Evaluating Surgical Strategies for Adolescent Idiopathic Scoliosis: A Meta-Analysis of Posterior Spinal Fusion and Vertebral Body Tethering

Purpose Adolescent Idiopathic Scoliosis (AIS) is a complex three-dimensional spinal deformity affecting adolescents worldwide, often necessitating surgical correction in progressive or severe cases. Posterior Spinal Fusion (PSF) has long been the gold standard, providing reliable curve correction at the cost of spinal mobility. In contrast, Vertebral Body Tethering (VBT) is a motion-preserving technique aimed at growth modulation, appealing particularly to skeletally immature patients. However, concerns about revision rates and long-term outcomes remain. This meta-analysis aims to compare PSF and VBT in terms of curve correction, complication and revision rates, functional outcomes, and patient satisfaction, offering evidence-based insights into the optimal surgical approach for AIS. Methods A systematic review and meta-analysis were conducted following PRISMA 2020 and QUORUM guidelines. Eight studies met the inclusion criteria, encompassing randomized controlled trials, cohort studies, and retrospective analyses with a minimum of two years' follow-up. A comprehensive database search included PubMed, Scopus, Cochrane Library, and Google Scholar. Outcomes analyzed included degree of spinal curve correction, postoperative complications, revision surgeries, and patient-centered measures such as functional outcomes and SRS-22 scores. Continuous variables were analyzed using Welch’s t-tests and Wilcoxon rank-sum tests. Heterogeneity was assessed using the I² statistic, and publication bias was evaluated through funnel plots and Egger’s test. Results Across all studies, PSF showed significantly superior mean curve correction (79°) compared to VBT (51°; p = 0.0117). Revision and complication rates were also lower in the PSF group (17%) relative to VBT (27.8%). While VBT preserved spinal motion and offered improved postoperative functional recovery and flexibility, it demonstrated higher variability in outcomes and a greater risk of tether breakage and overcorrection. SRS-22 scores reflected these trends: VBT patients reported higher functional mobility and earlier return to activity, whereas PSF patients had higher and more consistent satisfaction levels. Statistical analyses confirmed significant differences in revision (p = 0.0211), complications (p = 0.0225), and patient satisfaction (p = 0.0188). No significant heterogeneity was detected (I² = 0%), enhancing the reliability of pooled outcomes. Conclusion PSF remains the more robust and consistent surgical intervention for AIS, providing superior radiographic correction and fewer postoperative complications. However, the motion-sparing benefits of VBT make it a compelling alternative for skeletally immature patients prioritizing mobility and growth preservation. While PSF ensures structural stability, VBT offers functional advantages at the cost of increased revision risk. Surgical decision-making should therefore be individualized, balancing curve severity, patient age, skeletal maturity, and long-term functional goals. Continued research is warranted to refine patient selection and improve long-term VBT outcomes.