Alternative Treatments for Surgery and Bracing in Skeletally Immature Idiopathic Scoliosis Patients

In the past, for adolescents and children who developed a curvature of the spine during their formative years, bracing and surgery were the only options. But today, alternative treatments for idiopathic scoliosis are available. Vertebral Body Tethering is an exciting new treatment option available for young scoliosis patients who otherwise may have no other choice but to wear a brace for two to three years or undergo the difficulties and mobility limitations that happen as a result of spinal fusion surgery.

Vertebral Body Tethering works by mobilizing the natural growth forces happening in a young person’s body and using those forces to redirect the shape of the curvature. According to the Hueter-Volkmann law, growth plates that are under pressure don’t grow as quickly. Vertebral Body Tethering involves the strategic placement of screws into the spinal convexity along with a special tether that can be made tighter or shorter as necessary. As the child grows, the tether encourages growth at the concave areas of the spine, which then lessens the deformity.

Vertebral Body Tethering is a minimally invasive procedure performed using a thoracoscopic approach that’s far less traumatizing socially for young people than wearing a spinal brace for 23 hours a day, for years at a time. At the same time, this procedure diminishes the probability that the patient will need spinal fusion surgery in the future, a procedure that has some drawbacks, but that often presents as the only option if bracing doesn’t work.

This procedure is only viable for patients who have not reached full physical maturity. It’s most appropriate for skeletally immature patients who have a curvature of between 35 and 60 degrees. The type and direction of the curvature are important in determining if a particular patient would benefit from the procedure. It’s generally recommended for those with idiopathic scoliosis, or curvature of the spine that develops without an obvious underlying cause. Additional factors like the child’s height, their parents’ heights, the development of secondary sex characteristics, and other variables are also taken into consideration when making the decision about whether or not this treatment is appropriate for a particular patient. Age is not as important as physical maturity (as determined by various medical tests and observations) in determining whether a particular child is a candidate for Vertebral Body Tethering.

Though spinal fusion and bracing remain the primary modalities used to treat idiopathic scoliosis in young patients who are not fully mature, Vertebral Body Tethering is an exciting new option that may be appropriate in some situations. Though spinal bracing is more desirable than surgery, it carries some psychosocial and practical drawbacks that Vertebral Body Tethering can bypass entirely. Vertebral Body Tethering allows the doctor to manipulate the concavities of the spine by leveraging growth without the need for a brace. Spinal fusion surgery may still be necessary, even following treatment with Vertebral Body Tethering, but this new technology in idiopathic scoliosis treatment is a viable option for young people who are still in the midst of growth.