Abstract

<h3>BACKGROUND CONTEXT</h3> Fusionless surgery for the treatment of skeletally immature patients with idiopathic scoliosis has the theoretical benefit of preserved motion. Thoracic anterior lumbar posterior tethering (TALPT) is one option for fusionless surgery. However, little is known about how TALPT compares to PSF with respect to return to activity and sport. <h3>PURPOSE</h3> The purpose of this study is to compare patient-reported physical activity between TALPT and posterior spinal fusion (PSF) with minimum two-year followup. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort study. <h3>PATIENT SAMPLE</h3> Consecutive skeletally immature patients with idiopathic scoliosis and a thoracic and lumbar curve magnitude 40 degrees who underwent either TALPT or PSF were included. <h3>OUTCOME MEASURES</h3> The primary outcome was rate of returning to sport. Secondary outcomes included ability to bend and satisfaction with sport performance as well as weeks until return to sport, school, physical education (PE) classes and running. <h3>METHODS</h3> In this retrospective cohort study, consecutive skeletally immature patients with idiopathic scoliosis and a thoracic and lumbar curve magnitude of 40 degrees who underwent either TALPT or PSF were included. The primary outcome was rate of returning to sport. Secondary outcomes included ability to bend and satisfaction with sport performance as well as weeks until return to sport, school, physical education (PE) classes and running. <h3>RESULTS</h3> Of 41 patients with at least two-year follow-up, 6 underwent TALPT. TALPT patients reported significantly higher rate of return to sport (100% vs. 65.7%, p=0.01) and faster return to sport (18.9 weeks vs. 35.1 weeks, p < 0.01) compared to PSF patients. TALPT patients also reported improved ability to bend ("Minimal" or "No Change" 100% vs 60%, p < 0.01) as well as faster return to PE (15.2 weeks vs. 34.2 weeks, p < 0.01), and running (20.0 weeks vs. 41.6 weeks, p < 0.01) compared to PSF patients. However, TALPT patients were less satisfied with the cosmetic effect of their surgery ("Satisfied with cosmetic effect) 16.7% vs. 88.6%, p < 0.01) compared to PSF patients. <h3>CONCLUSIONS</h3> While TALPT patients were less satisfied than their PSF counterparts with respect to cosmesis, they also reported both significantly higher rates of returning to sport, improved ability to bend as well as faster return time to sport, PE and running. <h3>FDA DEVICE/DRUG STATUS</h3> Thoracic anterior and lumbar posterior tether (Investigational/Not Approved).

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