Posterior spinal fusion versus vertebral body tethering for paediatric scoliosis: a meta-analysis of comparative studies

Purpose Posterior spinal fusion (PSF) is currently the gold standard technique for surgical correction of scoliosis however, there is a growing interest in non-fusion techniques like vertebral body tethering (VBT). The aim of this study is to compare surgical outcomes between PSF and VBT. Methods This systematic review was performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines with a search of the following databases to identify all comparative studies: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL). Results A total of 11 comparative studies with 1112 patients were included. PSF offered significantly greater percentage coronal curve correction postoperatively (P = 0.0001) and at 2 years (P < 0.00001). Time to revision (P = 0.03), number of instrumented levels (P < 0.0001), estimated blood loss (EBL) (P = 0.001), operation duration (OD) (P < 0.00001) and postoperative shoulder height difference (P < 0.00001) were significantly greater in the PSF group. Odds of unplanned surgical revisions were lower in the PSF group (P < 0.0001). Secondary outcome data showed that VBT patients had significantly lower preoperative cobb angles (P < 0.00001), a younger age at surgery (P = 0.002), less postoperative pain (P = 0.002) and lower opioid consumption (P = 0.02). VBT tether breakage events were reported at rates of 13-23%. VBT also offered faster return to sports and greater lumbar flexibility. No significant difference was seen in length of hospital stay (P < 0.05). Conclusion PSF and VBT are viable treatment options with different pros and cons. Choice of treatment should consider individual patient characteristics and daily requirements.