{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T02:45:36Z","timestamp":1773974736655,"version":"3.50.1"},"reference-count":11,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T00:00:00Z","timestamp":1750809600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T00:00:00Z","timestamp":1750809600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Spine Deform"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Though chest tube removal at the completion of an endoscopic thoracic procedure is well accepted in the pediatric and adult general surgery literature, this practice has never been studied in pediatric patients treated with anterior vertebral tethering (AVT) for AIS. This study retrospectively analyzed pulmonary complications in a large series of AIS patients consecutively treated with chest tube removal at the completion of AVT. The rate of pulmonary complication in this series was then compared with the published rate of pulmonary complication in patients managed with chest tube retention after AVT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective review of all AIS patients treated with AVT over a twelve year period yielded 257 consecutive patients (248 primary\/9 revision) with 349 curves. Out of a total of 349 chest tubes placed intraoperatively, as a routine step of the procedure, 323 were removed at procedure completion while 26 were maintained for 2\u20135\u00a0days post-operatively as warranted. Patient charts, radiographs, and CT scans were reviewed to confirm any pulmonary complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In 257 AIS patients treated with AVT, 233 had chest tube removal at the completion of AVT with 4 (1.7%) peri-operative and 8 (3.4%) delayed pulmonary complications. Peri-operative complications included one symptomatic pneumothorax noted in the operating room that required chest tube reinsertion; one static pneumothorax that resolved without intervention; and two significant pleural effusions that resolved over time without intervention. Delayed complications included seven pleural effusions that occurred 2\u20136\u00a0weeks post-operatively and one chylothorax that occurred 1\u00a0week post-operatively. Several clinically significant pleural effusions (4\/7) required thoracentesis or chest tube drainage but subsequently resolved. The chylothorax required chest tube drainage, dietary fat restriction, and treatment with octreotide. In 24 patients, 26 chest tubes were retained for 2\u20135\u00a0days post-op for a persistent air leak with presumed parenchymal injury (14), revision with significant adhesions (6), bleeding disorder (2), or diaphragmatic repair related to renal eventration (1) or congenital diaphragmic hernia (1).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study demonstrated the relative safety of immediate chest tube removal at the completion of AVT in AIS patients. The rate of pulmonary complication in 233 patients with chest tube removal at the completion of AVT was 5.1% which compared favorably with a published rate of 10\u201311% after chest tube retention. In 24 patients with an indication for chest tube retention at the completion of AVT, chest tube retention for 2\u20135\u00a0days resulted in no pulmonary complications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s43390-025-01132-w","type":"journal-article","created":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T05:35:05Z","timestamp":1750829705000},"page":"1879-1888","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Immediate chest tube removal at the completion of anterior vertebral tethering is well-tolerated without an increased risk of pulmonary complication"],"prefix":"10.1007","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6558-0454","authenticated-orcid":false,"given":"John T.","family":"Braun","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sofia C.","family":"Federico","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cornelia","family":"Griggs","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David M.","family":"Lawlor","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel P.","family":"Croitoru","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian E.","family":"Grottkau","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,6,25]]},"reference":[{"key":"1132_CR1","doi-asserted-by":"publisher","first-page":"536","DOI":"10.1378\/chest.09-1044","volume":"137","author":"NM Rahman","year":"2010","unstructured":"Rahman NM, Maskell NA, Davies CWH, Hedley EL, Nunn AJ, Gleeson FV, Davies RJO (2010) The relationship between chest tube size and clinical outcome in pleural infection. Chest 137:536\u2013543. https:\/\/doi.org\/10.1378\/chest.09-1044","journal-title":"Chest"},{"key":"1132_CR2","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2024.107560","volume":"224","author":"BD Salguero","year":"2024","unstructured":"Salguero BD, Salman S, Agrawal A, Lo Cascio CM, Joy G, Chaddha U (2024) Evaluating the safety of intraprocedural chest tube removal during medical thoracoscopy. Respir Med 224:107560. https:\/\/doi.org\/10.1016\/j.rmed.2024.107560","journal-title":"Respir Med"},{"key":"1132_CR3","doi-asserted-by":"publisher","first-page":"794","DOI":"10.1007\/s11748-019-01094-7","volume":"67","author":"T Furuya","year":"2019","unstructured":"Furuya T, Ii T, Yanada M, Toda S (2019) Early chest tube removal after surgery for primary spontaneous pneumothorax. Gen Thorac Cardiovasc Surg 67:794\u2013799. https:\/\/doi.org\/10.1007\/s11748-019-01094-7","journal-title":"Gen Thorac Cardiovasc Surg"},{"key":"1132_CR4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1089\/lap.2008.0090","volume":"8","author":"TA