Vertebral Body Tethering (VBT) A new fusionless treatment option for scoliosis in the growing spine May 2012 (rev) Shriners Hospitals for Children® - Philadelphia Spinal Tethering Old use: FDA approved as a “dynamic stabilizer” in the posterior lumbar (lower) spine New use: Physician directed scoliosis treatment as a dynamic stabilizer in the growing anterior thoracic (upper) spine “Growth modulation”- partially restraining one side of the spine to allow growth on the other side to reverse the abnormal scoliosis growth pattern Here is a bone model of the tether (white cord) attached to bone screws in the vertebral bodies of the spine (anterior) front of the spine (posterior) back of the spine Components • Titanium pedicle screws placed on the convexity (outside) of the vertebrae causing scoliosis • Polyethylene-terephthalate (PET)* flexible tether connects to each screw and when tightened, compresses the adjacent screws to help straighten the spine – Cable safety extensively studied – Animal and computer simulation models show scoliotic correction *Dynesys system by Zimmer spine “Ideal” candidate • Idiopathic scoliosis (adolescent or juvenile) or Idiopathic “like” (i.e. post syrinx decompression) • >8 yrs old with remaining spine growth ( > 10 yrs old may be preferred to decrease the risk of overcorrecting the curve) • Thoracic curve 35° to 55° • OR curve <35° but does not bend below 20° • As an alternative to VBS + hybrid rod Tethering advantages • • • • • • FUSIONLESS Allows the spine to grow One time surgery No “lengthening” required (no rod) Can be used with lumbar staples (VBS) “burns no bridges”, can do a later fusion if needed Case #1 Feb 2011 12 yo female Before surgery 5 days after surgery During surgery Tethering  Staples  Case #1 1 year post op Pre op 35° 2° 35° 12° Case #3 Aug 2011 14 yo male 9 months post op 1st erect 38° 17° 25° 9° Case #8 Nov 2011 13 yo female Before surgery 3 months after surgery Providence TLSO at night for lumbar curve 44° 10° 30° 18° Unknowns • Not currently using for thoracolumbar or lumbar curves (but hope to in the future) • New use of an existing technology • No long-term follow-up • Only a few cases so far • Potential for overcorrection (curve opposite way) • Refined criteria for “ideal” candidate • Refined post op activity restrictions (temporary) For More Information If you have questions about tethering (VBT), please feel free to call Janet Cerrone, PA-C at 215 430-4067 or email [email protected]