Abstract
BACKGROUND: Although posterior spinal fusion (PSF) is considered the gold standard for the treatment of idiopathic scoliosis, it has been associated with several limitations. Vertebral body tethering (VBT) offers a motion-preserving alternative, with growing evidence supporting its clinical efficacy. METHODS: A comprehensive search of PubMed, Cochrane, Web of Science and Scopus databases was performed to identify comparative studies between VBT and PSF in patients with idiopathic scoliosis. Primary outcomes included major curve correction and postoperative major and minor curve angles. Secondary outcomes included radiographic parameters (shoulder height difference, spinal height gain, coronal balance, thoracic kyphosis, lumbar lordosis), perioperative metrics [length of stay (LOS), estimated blood loss (EBL), operative time, instrumented levels], patient-reported outcomes [Scoliosis Research Society-22 Questionnaire (SRS-22)], complication and revision rates. RESULTS: Seventeen studies met the inclusion criteria. VBT patients required shorter instrumentations (p < 0.00001). PSF achieved lower postoperative major (p < 0.00001) and minor curve angles (p = 0.00001), better coronal balance (p = 0.005) and superior major curve correction from baseline (p < 0.00001), but with questionable clinical significance. VBT demonstrated greater lumbar flexion capacity (p < 0.00001), superior shoulder balance (p < 0.00001) and better outcomes in SRS-22 pain (p = 0.02), satisfaction (p = 0.03) and function (p = 0.02) at two-year follow-up. VBT also had shorter operation times (p = 0.0007), less blood loss (p < 0.00001), but higher complication (p = 0.0002) and revision rates (p < 0.00001). No difference detected in lumbar lordosis (p = 0.08), thoracic kyphosis (p = 0.15), SRS-22 self-image (p = 0.20) and total (p = 0.12), lumbar side bending (p = 0.81), axial rotation (p = 0.43) and hospital stay (p = 0.7). CONCLUSIONS: PSF demonstrates superior coronal spinal alignment, along with lower complication and revision rates. In contrast, VBT offers better preservation of spinal motion, improved shoulder balance, enhanced early quality of life, and reduced blood loss and operative time, while requiring shorter instrumentations. Treatment decisions should be individualized, taking into account patient-specific factors. Long-term outcome data are needed to guide clinical practice.