Ponsky","year":"2008","unstructured":"Ponsky TA, Rothenberg SS, Tsao K, Ostlie DJ, St. Peter SD, Holcomb GW (2008) Thoracoscopy in children: is a chest tube necessary? J Laparoendosc Adv Surg Tech 8:1\u20133. https:\/\/doi.org\/10.1089\/lap.2008.0090","journal-title":"J Laparoendosc Adv Surg Tech"},{"key":"1132_CR5","doi-asserted-by":"publisher","first-page":"1355","DOI":"10.1007\/s43390-024-00897-w","volume":"12","author":"JT Braun","year":"2024","unstructured":"Braun JT, Federico SC, Lawlor DM, Paschos NJ, Croitoru DP, Grottkau BE (2024) Anterior vertebral tethering for adolescent idiopathic scoliosis: our initial ten year clinical experience. Spine Deform 12:1355\u20131367. https:\/\/doi.org\/10.1007\/s43390-024-00897-w","journal-title":"Spine Deform"},{"key":"1132_CR6","volume-title":"Fusionless scoliosis surgery","author":"JT Braun","year":"2011","unstructured":"Braun JT (2011) Fusionless scoliosis surgery. American Academy of Orthopaedic Surgeons Publications, Rosemont"},{"key":"1132_CR7","doi-asserted-by":"publisher","first-page":"e887","DOI":"10.1016\/j.eats.2020.11.003","volume":"10","author":"HJ Szapary","year":"2021","unstructured":"Szapary HJ, Greene N, Paschos NK, Grottkau BE, Braun JT (2021) A thoracoscopic technique used in anterior vertebral tethering for adolescent idiopathic scoliosis. Arthrosc Tech 10:e887\u2013e895. https:\/\/doi.org\/10.1016\/j.eats.2020.11.003","journal-title":"Arthrosc Tech"},{"key":"1132_CR8","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1093\/ejcts\/ezy301","volume":"55","author":"TJP Batchelor","year":"2019","unstructured":"Batchelor TJP, Rasburn NJ, Abdelnour-Berchtold E, Brunelli A, Cerfolio RJ, Gonzalez M, Ljungqvist O, Petersen RH, Popescu WM, Slinger PD, Naidu B (2019) Guidelines for enhanced recovery after lung surgery: recommendations of the enhanced recovery after surgery (ERAS\u00ae) Society and the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg 55:91\u2013115. https:\/\/doi.org\/10.1093\/ejcts\/ezy301","journal-title":"Eur J Cardiothorac Surg"},{"key":"1132_CR9","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1007\/s00383-024-05636-w","volume":"40","author":"GK Tinawi","year":"2024","unstructured":"Tinawi GK, Mishra P (2024) Chest drains after open paediatric lung resections: not always required. Pediatr Surg Int 40:40. https:\/\/doi.org\/10.1007\/s00383-024-05636-w","journal-title":"Pediatr Surg Int"},{"key":"1132_CR10","doi-asserted-by":"publisher","first-page":"3778","DOI":"10.3390\/jcm11133778","volume":"11","author":"P Trobisch","year":"2022","unstructured":"Trobisch P, Migliorini F, Vanspauwen T, Baroncini A (2022) Pulmonary complications after vertebral body tethering: incidence, treatment, outcomes and risk factor analysis. J Clin Med 11:3778. https:\/\/doi.org\/10.3390\/jcm11133778","journal-title":"J Clin Med"},{"key":"1132_CR11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2024.162003","volume":"60","author":"JW Sample","year":"2025","unstructured":"Sample JW, Curran BF, Milbrandt TA, Larson AN, Potter DD (2025) Perioperative outcomes related to thoracic and lumbar spine exposure during vertebral body tethering for adolescent idiopathic scoliosis: a large single-institution retrospective review. J Pediatr Surg 60:162003. https:\/\/doi.org\/10.1016\/j.jpedsurg.2024.162003","journal-title":"J Pediatr Surg"}],"container-title":["Spine Deformity"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s43390-025-01132-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s43390-025-01132-w\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s43390-025-01132-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T17:52:02Z","timestamp":1763661122000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s43390-025-01132-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,25]]},"references-count":11,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,11]]}},"alternative-id":["1132"],"URL":"https:\/\/doi.org\/10.1007\/s43390-025-01132-w","relation":{},"ISSN":["2212-134X","2212-1358"],"issn-type":[{"value":"2212-134X","type":"print"},{"value":"2212-1358","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,25]]},"assertion":[{"value":"10 February 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 June 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 June 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Though the lead author (Braun) has several disclosures, there is no conflict of interest. The lead author is a consultant for ZimVie on the current FDA approved tether system (The Tether System) and receives royalties from Zimmer on a pedicle screw-based fusion system (Vitality), but neither is the subject of this paper as this study includes only patients treated off-label with the Dynesys System. The lead author is also an FDA consultant for non-fusion devices. None of the other authors have any relevant disclosures.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"See above.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"See above.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent"}},{"value":"This research study was conducted retrospectively from data obtained for clinical purposes. We consulted extensively with the IRBs of both Dartmouth-Hitchcock Medical Center\/Giesel Medical School at Dartmouth (#00029300) and Massachusetts General Hospital\/Harvard Medical School (#2020P001760) who determined that this study did not require patient consent and could proceed under the standard ethical guidelines of both Dartmouth and Harvard.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate and compliance with ethical standards"}}]}}