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. Fusion-less surgery — maintains better spine flexibility.
  3. One-time surgery.
  4. Can be used with vertebral body stapling.
  5. A posterior spine fusion can still be done if needed.

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.  

 

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