Reoperation and fusion after documented tether breakage following vertebral body tethering: a systematic review and meta-analysis.

PURPOSE: Radiographic tether breakage after vertebral body tethering (VBT) is common, but its clinical consequence remains uncertain. After a break is detected, the relevant question is not breakage incidence but the conditional probability of further surgery. We quantified patient-level reoperation and fusion-containing surgery after documented breakage. METHODS: PubMed/MEDLINE, Scopus, and Web of Science Core Collection were searched from inception through June 30, 2026. Two reviewers independently screened English-language full-text reports, extracted linked post-breakage outcomes, and adjudicated cohort overlap. The primary outcome was any unplanned reoperation after documented breakage; the principal secondary outcome was fusion-containing surgery. One representative cohort per overlap cluster was selected. Proportions were synthesized using a binomial normal generalized linear mixed model. RESULTS: Five independent cohorts contributed 230 break-positive patients; 41 underwent unplanned reoperation (pooled proportion, 15.7%; 95% CI 6.0-24.4). Four cohorts reported unique fusion-patient counts; 13 of 146 patients underwent fusion-containing surgery (8.9%; 95% CI 3.2-14.2). Thus, 189 of 230 patients (82.2%) had no reported reoperation and 133 of 146 (91.1%) had no reported fusion-containing surgery during source-study follow-up. Certainty was very low for both outcomes. CONCLUSION: Documented breakage should not be assumed to represent treatment failure or an automatic indication for revision. Most break-positive patients had no reported further surgery during available follow-up in these observational cohorts, although selected patients required tether revision, hybrid salvage, or fusion. Management should be based on interval progression, symptoms, residual deformity, alignment, skeletal maturity, and patient priorities rather than radiographic breakage alone.