# Juvenile Idiopathic Scoliosis — GCMD Library living collection

Everything in the library about juvenile idiopathic scoliosis — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 70 cited statements

## Episodes
### Surgical Management
- [2025 Pediatric Surgery Update Course - Vertebral Body Tethering (VBT) for Scoliosis](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-vertebral-body-tethering-for-scoliosis-10906) — video · 15:50 · [machine version](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-vertebral-body-tethering-for-scoliosis-10906.md)
- [Update Course Rewind 2025: Vertebral Body Tethering (VBT) for Pediatric Scoliosis](https://library.globalcastmd.com/watch/update-course-rewind-2025-vertebral-body-tethering-for-pediatric-scoliosis-12192) — video · 5:39 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-2025-vertebral-body-tethering-for-pediatric-scoliosis-12192.md)
- [Vertebral body tethering for pediatric scoliosis: patient selection and surgical technique](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848) — podcast · 5:39 · [machine version](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-vertebral-body-tethering-for-scoliosis-10906?t=0) Introduction and VBT Indications (Ep 1)
- [3:52](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-vertebral-body-tethering-for-scoliosis-10906?t=232) Surgical Technique and Approach (Ep 1)
- [8:30](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-vertebral-body-tethering-for-scoliosis-10906?t=510) Adoption Trends and Outcomes Data (Ep 1)
- [12:43](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-vertebral-body-tethering-for-scoliosis-10906?t=763) Multidisciplinary Collaboration and Technical Pearls (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/update-course-rewind-2025-vertebral-body-tethering-for-pediatric-scoliosis-12192?t=0) Introduction and Clinical Scenario (Ep 2)
- [0:57](https://library.globalcastmd.com/watch/update-course-rewind-2025-vertebral-body-tethering-for-pediatric-scoliosis-12192?t=57) VBT Overview and Mechanism (Ep 2)
- [1:47](https://library.globalcastmd.com/watch/update-course-rewind-2025-vertebral-body-tethering-for-pediatric-scoliosis-12192?t=107) Timing and Patient Selection (Ep 2)
- [2:40](https://library.globalcastmd.com/watch/update-course-rewind-2025-vertebral-body-tethering-for-pediatric-scoliosis-12192?t=160) Surgical Technique (Ep 2)
- [4:11](https://library.globalcastmd.com/watch/update-course-rewind-2025-vertebral-body-tethering-for-pediatric-scoliosis-12192?t=251) Outcomes and Recovery (Ep 2)
- [5:06](https://library.globalcastmd.com/watch/update-course-rewind-2025-vertebral-body-tethering-for-pediatric-scoliosis-12192?t=306) Summary (Ep 2)
- [0:01](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=1) Introduction and Clinical Scenario (Ep 3)
- [0:57](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=57) VBT Fundamentals and Mechanism (Ep 3)
- [2:08](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=128) Timing and Peak Growth Velocity (Ep 3)
- [2:40](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=160) Patient Selection Criteria (Ep 3)
- [2:57](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=177) Surgical Technique (Ep 3)
- [4:11](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=251) Postoperative Recovery and Outcomes Data (Ep 3)
- [5:06](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=306) Summary and Conclusions (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- VBT is less invasive and more physiologic than standard spinal fusion. (opinion) [Ep 2 · 1:05](https://library.globalcastmd.com/watch/update-course-rewind-2025-vertebral-body-tethering-for-pediatric-scoliosis-12192?t=65)
- VBT uses a polyethylene flexible band placed on the convex side of the spine. (clinical) [Ep 2 · 1:32](https://library.globalcastmd.com/watch/update-course-rewind-2025-vertebral-body-tethering-for-pediatric-scoliosis-12192?t=92)
- VBT requires a skeletally immature patient so that as they grow, they grow straighter. (clinical) [Ep 2 · 1:37](https://library.globalcastmd.com/watch/update-course-rewind-2025-vertebral-body-tethering-for-pediatric-scoliosis-12192?t=97)
- If VBT is done in a mature patient, it is probably not going to work. (clinical) [Ep 2 · 1:49](https://library.globalcastmd.com/watch/update-course-rewind-2025-vertebral-body-tethering-for-pediatric-scoliosis-12192?t=109)
