{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T20:56:52Z","timestamp":1790629012202,"version":"4.1.0"},"reference-count":48,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"Li Shu Fan Medical Foundation Professorship in Orthopaedic Surgery"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Vertebral body tethering (VBT) offers fusionless correction for idiopathic scoliosis, yet midterm growth modulation remains poorly characterized. This study established a clinically relevant success criterion and characterized growth modulation kinetics with associated predictors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This multicenter prospective study enrolled patients with idiopathic scoliosis with Sanders stage \u22647A, preoperative fulcrum-bending flexibility rate \u226550%, and \u22652-year follow-up after VBT. Parameters were collected before surgery and at 7 postoperative time points. Two-year success was defined as Cobb angle &lt;35\u00b0 (group 1) and correction rate (CR) \u226550% without overcorrection (Group 2). Group 3 included cases with an instrumented Cobb angle &lt;35\u00b0 but CR &lt;50%. Curves were further classified as undercorrection (CR &lt;50%), overcorrection (negative curve), and short-term clinical success (same as group 2) at 2 years postoperatively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Thirty-eight patients (50 curves, mean age 11.9 \u00b1 1.17 years; 89.5% female) were analyzed. Coronal CR was 63.2% at 24 months. T2-12 kyphosis (p = 0.637), thoracolumbar kyphosis (p = 0.104), lumbar lordosis (p = 0.869), and sacral slope (p = 0.091) remained unchanged. While pelvic obliquity improved at 12 months (2.1\u00b0 vs. 1.6\u00b0, p = 0.001) and trended toward recurrence at 24 months (2.1\u00b0 vs. 1.8\u00b0, p = 0.142), the difference was below the minimally clinically important difference. Apical (11.3\u00b0 vs. 6.8\u00b0) and upper end vertebral (8.5\u00b0 vs. 2.8\u00b0) rotation improved significantly, while lower end vertebral rotation remained unchanged. Although no significant differences were found between group 1 (n = 39) and group 2 (n = 25) in CR and postoperative revisions, among curves under group 1 but not group 2 (group 3, n = 14), a significantly higher revision rate was observed compared with group 2 (28.6% vs. 4.0%, p = 0.047). Eighty-four percent of successful operations under the new criterion remained successful at the 3.4-year follow-up. The change in correction (\u0394correction) diverged at 3 to 6 months postoperatively. Overcorrection was associated with greater flexibility, a younger Risser sign, lower body mass index (14.5 \u00b1 0.86 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ), and higher immediate CR (84.9%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>VBT effectively corrects coronal and axial deformity. A short-term success criterion based on a Cobb angle CR \u2265 50% without overcorrection better reflects a favorable biological response than the &lt;35\u00b0 benchmark at 2 years. Skeletally immature, lean patients with high flexibility and continued correction beyond 6 months may signal overcorrection risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Prognostic\n                      <jats:underline>Level II<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.oa.26.00198","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T18:00:50Z","timestamp":1787076050000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Redefining Success and Characterizing Midterm Growth Modulation: Analysis of Radiographic Outcomes in 2 Years Following Vertebral Body Tethering"],"prefix":"10.2106","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9409-5711","authenticated-orcid":false,"given":"Qiuya","family":"Li","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6416-4607","authenticated-orcid":false,"given":"Lijuan","family":"Ren","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3213-7373","authenticated-orcid":false,"given":"Prudence Wing Hang","family":"Cheung","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7052-0875","authenticated-orcid":false,"given":"Jason Pui Yin","family":"Cheung","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,7]]},"reference":[{"key":"R1-20260928","doi-asserted-by":"crossref","first-page":"e737","DOI":"10.1016\/j.wneu.2019.06.207","article-title":"Idiopathic scoliosis in children and adolescents: emerging techniques in surgical treatment","volume":"130","author":"Cheung","year":"2019","journal-title":"World Neurosurg"},{"issue":"9","key":"R2-20260928","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1056\/NEJMcp1209063","article-title":"Clinical practice. 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