Double major curvature treated with vertebral body tethering of both curves: how do outcomes compare to posterior spinal fusion?

Baron Lonner, Lily Eaker, Daniel Hoernschemeyer, Jessica Zhang, Ashley Wilczek, Patrick Elliot, Melanie E. Boeyer, Nicholas D. Fletcher, Ahmet Alanay, Caglar Yilgor, Peter Newton, Firoz Miyanji

Research output: Contribution to journalArticlepeer-review


Purpose: Vertebral body tethering (VBT) is a non-fusion alternative to posterior spinal fusion (PSF). There have been few reports on VBT of two curvatures. We aim to compare the radiographic outcomes between VBT and PSF in patients with double curvatures in which both curves were instrumented. Methods: 29 AIS patients matched by Lenke, age (± 2 years), triradiate cartilage closure status, major Cobb angle (± 8°), and T5–T12 kyphosis (± 10°). Variables were compared using Wilcoxon rank-sum tests, Student’s t tests, and chi-Square. Clinical success was defined as major curve < 35°. Results: Group baseline demographics were similar. Major thoracic (T) curve types had significantly better major (VBT 51.5 ± 7.9° to 31.6 ± 12.0° [40%] vs. PSF 54.3 ± 7.4° to 17.4 ± 6.5° [68%]; p = 0.0002) and secondary curve correction in the PSF group. 71% of major T VBT patients were clinically successful versus 100% of PSF. Major thoracolumbar (TL) curve types experienced comparable major (VBT 52.3 ± 7.0° to 18.3 ± 11.4° (65%) vs. PSF 53.0 ± 5.2° to 23.8 ± 10.9° (56%); p = 0.2397) and secondary curve correction. 92% of major TL VBT patients were clinically successful versus 75% in the PSF group. There was no difference in T5–12 kyphosis or lumbar lordosis between groups for any curve type. There were 4 patients (13.8%) with major complications in the VBT group compared to 0 (0%) in the PSF. Conclusion: Patients with double major AIS who underwent VBT with major T curve types had less correction than PSF; however, those with major TL curves experienced similar radiographic outcomes regardless of procedure. Complications were greater for VBT.

Original languageEnglish
Pages (from-to)651-662
Number of pages12
JournalSpine Deformity
Issue number3
StatePublished - May 2024


  • Adolescent idiopathic scoliosis
  • Double curve
  • Posterior spinal fusion
  • Vertebral body tethering


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