Reducing Uncertainty in Anterior Vertebral Body Tethering: Predicting Postoperative Curvature With Fulcrum Bending Radiographs

Zacharia Matthew Silk, Jared C. Tishelman, Lily Eaker, Baron Lonner

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Study Design: Retrospective Cohort Study Objectives: Mid-term Anterior Vertebral Body Tethering (AVBT) results demonstrate an acceptable degree of clinical success, yet the revision rate remains notably higher than fusion. Fulcrum-bending radiographs have previously been shown to more reliably predict radiological outcomes in Adolescent Idiopathic Scoliosis (AIS) as compared to supine-lateral bending radiographs. This study aims to discern how Fulcrum Flexibility Rate (FFR) correlates with Correction Rate (CR) and establish whether this can reliably predict residual deformity following AVBT surgery. Methods: A review of 38 consecutive AIS patients undergoing thoracic AVBT between 2015 – 2020 was performed. Preoperative (standing and fulcrum-bending) and postoperative (first-erect) radiographs were evaluated for curve magnitude using the Cobb-method. The FFR, CR and Fulcrum Bending Correction Index (FBCI) were calculated. Patients were also percentile-ranked according to their FFR and dichotomized into flexible and rigid cohorts for comparison. Student t-test, Pearson correlation and linear stepwise regression was applied. Results: AVBT resulted in a significant improvement in the major Cobb angle (Preoperative: 50.9±7.5° vs Postoperative: 19.9±9.4°; P <.0001) with a mean FBCI of 98.0%. Bivariate correlation revealed a moderate relationship between fulcrum-bending and first-erect Cobb angle (r =.5306, P =.0006). Linear regression demonstrated a predictive relationship between fulcrum-bending and first-erect Cobb using the equation ‘Postoperative Cobb = 7.5 +.65(Fulcrum-bending Cobb).’ Conclusion: This is the first study to demonstrate the ability of fulcrum-bending radiographs to predict early radiographic outcomes following AVBT, ‘timepoint-zero’ for the growth modulation process.

Original languageEnglish
Pages (from-to)219-224
Number of pages6
JournalGlobal Spine Journal
Issue number1
StatePublished - Jan 2024


  • Fulcrum bending radiographs
  • anterior vertebral body tethering
  • fulcrum bending correction index
  • fulcrum flexibility rate


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