A new study suggests that vertebral body tethering (VBT) could provide a reliable treatment option for scoliosis in skeletally immature pediatric patients.

Researchers at the University of Missouri (MU; Columbia, USA), Missouri Orthopedic Institute (Columbia, MO, USA), and other institutions conducted a retrospective review of 29 consecutive patients who underwent VBT, as an alternative treatment option for children and adolescents with idiopathic scoliosis that do not respond to bracing. The researchers defined successful outcomes as a residual Cobb angle less than 30 degrees in those who reached skeletal maturity, and whom did not undergo a posterior spinal fusion (PSF).

The results showed that mean patient age at the time of the surgical procedure was 12.7 years. A mean of 7.2 vertebral levels were instrumented, with a minimum preoperative Cobb angle of 42°. At the latest follow-up, 27 of the patients had reached skeletal maturity, and 20 patients exhibited a curve magnitude lower than 30°, for a success rate of 74%. A suspected broken tether occurred at one level or more in 14 patients (48%); two patients underwent PSF and four had tether revision, for an overall revision rate of 21%. The study was published in the July 2020 issue of The Journal of Bone and Joint Surgery.

“If the child's spine has more than 45 degrees of scoliosis and still has some growth remaining, VBT is a way to correct the scoliosis, preserve motion and modulate normal growth instead of fusing it,” said lead author Dan Hoernschemeyer, MD. “Despite our patient population being slightly more mature at the time of surgery than when compared to previous studies, we found a higher success rate and a lower revision rate.”

Idiopathic scoliosis is a sideways curvature of the spine whose cause is unknown. It is the most common spinal deformity in children, most often diagnosed between ages 10 to 18. The standard treatments for idiopathic scoliosis among children and adolescents who are still growing are conservative, non-surgical treatments such as external bracing to help correct the spinal curvature. For those who do not respond to bracing, PSF may be used to stabilize and correct spinal curvatures, but restricts spine motion and incurs long-term complications such as pain, arthritis, and potential spinal deformities.

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