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

Abstract

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