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Review
. 2025 Aug 22;17(8):e90739.
doi: 10.7759/cureus.90739. eCollection 2025 Aug.

Evaluating Surgical Strategies for Adolescent Idiopathic Scoliosis: A Meta-Analysis of Posterior Spinal Fusion and Vertebral Body Tethering

Daniel E Onobun  1 , Rahim Hussain  2 , Gerald Lim  1 , Ethel O Ojo  1 , Chijioke Orji  3 , Althea O George  4 , Ajibola A Adebisi  5
Affiliations
Review

Evaluating Surgical Strategies for Adolescent Idiopathic Scoliosis: A Meta-Analysis of Posterior Spinal Fusion and Vertebral Body Tethering

Daniel E Onobun et al. Cureus. .

Abstract

Adolescent idiopathic scoliosis (AIS) is a three-dimensional spinal deformity commonly affecting adolescents worldwide. Surgical management traditionally involves posterior spinal fusion (PSF), which achieves stable deformity correction but may limit spinal motion and growth potential. Vertebral body tethering (VBT) has emerged as a motion-preserving alternative aimed at modulating spinal growth while correcting curvature. This systematic review and meta-analysis compared PSF and VBT in terms of deformity correction, complication and revision rates, and postoperative functional outcomes. Data from multiple clinical studies were analyzed using standardized methods for pooling and evaluating outcomes. Results indicated that PSF generally provides more consistent and reliable curve correction with fewer complications and revisions, while VBT offers advantages in preserving motion and facilitating earlier postoperative recovery. However, VBT demonstrated greater variability in results and a higher likelihood of requiring additional interventions. These findings highlight the need for individualized treatment planning that considers curve severity, skeletal maturity, and long-term functional goals. PSF remains a robust corrective option, whereas VBT represents a promising motion-sparing approach for carefully selected patients. Further research is warranted to refine patient selection criteria and optimize long-term outcomes of non-fusion techniques.

Keywords: adolescent idiopathic scoliosis; motion preservation surgery; posterior spinal fusion; spinal deformity correction; surgical outcomes; vertebral body tethering.

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Conflict of interest statement

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. A PRISMA flowchart outlining the study selection process
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Figure 2
Figure 2. Distribution of preoperative curve for PSF and VBT
IPSF: instrumented posterior spinal fusion; PSF: posterior spinal fusion; VBT: vertebral body tethering
Figure 3
Figure 3. Distribution of curve correction for PSF and VBT
IPSF: instrumented posterior spinal fusion; PSF: posterior spinal fusion; VBT: vertebral body tethering
Figure 4
Figure 4. Funnel plot for correction (assessment of publication bias)
Figure 5
Figure 5. Funnel plot with regression line (bias symmetry analysis)
Figure 6
Figure 6. Forest plot of correction outcomes across studies
Figure 7
Figure 7. Boxplot comparison of curve correction between PSF and VBT
IPSF: instrumented posterior spinal fusion; PSF: posterior spinal fusion; VBT: vertebral body tethering
Figure 8
Figure 8. Revision rates comparison between PSF and VBT
PSF: posterior spinal fusion; VBT: vertebral body tethering
Figure 9
Figure 9. Complication rates comparison between PSF and VBT
PSF: posterior spinal fusion; VBT: vertebral body tethering
Figure 10
Figure 10. Comparison of functional outcomes between PSF and VBT
PSF: posterior spinal fusion; VBT: vertebral body tethering
Figure 11
Figure 11. Comparison of SRS-22 patient satisfaction scores between PSF and VBT
SRS-22: Scoliosis Research Society-22; PSF: posterior spinal fusion; VBT: vertebral body tethering
See this image and copyright information in PMC

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