Scoliosis: A New Era

In recent years, there has been a major effort to develop surgical techniques that correct scoliosis while preserving motion.

Today, a new technique with a significant follow-up period exists, called VBT (vertebral body tethering).

• The principle of VBT is to slow growth on the convex sideof the curve so that the concave side can “catch up,” gradually straightening the spine.
• VBT started in 2011 at Shriners Hospital in Philadelphia, USA, by R. Betz and A. Samdani.

The same operation in adults is called ASC (anterior scoliosis correction).

• The difference is that maximum correction must occur during surgery, because growth is absent and no further correction will occur after surgery.

During VBT or ASC, screws are placed in the anterior-convex side of the spine through a thoracoscopic or minimally invasive approach and connected with a polyester tether, correcting the scoliosis.

• Initially, the scoliosis is corrected by about 50%, and the rest occurs gradually during growth.
• In ASC, 2–3 disc annuli are released without disrupting the disc cores.

Advantages:

• Preserves spinal motion and growth
• Less blood loss
• No muscle damage
• Fewer complications
• Faster recovery

Complications:

• Tether breakage (now reduced with double tethers)
• Unpredictable or insufficient correction, which may require another operation or spinal fusion

Criteria for VBT

• Remaining growth is essential:

• For girls: before or within one year of menarche
• For both sexes: assessed via hand X-rays (generally 10–14 years old, not younger than 10)
  • Scoliosis: 30–60°, with ≥50% correction on dynamic X-rays
  • In double curves: lumbar scoliosis <30°; both curves should be corrected
  • Excessive kyphosis must be absent

For ASC, spinal flexibility and absence of degenerative changes are required.