- VBT only works in kids because you have to grow; you cannot use this in adults. (clinical) [Ep 2 · 1:53](https://library.globalcastmd.com/watch/update-course-rewind-2025-vertebral-body-tethering-for-pediatric-scoliosis-12192?t=113)
- People doing VBT in adults have outcomes that are not very good. (clinical) [Ep 2 · 1:56](https://library.globalcastmd.com/watch/update-course-rewind-2025-vertebral-body-tethering-for-pediatric-scoliosis-12192?t=116)
- Everybody is moving towards only doing VBT in skeletally immature kids right around the time of peak growth velocity. (clinical) [Ep 2 · 2:01](https://library.globalcastmd.com/watch/update-course-rewind-2025-vertebral-body-tethering-for-pediatric-scoliosis-12192?t=121)
- The sweet spot for VBT is when we can actually modulate growth and change the shape of the disk space and the shape of the vertebrae as they grow. (clinical) [Ep 2 · 2:28](https://library.globalcastmd.com/watch/update-course-rewind-2025-vertebral-body-tethering-for-pediatric-scoliosis-12192?t=148)
- Current indications for VBT are immature, moderately severe curves, and flexible. (guideline) [Ep 2 · 2:40](https://library.globalcastmd.com/watch/update-course-rewind-2025-vertebral-body-tethering-for-pediatric-scoliosis-12192?t=160)
- Hybrid techniques are being done where if the thoracic curve does not meet criteria, the lumbar spine is where you need motion, so you can do a hybrid. (clinical) [Ep 2 · 2:47](https://library.globalcastmd.com/watch/update-course-rewind-2025-vertebral-body-tethering-for-pediatric-scoliosis-12192?t=167)
- You can usually get down to T12, L1 through the thoracoscopic approach and bluntly dissect the plane along the diaphragm to get to that level. (clinical) [Ep 2 · 3:01](https://library.globalcastmd.com/watch/update-course-rewind-2025-vertebral-body-tethering-for-pediatric-scoliosis-12192?t=181)
- L1 to L4 is accessed through an open incision. (clinical) [Ep 2 · 3:11](https://library.globalcastmd.com/watch/update-course-rewind-2025-vertebral-body-tethering-for-pediatric-scoliosis-12192?t=191)
- Segmental vessels are typically ligated during VBT. (clinical) [Ep 2 · 3:15](https://library.globalcastmd.com/watch/update-course-rewind-2025-vertebral-body-tethering-for-pediatric-scoliosis-12192?t=195)
- You certainly do not want to ligate segmental vessels on both sides of the spine due to risk of a spinal infarct. (clinical) [Ep 2 · 3:18](https://library.globalcastmd.com/watch/update-course-rewind-2025-vertebral-body-tethering-for-pediatric-scoliosis-12192?t=198)
- Be really careful around the lumbosacral plexus during VBT. (clinical) [Ep 2 · 3:44](https://library.globalcastmd.com/watch/update-course-rewind-2025-vertebral-body-tethering-for-pediatric-scoliosis-12192?t=224)
- EMG neuromonitoring is used during VBT. (clinical) [Ep 2 · 3:47](https://library.globalcastmd.com/watch/update-course-rewind-2025-vertebral-body-tethering-for-pediatric-scoliosis-12192?t=227)
- You can bluntly retract the psoas off the vertebral body during VBT. (clinical) [Ep 2 · 3:50](https://library.globalcastmd.com/watch/update-course-rewind-2025-vertebral-body-tethering-for-pediatric-scoliosis-12192?t=230)
- The tether is threaded through each screw and a tensioning gun is used to place tension. (clinical) [Ep 2 · 4:05](https://library.globalcastmd.com/watch/update-course-rewind-2025-vertebral-body-tethering-for-pediatric-scoliosis-12192?t=245)
- VBT patients are mobilized immediately postoperatively. (clinical) [Ep 2 · 4:14](https://library.globalcastmd.com/watch/update-course-rewind-2025-vertebral-body-tethering-for-pediatric-scoliosis-12192?t=254)
- VBT patients return to sports within 6 weeks, compared to typical return to sports for a fusion of 3 to 6 months. (clinical) [Ep 2 · 4:16](https://library.globalcastmd.com/watch/update-course-rewind-2025-vertebral-body-tethering-for-pediatric-scoliosis-12192?t=256)
- A Mayo study showed VBT success rate of only 75% at 2 years based on curve size and lack of revisions. (epidemiological) [Ep 2 · 4:26](https://library.globalcastmd.com/watch/update-course-rewind-2025-vertebral-body-tethering-for-pediatric-scoliosis-12192?t=266)
- The Mayo study showed VBT success rate down to 63% at 3.8 years with a 20% revision rate. (epidemiological) [Ep 2 · 4:36](https://library.globalcastmd.com/watch/update-course-rewind-2025-vertebral-body-tethering-for-pediatric-scoliosis-12192?t=276)
