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Scoliosis: A New Era
VBT/ASC: A New Technique for Correcting Scoliosis
- Spinal fusion for scoliosis is an excellent operation but sacrifices spinal mobility.
- Correction of scoliosis while preserving motion is called VBT/ASC. Preserving motion is especially important in lumbar scoliosis.
- Advantages: natural spinal movement, faster recovery.
- It is a new technique, but results are very encouraging. The main drawbacks are possible inadequate correction or loss of the initial correction.
- The first VBT surgery in Greece was performed at Mitera Hospital by the scoliosis surgery team of Elias Papadopoulos in November 2019. And the work continues…
Challenges of Scoliosis in Growing Children
Treating progressive scoliosis in a growing child is particularly challenging. The surgeon must balance maximum correction of the curve while preserving spinal mobility.
Spinal Fusion
The classic surgical technique is spinal fusion, which has the major drawback of eliminating spinal movement. In effect, one replaces the disadvantage of scoliosis with a rigid spine.
New Surgical Techniques
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.
Recovery
- Hospital stay: ~4 days, until thoracic drain removal
- No postoperative brace needed
- Return to school: ~2 weeks
Postoperative Follow-Up
- X-rays at 6 weeks, then every 6 months until growth completion and skeletal maturity
- Adults: follow-up for 5 years
Results
- Two-year results are very encouraging.
- Samdani and Betz operated on 65 children and reported that none required reoperation for scoliosis progression or had serious surgery-related complications.
- Two children underwent reoperation for overcorrection; in these cases, the tether was simply cut, stopping the reverse progression.
