Pain After Anterior Vertebral Body Tethering

Abstract

Study Design: Retrospective case series. Objective: To examine the incidence and risk factors for postoperative pain following anterior vertebral body tethering (AVBT) for adolescent idiopathic scoliosis (AIS). Summary of Background Data: Up to 78% of patients with AIS report preoperative pain; it is the greatest patient concern surrounding surgery. Pain significantly decreases following posterior spinal fusion, but pain following AVBT is poorly understood. Materials and Methods: We retrospectively reviewed 279 patients with a two-year follow-up after AVBT for AIS. We collected demographic, radiographic, and clinical data pertinent to postoperative pain at each time interval of preoperative and postoperative visits (6 wk, 6 mo, 1 y, and annually thereafter). Results: Within our cohort, 68.1% of patients reported preoperative pain. Older age (P=0.014) and greater proximal thoracic (P=0.013) and main thoracic (P=0.002) coronal curve magnitudes were associated with preoperative pain. Pain at any time point > 6 weeks postoperatively was reported in 41.6% of patients; it was associated with the female sex (P=0.032), need for revision surgery (P=0.019), and greater lateral displacement of the apical lumbar vertebrae (P=0.028). The association between preoperative and postoperative pain trended toward significance (P=0.07). At 6 months postoperatively, 91.8% had pain resolution; the same number remained pain-free at the time of last follow-up. The presence of a postoperative complication was associated with new-onset postoperative pain that resolved (P=0.009). Only 8.2% had persistent pain, although no risk factors were found to be associated with persistent pain. Conclusion: In our cohort of 279 patients with a minimum 2-year follow-up after AVBT, 68.1% reported preoperative pain. Nearly 42% reported postoperative pain at any time point, but only 8.2% had persistent pain. Postoperative pain after AVBT was associated with female sex, revision surgery, and Lenke lumbar modifier. AVBT is associated with a significant reduction in pain, and few patients report long-term postoperative pain.