- VBT is gaining in popularity; it started to be done mid 2000s at certain centers and has exploded in recent years. (epidemiological) [Ep 2 · 4:52](https://library.globalcastmd.com/watch/update-course-rewind-2025-vertebral-body-tethering-for-pediatric-scoliosis-12192?t=292)
- You have to be really careful about doing VBT in the right patient at the right time. (opinion) [Ep 2 · 5:01](https://library.globalcastmd.com/watch/update-course-rewind-2025-vertebral-body-tethering-for-pediatric-scoliosis-12192?t=301)
- VBT is less invasive and more physiologic than spinal fusion, with hoped-for improved long-term outcomes due to preserved disc mobility — Lourina Flakari (opinion) [Ep 1 · 0:26](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-vertebral-body-tethering-for-scoliosis-10906?t=26)
- The tether is placed on the convex side of the spine anteriorly to partially correct the curve and modulate growth — Lourina Flakari (clinical) [Ep 1 · 0:26](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-vertebral-body-tethering-for-scoliosis-10906?t=26)
- The procedure requires a skeletally immature patient so that as they grow, they grow straighter — Lourina Flakari (clinical) [Ep 1 · 0:26](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-vertebral-body-tethering-for-scoliosis-10906?t=26)
- If VBT is performed in a mature patient, it is probably not going to work — Lourina Flakari (clinical) [Ep 1 · 0:26](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-vertebral-body-tethering-for-scoliosis-10906?t=26)
- Current indications for VBT are immature, moderately severe curves that are flexible — Lourina Flakari (guideline) [Ep 1 · 0:26](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-vertebral-body-tethering-for-scoliosis-10906?t=26)
- Hybrid techniques can be used where if the thoracic curve doesn't meet criteria, only the lumbar spine is tethered since motion is needed there — Lourina Flakari (clinical) [Ep 1 · 0:26](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-vertebral-body-tethering-for-scoliosis-10906?t=26)
- For double tethering, the patient must be positioned in lateral decubitus with convex side up, then flipped to do the lumbar side — Lourina Flakari (clinical) [Ep 1 · 0:26](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-vertebral-body-tethering-for-scoliosis-10906?t=26)
- Ports are placed on the anterior axillary line with three 5mm ports and one 15mm port for the instrument — Justin (clinical) [Ep 1 · 3:52](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-vertebral-body-tethering-for-scoliosis-10906?t=232)
- Two to three vertebral levels can usually be accessed through each skin incision by moving the port up the next intercostal space — Justin (clinical) [Ep 1 · 3:52](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-vertebral-body-tethering-for-scoliosis-10906?t=232)
- Segmental vessels are typically ligated on one side during VBT, which is considered safe with neuromonitoring, though taking vessels on both sides risks spinal infarct — Lourina Flakari (clinical) [Ep 1 · 4:46](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-vertebral-body-tethering-for-scoliosis-10906?t=286)
- T12-L1 levels can usually be reached through the thoracoscopic approach by bluntly dissecting along the diaphragm — Lourina Flakari (clinical) [Ep 1 · 4:46](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-vertebral-body-tethering-for-scoliosis-10906?t=286)
- L1-L4 levels are accessed through an open incision — Lourina Flakari (clinical) [Ep 1 · 4:46](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-vertebral-body-tethering-for-scoliosis-10906?t=286)
- Screws are placed under fluoroscopic guidance at each level, attempting to go straight across the vertebrae — Lourina Flakari (clinical) [Ep 1 · 4:46](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-vertebral-body-tethering-for-scoliosis-10906?t=286)
- EMG neuromonitoring is used during the procedure — Lourina Flakari (clinical) [Ep 1 · 4:46](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-vertebral-body-tethering-for-scoliosis-10906?t=286)
- The tether is threaded through each screw and a tensioning gun is used to place tension, mostly centered around the apex, to achieve correction — Lourina Flakari (clinical) [Ep 1 · 4:46](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-vertebral-body-tethering-for-scoliosis-10906?t=286)
