Vertebral Body Tethering (VBT) In 2014 A fusionless treatment option for scoliosis in the growing spine UPDATED March 2014 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 – Early adolescent cases show scoliotic correction *Dynesys system by Zimmer spine “Ideal” candidate • Idiopathic scoliosis (adolescent or juvenile) or Idiopathic “like” (i.e. post syrinx decompression) • >10yrs old with remaining spine growth ( done TOO young increases risk of overcorrecting the curve) • Thoracic, thoracolumbar or lumbar curves 30° to 60° Tethering advantages • • • • FUSIONLESS Allows the spine to grow Allows the spine to move and bend Most are one time surgery ( may need an adjustment of tether if overcorrection seen) • “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 Before surgery 35° 35° 3 years later Case #3 Aug 2011 14 yo male Before surgery 2 years later 1st erect 38° 25° 6° Case #6 Oct 2011 13 yo female Before surgery 44° 2 years later 6° 36° 6° Case #11 Feb 2012 12 yo female Before surgery 50° 18 months later 3° Case #65 Nov 2013 12 yo female Before surgery 6 weeks later Unknowns • • • • • New use of an existing technology No long term follow-up Potential for overcorrection (curve opposite way) Refined criteria for “ideal” candidate Quicker return to all activities (currently 6 weeks) For More Information If you have questions about tethering (VBT), please feel free to contact Janet Cerrone, PA-C [email protected] [email protected]