Since the first description of spinal fusions for the
treatment of scoliosis over 100 years ago, there have been significant
advancements in the surgical technique, which have led to improved fusion
rates, lower complication frequency, greater three-dimensional correction of
the deformity and more rapid postoperative recovery. However, spine fusions mean fewer motion
segments (less spine motion) which may lead to lower function in high-level
physical activity (e.g. competitive athletics) and greater chance for spine
arthritis. Hence preservation of spinal motion, particularly in the low back,
is a highly attractive goal. The desire
to maintain spine motion has fueled the development of various growth
modulation procedures, whose goals are correct the spinal deformity and maintain
motion (without fusion). One of these promising
techniques which has gained traction in the last 10 years is vertebral body
tethering (VBT).
treatment of scoliosis over 100 years ago, there have been significant
advancements in the surgical technique, which have led to improved fusion
rates, lower complication frequency, greater three-dimensional correction of
the deformity and more rapid postoperative recovery. However, spine fusions mean fewer motion
segments (less spine motion) which may lead to lower function in high-level
physical activity (e.g. competitive athletics) and greater chance for spine
arthritis. Hence preservation of spinal motion, particularly in the low back,
is a highly attractive goal. The desire
to maintain spine motion has fueled the development of various growth
modulation procedures, whose goals are correct the spinal deformity and maintain
motion (without fusion). One of these promising
techniques which has gained traction in the last 10 years is vertebral body
tethering (VBT).
The concept of VBT in scoliosis is to alter the
relative vertebral growth (right vs. left) of the front of the spine. This is accomplished by relative slowing the
vertical growth on the convex side (by tensioning of the tether) with unloading
of the concave side of the vertebra, to permit greater growth. In order for growth modulation to occur the
spine need to have enough spinal growth remaining.
relative vertebral growth (right vs. left) of the front of the spine. This is accomplished by relative slowing the
vertical growth on the convex side (by tensioning of the tether) with unloading
of the concave side of the vertebra, to permit greater growth. In order for growth modulation to occur the
spine need to have enough spinal growth remaining.
This is a patient 4 days after VBT
At present in 2017 there is no FDA-approved devices
for use in the U.S. in a nonfusion, growth-modulation technique in a skeletally
immature patients. This means the use of
this tether system to the children and adolescents is in an “off-label”
manner.
for use in the U.S. in a nonfusion, growth-modulation technique in a skeletally
immature patients. This means the use of
this tether system to the children and adolescents is in an “off-label”
manner.
Studies on VBT in animal models have demonstrated proof
of concept that tethering of the immature spine can alter its growth. The first description of VBT use in humans was a case report
in 2010.
Reports of VBT use in children/adolescents have been encouraging with a
low frequency of complications. At
present there is limited data available on the use of VBT in
skeletally-immature patients with scoliosis.
of concept that tethering of the immature spine can alter its growth. The first description of VBT use in humans was a case report
in 2010.
Reports of VBT use in children/adolescents have been encouraging with a
low frequency of complications. At
present there is limited data available on the use of VBT in
skeletally-immature patients with scoliosis.