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. 2025 Mar 15;50(6):E110-E117.
doi: 10.1097/BRS.0000000000005261. Epub 2025 Jan 20.

Analysis of the Biomechanical Effects of Vertebral Body Tethering With Apical Fusion

Jil Frank  1   2 , Per David Trobisch  3 , Miguel Pishnamaz  1 , Frank Hildebrand  1 , Maximilian Praster  2
Affiliations

Analysis of the Biomechanical Effects of Vertebral Body Tethering With Apical Fusion

Jil Frank et al. Spine (Phila Pa 1976). .

Abstract

Study design: Biomechanical study by using a multibody simulation approach.

Objective: Objectification of spinal biomechanics after vertebral body tethering with and without apical fusion.

Summary of background data: Vertebral body tethering, a motion-preserving surgical technique for correction of adolescent idiopathic scoliosis, is increasingly being used for thoracolumbar curves. However, tether breakage remains a common problem with breakage rates up to 60% for TL curves. Therefore, surgeons have begun to adapt their surgical technique by fusing the apex. The short-term clinical studies show a significant reduction of the tether breakage rate to 10%, but little is known about the biomechanical reasons. Therefore, this study analyzes the intervertebral compression and tether force in a tethered spine without apical fusion and in a tethered spine with apical fusion between L1/2.

Methods: A multibody simulation approach was chosen to analyze the biomechanical effects of two surgical techniques during different physiological movements. The tether and intervertebral compression forces in the different instrumented segments are once analyzed for a T10 to L3 tethered spine and once for a T10 to L3 tethered with additional L1/2 fusion using an intervertebral cage.

Results: VBT with apical fusion reduces the prevailing tether forces not only at the fused level by nearly 861 N but also at the adjacent spinal segments by around 100 N. However, a significant increase in intervertebral compression force of ~706 N can be observed, especially at the adjacent spinal segments.

Conclusion: L1/2 fusion in a tethered spine reduces tether forces in adjacent segments and thus might decrease the rate of tether breakage. However, fusion results in increased intervertebral compression forces by up to 31% compared with an unfused spine. Long-term clinical studies are needed to further analyze and evaluate the biomechanical consequences.

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Conflict of interest statement

The authors report no conflicts of interest.

References

    1. Trobisch PD, Baroncini A. Preliminary outcomes after vertebral body tethering (VBT) for lumbar curves and subanalysis of a 1- versus 2-tether construct. Eur Spine J. 2021;30:3570–3576.
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    1. Nicolini LF, Oliveira RC, Ribeiro M, et al. Tether pre-tension within vertebral body tethering reduces motion of the spine and influences coupled motion: a finite element analysis. Comput Biol Med. 2023;169:107851.
    1. Trobisch PD, Kim H-J, Da Paz S, Alkharsawi M, Castelein R, Chang DG. Early-term outcome of apical fusion with vertebral body tethering for thoracolumbar curves in adolescent idiopathic scoliosis: a preliminary study. Eur Spine J. 2024;33:2530–2535.

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