2025 Pediatric Surgery Update Course - Vertebral Body Tethering (VBT) for Scoliosis
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clinicalThe tether is placed on the convex side of the spine anteriorly to partially correct the curve and modulate growth↗
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clinicalThe procedure requires a skeletally immature patient so that as they grow, they grow straighter↗
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clinicalIf VBT is performed in a mature patient, it is probably not going to work↗
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guidelineCurrent indications for VBT are immature, moderately severe curves that are flexible↗
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quoteSo should we even back it up a little and who in the audience has even heard of this? Like are we doing tethering at all of the hospitals? Maybe 50-50?↗
▶Ep 1 · 0:26
quoteIf you do it in a mature patient, it's probably not going to work.↗
▶Ep 1 · 0:26
quoteBut we don't want the spine to fuse. So going anteriorly, you can place these tether devices without actually fusing the spine.↗
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clinicalHybrid techniques can be used where if the thoracic curve doesn't meet criteria, only the lumbar spine is tethered since motion is needed there↗
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clinicalFor double tethering, the patient must be positioned in lateral decubitus with convex side up, then flipped to do the lumbar side↗
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quoteSo at Akron Children's, we have not been a super early adopter. So some of you might have even more experience than we do.↗
▶Ep 1 · 0:26
opinionVBT is less invasive and more physiologic than spinal fusion, with hoped-for improved long-term outcomes due to preserved disc mobility↗
▶Ep 1 · 4:46
clinicalPatients are mobilized immediately postoperatively and returned to sports within six weeks, compared to three to six months for fusion↗
▶Ep 1 · 4:46
clinicalSegmental vessels are typically ligated on one side during VBT, which is considered safe with neuromonitoring, though taking vessels on both sides risks spinal infarct↗
▶Ep 1 · 4:46
clinicalT12-L1 levels can usually be reached through the thoracoscopic approach by bluntly dissecting along the diaphragm↗
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clinicalL1-L4 levels are accessed through an open incision↗
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clinicalScrews are placed under fluoroscopic guidance at each level, attempting to go straight across the vertebrae↗
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clinicalEMG neuromonitoring is used during the procedure↗
▶Ep 1 · 4:46
clinicalThe tether is threaded through each screw and a tensioning gun is used to place tension, mostly centered around the apex, to achieve correction↗
▶Ep 1 · 8:57
clinicalThe 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↗
▶Ep 1 · 8:57
clinicalIf 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↗
▶Ep 1 · 8:57
clinicalPeople doing VBT in adults have not had very good outcomes↗
▶Ep 1 · 8:57
opinionVBT has exploded in popularity in recent years as data shows outcomes are improving over time↗
▶Ep 1 · 8:57
clinicalVBT started being performed in the mid-2000s at certain centers↗
▶Ep 1 · 8:57
quoteYeah, so those are some great points and there are people out there doing this in adults and their outcomes are not very good.↗
▶Ep 1 · 8:57
quoteSo I think that we're starting to do a better job now that we have this FDA investigational device exemption that we can study this better prospectively.↗
Summaries Lourina gave as host
· 5 summaries
Recaps of other experts' statements, not Lourina's own clinical position.
Summaries Lourina gave as host · Juvenile Idiopathic Scoliosis5 summaries
2025 Pediatric Surgery Update Course - Vertebral Body Tethering (VBT) for Scoliosis
▶Ep 1 · 8:57
host summaryLourina Flakari summarizing the discussion: 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↗
▶Ep 1 · 8:57
host summaryLourina Flakari summarizing the discussion: Most VBT complications occurred early on when centers didn't know how to select the right patient, and success improves with experience↗
▶Ep 1 · 8:57
host summaryLourina Flakari summarizing the discussion: One study showed no difference in complications between chest tubes and bulb suction drains for VBT↗
▶Ep 1 · 8:57
host summaryLourina Flakari summarizing the discussion: Another study looked at postoperative tranexamic acid to reduce drainage and retention time↗
▶Ep 1 · 8:57
host summaryLourina Flakari summarizing the discussion: A study suggested that multidisciplinary collaborative approach can improve VBT outcomes↗