- Patients are mobilized immediately postoperatively and returned to sports within six weeks, compared to three to six months for fusion — Lourina Flakari (clinical) [Ep 1 · 4:46](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-vertebral-body-tethering-for-scoliosis-10906?t=286)
- VBT started being performed in the mid-2000s at certain centers — Lourina Flakari (clinical) [Ep 1 · 8:57](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-vertebral-body-tethering-for-scoliosis-10906?t=537)
- VBT has exploded in popularity in recent years as data shows outcomes are improving over time — Lourina Flakari (opinion) [Ep 1 · 8:57](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-vertebral-body-tethering-for-scoliosis-10906?t=537)
- The sweet spot for VBT timing is when growth can be modulated to change the shape of the disc space and vertebrae as the patient grows — Lourina Flakari (clinical) [Ep 1 · 8:57](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-vertebral-body-tethering-for-scoliosis-10906?t=537)
- If VBT is done too soon, patients can over-correct; if done too late, nothing happens and the tether will eventually break, reverting to the previous shape — Lourina Flakari (clinical) [Ep 1 · 8:57](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-vertebral-body-tethering-for-scoliosis-10906?t=537)
- People doing VBT in adults have not had very good outcomes — Lourina Flakari (clinical) [Ep 1 · 8:57](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-vertebral-body-tethering-for-scoliosis-10906?t=537)
- Chest tube outputs tend to be high for the first six to eight hours after VBT, likely from serous fluid from opening the pleura over a large surface area — Justin (clinical) [Ep 1 · 13:29](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-vertebral-body-tethering-for-scoliosis-10906?t=809)
- For severe scoliosis with anterior lumbar exposure, the spine can be quite deep in younger kids compared to cases where you can almost feel the spine — Justin (clinical) [Ep 1 · 14:13](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-vertebral-body-tethering-for-scoliosis-10906?t=853)
- Removing one of the floating ribs can be helpful to give more space for lumbar exposure in the space between lower ribs and iliac crest — Todd Ponsky (clinical) [Ep 1 · 14:38](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-vertebral-body-tethering-for-scoliosis-10906?t=878)
- Double-lumen endotracheal tubes are used for VBT procedures — Todd Ponsky (clinical) [Ep 1 · 15:14](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-vertebral-body-tethering-for-scoliosis-10906?t=914)
- VBT is definitely less invasive and more physiologic than standard spinal fusion. (opinion) [Ep 3 · 1:10](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=70)
- VBT uses a polyethylene flexible band placed on the convex side of the spine. (clinical) [Ep 3 · 1:32](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=92)
- VBT requires a skeletally immature patient so that as they're growing, they're growing straighter. (clinical) [Ep 3 · 1:37](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=97)
- If VBT is done in a mature patient, it's probably not going to work. (clinical) [Ep 3 · 1:49](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=109)
- VBT cannot be used in adults; outcomes in adults are not very good. (clinical) [Ep 3 · 1:55](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=115)
- Everybody is moving towards only doing VBT in skeletally immature kids right around the time of peak growth velocity. (clinical) [Ep 3 · 2:01](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=121)
- The sweet spot for VBT is when we can actually modulate growth and change the shape of the disk space and the shape of the vertebrae as they grow. (clinical) [Ep 3 · 2:28](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=148)
- Current indications for VBT are immature, moderately severe curves, and flexible. (guideline) [Ep 3 · 2:40](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=160)
- Hybrid techniques can be used where if the thoracic curve doesn't meet criteria, the lumbar spine is where you need motion. (clinical) [Ep 3 · 2:47](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=167)
