and a first erect radiograph was 10° ± 4°, whereas the mean difference from preoperative bending radiograph at first erect was 2° ± 7°. Thus, correction on preoperative flexibility films correlated with the first erect radiograph.


Preoperative bending radiographs provide a reasonable estimate of postoperative correction for patients undergoing AVBT with tensioning of the cord. Surgeons should expect the major Cobb angle to increase on first erect radiographs compared to intraoperative radiographs. These findings may guide patient selection and assist surgeons in achieving appropriate correction intraoperatively.

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Funding for this study was obtained from Orthopedic Research and Education Foundation, Pediatric Orthopedic Society of North America, and Mayo CCaTS-CBD Pilot Award for Team Science.

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SEM, TAM, AFB, DDP, ANL: Substantial contributions to the conception or design of the work, or the acquisition, analysis, or interpretation of data. SEM, TAM, AFB, DDP, ANL: Drafting the work or critically revising it for important intellectual content. SEM, TAM, AFB, DDP, ANL: Final Approval of the version to be published. SEM, TAM, AFB, DDP, ANL: Responsible for content and accuracy of the entire manuscript. SEM, TAM, AFB, DDP, ANL: The order and inclusion should be decided by consensus among the authors and acknowledged in writing.

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Correspondence to A. Noelle Larson.

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Conflict of interest

Outside of the study, Dr. Milbrandt reports consulting activities with Orthopediatrics, Medtronic, Zimmer and stock ownership in Viking Scientific. Dr. Larson reports consulting activities with Orthopediatrics, Medtronic, Zimmer, and Globus. Drs. Mathew, Potter, and Buyuk have no conflicts to report.

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IRB approval was obtained for all aspects of this study.

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Buyuk, A.F., Milbrandt, T., Mathew, S. et al. Does preoperative and intraoperative imaging for anterior vertebral body tethering predict postoperative correction?. Spine Deform (2021).

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  • Spinal growth modulation
  • Flexibility
  • Curve correction
  • Scoliosis
  • Vertebral body tethering
  • Anterior spinal instrumentation