Vertebral Body Tethering

What is Vertebral Body Tethering?

  • A growth modulation technique that works by partially restraining growth on one side (convex, long side) of the spine to allow growth on the other (concave, short) side.  This guided growth can correct scoliosis curvature.
  • This is a possible alternative to bracing and, ideally, spine fusion for some patients who are at risk for a steady progression of the curve.
  • This procedure should allow for more spine motion and less chance of back pain in adulthood.

Who is a candidate?

  • Idiopathic scoliosis (Adolescent or Juvenile)
  • A child older than 8 years
  • A child who will still have years of growth:
    - Boys up to 16 years
    - Girls up to 14 years                                                    
  • Curve less than 65 degrees
  • Spine flexibility
  • Neurologically normal individuals

Which curves can be tethered?
Both thoracic and lumbar curves.

What are the advantages of Vertebral Body Tethering?

  1. No brace
  2. Fusionless surgery — maintains better spine flexibility.
  3. One time surgery
  4. Can be used with vertebral body stapling.
  5. Can still do a posterior spine fusion if needed later.

What are the disadvantages of Vertebral Body Tethering?

  1. It is a surgery with all the inherent risks of surgery.
  2. Potential to “over correct” curve.
  3. New technology.

What happens if the curves progress despite the tethering?
It depends on the amount of progression. Slight progression may occur, but likely will not need to be treated (such as a spine fusion). However, significant progression of the curves can still be treated with a spine fusion without difficulty.

How is the tether inserted?
The approach is “minimally-invasive” with small incisions on the chest (if the thoracic spine is to be tethered) or on the side of the abdomen (if the lumbar spine is to be tethered).

Will there be a most difficult part of the recovery process?
When the thoracic spine is tethered the surgical approach is through the chest. To get there safely the lung on that side of the chest is completely or partially deflated, temporarily. When the tether procedure has been completed the lung will be re-inflated.  After surgery there will be a small tube that will go into the chest, next to the lung, to help keep it inflated. This tube can cause soreness/pain while it is in, making it uncomfortable to take deep breaths or to cough. When the tube is removed the soreness/pain go away.

How long will I need to take pain medication?
Typically the prescription pain medication can be tapered off around 2 weeks postoperatively. Thereafter over the counter medications such as acetaminophen, ibuprofen or naproxen sodium can be used for mild discomfort.

When can I return to school?
Usually by two weeks after surgery. 

When can I return to sports?
Your postoperative follow-up will be approximately four weeks after surgery.You will be partially, or completely, released to begin athletic activities. 

Planning for Surgery

Please note: If your nasal swab was positive for MRSA, don’t forget to use the ointment prescribed to you! You should use it twice a day for 5 days). Please remember to wash with hibiclens soap for three days prior to surgery!

What do I need to bring to the hospital? You may bring:

  • Current list of medications, dosages and frequency
  • Slip on shoes
  • Personal Items of comfort (blanket, stuffed animal, books, movies)
  • Toiletry items you feel you will need during your stay
  • Comfortable clothes for day of going home

Can my mom, dad or caregiver stay at the bedside?

  • The Pediatric Intensive Care Unit (PICU) allows two people to visit at a time, but they can not sleep in the room with the patient.
  • Parents can sleep in the PICU lounge.
  • On the floor — one parent can sleep at the bedside. The other parent can sleep in the parent lounge. Typically there is not a roommate. If there is not a roommate, both parents are welcome to stay the night. 

What do we do the night before surgery?

  • If you live far…you may want to stay at a local hotel because you will be required to be here early. (about 6 am)
  • The patient may not have anything to eat or drink after Midnight this includes gum, candy, mints, etc.
  • Please shower thoroughly shampooing your hair the night prior to surgery
  • Please remove any nail polish, and be sure your nail beds are clean for surgery.

Walking Through the Surgery Steps

Same Day Surgery:
The 6th Floor Same Day Surgery Unit is where you and your family will begin your journey. The day of surgery you will be able to meet with the anesthesiologist, child life therapist and nurses. Your weight, height and vitals signs will be obtained. You may be given medication prior to surgery by the nurse. You will be able to pick a flavor for the mask that will help us put you to sleep.

Operating Room:             
You will drift off to sleep with the help of the “flavored mask”.  We will place an IV (intravenous catheter) in order to provide fluids and pain medication. Your abdomen/chest will be cleaned prior to surgery with special soap. Gel pads and pillows will be used to have you placed in a comfortable position for surgery.

We will have special electrodes placed on your body to check for neuro/sensory movement and spinal cord function.

Post Anesthesia Care Unit (PACU):
We will wake you up when the surgery is complete.  You will be asked to do a “wake-up test”. You will then be wheeled in a bed to the PACU. Once you are settled and alert, we will be able to call your parent(s) or caregiver to be with you. You will be closely monitored by the doctors and nurses.

Pain Control: You will have a Patient Controlled Anesthesia (PCA). This is controlled by the Pain Service Team. The pain service team is a special team of doctors (anesthesiologists) and Nurse Practitioners who are trained in monitoring your post operative pain. If the patient is able to comprehend, the patient will be able to press the button for pain medication. The patient may also be delivered medication continuously through the PCA.

Recovery on the 10th floor: 
Typical stay for a patient in the hospital is 2-3 days. There are single and double rooms. You may have a roommate if the hospital is full. There is a parent lounge and small kitchen with a refrigerator and microwave. 

For successful recovery, the following needs to happen:

  1. Patients are turned every two hours.
  2. Patients need to be up out of bed two to three times a day. This means you will need sit in the bedside chair, wheelchair or ambulate in the hall.
  3. You will have pain, but it will be manageable. We expect your average pain score to be 4 out of 10. 
  4. It is important for patients to use the incentive spirometer, blow bubbles and or pretend to blow out candles on a birthday cake. The bedside nurse will be able to assist with this. These are all ways to help expand the lungs. Some patients will require respiratory therapy.
  5. Have a can-do attitude, and try your best, even when you don’t feel well.

Important Contact Information

Dr. Luhmann's Team: 
Amanda Robertson, Medical Assistant: (314) 454-4191
Jenn Ledbetter, Nurse Practitioner: (314) 454-4261
Kirsten Brouillet, Research Coordinator

St. Louis Children's Hospital:
Orthopedics Appointment Desk: (314) 454-2500
Main Number: (314) 454-6000
Same Day Surgery: (314) 454-6174
PICU: (314) 454-6213
10th Floor: (314) 454-6038
After-hours Number: (866) 582-8055


 

 

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