- You can usually get down to T12, L1 through the thoracoscopic approach and bluntly dissect the plane along the diaphragm to get to that level. (clinical) [Ep 3 · 3:01](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=181)
- L1 to L4 is accessed through an open incision. (clinical) [Ep 3 · 3:11](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=191)
- Segmental vessels are typically ligated, but you certainly don't want to do that on both sides of the spine due to risk of a spinal infarct. (clinical) [Ep 3 · 3:15](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=195)
- Be really careful around the lumbosacral plexus; EMG neuromonitoring is used. (clinical) [Ep 3 · 3:44](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=224)
- You can bluntly retract the psoas off the vertebral body and dilate it up through tubes. (clinical) [Ep 3 · 3:50](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=230)
- The tether is threaded through each screw and a tensioning gun is used to place tension. (clinical) [Ep 3 · 4:05](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=245)
- VBT patients are mobilized immediately postoperatively. (clinical) [Ep 3 · 4:14](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=254)
- VBT patients return to sports within 6 weeks, while typical return to sports for a fusion would be 3 to 6 months. (clinical) [Ep 3 · 4:16](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=256)
- A Mayo study showed VBT success rate is only considered to be 75% at 2 years based on curve size and lack of revisions. (epidemiological) [Ep 3 · 4:26](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=266)
- The Mayo study showed VBT success declined to 63% at 3.8 years with a 20% revision rate. (epidemiological) [Ep 3 · 4:36](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=276)
- VBT started to be done mid 2000s at certain centers, and it has exploded in recent years. (epidemiological) [Ep 3 · 4:54](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=294)
- You have to be really careful about doing VBT in the right patient at the right time. (opinion) [Ep 3 · 5:01](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=301)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- Vertebral body tethering is an FDA approved minimally invasive non-fusion surgical treatment for growing patients with idiopathic scoliosis. — Jill Knepprath summarizing the discussion [Ep 2 · 1:18](https://library.globalcastmd.com/watch/update-course-rewind-2025-vertebral-body-tethering-for-pediatric-scoliosis-12192?t=78)
- If VBT is done too early, you overcorrect. — Jill Knepprath summarizing the discussion [Ep 2 · 2:11](https://library.globalcastmd.com/watch/update-course-rewind-2025-vertebral-body-tethering-for-pediatric-scoliosis-12192?t=131)
- Peak growth velocity occurs when kids are going through a period of significant skeletal growth around ages 8 to 15. — Jill Knepprath summarizing the discussion [Ep 2 · 2:14](https://library.globalcastmd.com/watch/update-course-rewind-2025-vertebral-body-tethering-for-pediatric-scoliosis-12192?t=134)
- If VBT is done too late, the tethering will eventually break and the spine will revert back to its initial shape. — Jill Knepprath summarizing the discussion [Ep 2 · 2:22](https://library.globalcastmd.com/watch/update-course-rewind-2025-vertebral-body-tethering-for-pediatric-scoliosis-12192?t=142)
- L1 can be accessed more easily thoracoscopically than by open surgery. — Jill Knepprath summarizing the discussion [Ep 2 · 3:23](https://library.globalcastmd.com/watch/update-course-rewind-2025-vertebral-body-tethering-for-pediatric-scoliosis-12192?t=203)
- L2 through L4 is better accessed by open approaches and removing one of the floating ribs. — Jill Knepprath summarizing the discussion [Ep 2 · 3:28](https://library.globalcastmd.com/watch/update-course-rewind-2025-vertebral-body-tethering-for-pediatric-scoliosis-12192?t=208)
- Lumbar exposure can be challenging, especially distally because of the iliac crest. — Jill Knepprath summarizing the discussion [Ep 2 · 3:40](https://library.globalcastmd.com/watch/update-course-rewind-2025-vertebral-body-tethering-for-pediatric-scoliosis-12192?t=220)
- The key is to bluntly retract the psoas off of the vertebral bodies during the open approach and make sure you are around the entire psoas muscle. — Jill Knepprath summarizing the discussion [Ep 2 · 3:56](https://library.globalcastmd.com/watch/update-course-rewind-2025-vertebral-body-tethering-for-pediatric-scoliosis-12192?t=236)
- The Mayo study explained that the issues early on with VBT were due to poor patient selection. — Jill Knepprath summarizing the discussion [Ep 2 · 4:41](https://library.globalcastmd.com/watch/update-course-rewind-2025-vertebral-body-tethering-for-pediatric-scoliosis-12192?t=281)
- With more experience and better selection criteria, VBT data is now showing improved outcomes. — Jill Knepprath summarizing the discussion [Ep 2 · 4:46](https://library.globalcastmd.com/watch/update-course-rewind-2025-vertebral-body-tethering-for-pediatric-scoliosis-12192?t=286)
- The first prospective VBT study from Mayo Clinic found 75% success rate at two years based on curve size and lack of revisions, down to 63% at 3.8 years with a 20% revision rate — Lourina Flakari summarizing the discussion [Ep 1 · 8:57](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-vertebral-body-tethering-for-scoliosis-10906?t=537)
- Most VBT complications occurred early on when centers didn't know how to select the right patient, and success improves with experience — Lourina Flakari summarizing the discussion [Ep 1 · 8:57](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-vertebral-body-tethering-for-scoliosis-10906?t=537)
- One study showed no difference in complications between chest tubes and bulb suction drains for VBT — Lourina Flakari summarizing the discussion [Ep 1 · 8:57](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-vertebral-body-tethering-for-scoliosis-10906?t=537)
- Another study looked at postoperative tranexamic acid to reduce drainage and retention time — Lourina Flakari summarizing the discussion [Ep 1 · 8:57](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-vertebral-body-tethering-for-scoliosis-10906?t=537)
- A study suggested that multidisciplinary collaborative approach can improve VBT outcomes — Lourina Flakari summarizing the discussion [Ep 1 · 8:57](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-vertebral-body-tethering-for-scoliosis-10906?t=537)
- Vertebral body tethering is an FDA approved minimally invasive non-fusion surgical treatment for growing patients with idiopathic scoliosis. — Jill Knepprath summarizing the discussion [Ep 3 · 1:18](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=78)
- The goal is to operate during peak growth velocity; if done too early, you overcorrect. — Jill Knepprath summarizing the discussion [Ep 3 · 2:08](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=128)
- Peak growth velocity occurs when kids are going through a period of significant skeletal growth around ages 8 to 15. — Jill Knepprath summarizing the discussion [Ep 3 · 2:14](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=134)
- If VBT is done too late, the tethering will eventually break and the spine will revert back to its initial shape. — Jill Knepprath summarizing the discussion [Ep 3 · 2:22](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=142)
- L1 can be accessed more easily thoracoscopically than by open surgery. — Jill Knepprath summarizing the discussion [Ep 3 · 3:23](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=203)
- L2 through L4 is better accessed by open approaches and removing one of the floating ribs. — Jill Knepprath summarizing the discussion [Ep 3 · 3:28](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=208)
- Lumbar exposure can be challenging, especially distally because of the iliac crest. — Jill Knepprath summarizing the discussion [Ep 3 · 3:40](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=220)
- The key is to bluntly retract the psoas off of the vertebral bodies during the open approach and make sure you are around the entire psoas muscle. — Jill Knepprath summarizing the discussion [Ep 3 · 3:56](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=236)
- The issues early on with VBT were due to poor patient selection. — Jill Knepprath summarizing the discussion [Ep 3 · 4:41](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=281)
- With more experience and better selection criteria, the data is now showing improved outcomes for VBT. — Jill Knepprath summarizing the discussion [Ep 3 · 4:46](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=286)

## Changelog
- Nov 11: 3 items added automatically

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