Anterior vertebral body tethering explained

Anterior vertebral body tethering (AVBT) is a relatively new surgery for the treatment of scoliosis[1] in pediatric patients.[2] Left untreated, severe scoliosis can worsen and eventually affect a person's lungs and heart.[3] [4] [5]

History

In the 1950s and 1960s, doctors began experimenting with a technique called spinal fusion to straighten the spine and prevent long-term health consequences of curvatures. Fusion surgery in children employs pedicle screws[6] and metal rods to correct the curve. Improvements to fusion techniques have been made over the years, and it remains the standard of care today.[7] However, fusion has drawbacks,[8] and pioneers in the field of pediatric orthopedics and neurosurgery have introduced AVBT as a minimally invasive alternative.[9]

New developments

The US Food and Drug Administration (FDA) approved the compassionate use of AVBT for a small population of patients.[10] VBT uses a strong, flexible tether that is attached to screws embedded in the spine. It is important to have the surgery while the child or teen is still growing because the tether is meant to gradually change the severity of the curve as growth occurs. In addition to realigning the spine, the main benefit of VBT is that flexibility is maintained. The word "anterior" is connected with this technique because it can be done through the front or side of the chest wall (rather than the back)[2] via a number of small incisions that typically heal quickly with proper post-surgical care. The ideal candidate has a severe curve that cannot be corrected with bracing and a Sanders Score (which measures skeletal maturity) of 3-4.[11]

Procedure and healing process

This procedure is considered an in-patient surgery under general anesthesia with hospital stays that typically last several days. AVBT may not be covered by health care insurance;[12] nevertheless several state-of-the-art US health systems (Cincinnati Children's Hospital, Mayo Clinic, Shriners Hospitals for Children, Texas Children's Hospital and University of Missouri Health Care) offer it as an alternative to fusion for a small number of patients through the FDA's humanitarian device exemption (HDE) pathway.[13] Most patients are eventually able to return to sports and other physical activities that require spinal flexibility.[14]

Notes and References

  1. Web site: Scoliosis . Medline Plus . 2021-02-01 . 2021-03-18 . https://web.archive.org/web/20210318032815/https://medlineplus.gov/scoliosis.html . live .
  2. Web site: Jain . Viral V. . 20 October 2020 . A New Scoliosis Treatment: Vertebral Body Tethering . Cincinnati's Children's Blog . 6 January 2024 . 6 January 2024 . https://web.archive.org/web/20240106154537/https://blog.cincinnatichildrens.org/research-and-discoveries/a-new-scoliosis-treatment-vertebral-body-tethering/ . live .
  3. Dr. Amer Samdani of Shriners Hospitals for Children in Philadelphia on Innovative Treatments - YouTube . 24 March 2015 . Comcast Newsmakers . Videotape . 6 January 2024 . 6 January 2024 . https://web.archive.org/web/20240106153130/https://www.youtube.com/watch?v=LIdqk2b1zhI . live .
  4. Baker . Courtney E. . Milbrandt . Todd A. . Larson . A. Noelle . April 2021 . Anterior Vertebral Body Tethering for Adolescent Idiopathic Scoliosis: Early Results and Future Directions . The Orthopedic Clinics of North America . 52 . 2 . 137–147 . 10.1016/j.ocl.2021.01.003 . 33752835. 232325947 .
  5. Zimmer Biomet's Innovative Treatment for Young Patients with Scoliosis Receives FDA Approval . August 16, 2019 . Zimmer Biomet Holdings.
  6. Web site: Spinal fusion - series - Pedicle screw: MedlinePlus Medical Encyclopedia . 2024-01-06 . medlineplus.gov . en . 2024-01-06 . https://web.archive.org/web/20240106040905/https://medlineplus.gov/ency/presentations/100121_6.htm . live .
  7. Miyanji . Firoz . Pawelek . Jeff . Nasto . Luigi A. . Rushton . Paul . Simmonds . Andrea . Parent . Stefan . December 2020 . Safety and efficacy of anterior vertebral body tethering in the treatment of idiopathic scoliosis . The Bone & Joint Journal . 102-B . 12 . 1703–1708 . 10.1302/0301-620X.102B12.BJJ-2020-0426.R1 . 7954148 . 33249889.
  8. Scoliosis: Mayo Clinic Radio . 6 October 2019 . Mayo Clinic . 6 January 2024 . 6 January 2024 . https://web.archive.org/web/20240106153132/https://www.youtube.com/watch?v=5ljrntTFwyM . live .
  9. Joint SRS/POSNA Position Statement on Payor Coverage for Anterior Fusionless Scoliosis Technologies for Immature Patients with Idiopathic Scoliosis . 2 April 2020.
  10. Web site: 2021 . FDA Executive Summary Prepared for the Spring 2021, Meeting of the FDA's Pediatric Advisory Committee: H190005 The Tether™ – Vertebral Body Tethering System . Food and Drug Administration . 2024-01-06 . 2022-05-16 . https://web.archive.org/web/20220516164022/https://www.fda.gov/media/147902/download . live .
  11. Samdani . Amer F. . Ames . Robert J. . Kimball . Jeff S. . Pahys . Joshua M. . Grewal . Harsh . Pelletier . Glenn J. . Betz . Randal R. . September 2014 . Anterior Vertebral Body Tethering for Idiopathic Scoliosis: Two-Year Results . Spine . en . 39 . 20 . 1688–1693 . 10.1097/BRS.0000000000000472 . 24921854 . 26250980 . 2021-02-01 . 2021-02-07 . https://web.archive.org/web/20210207212817/https://pediatricscoliosissurgery.com/wp-content/uploads/2020/08/Anterior-Vertebral-Body-Tethering-for-Idiopathic-14.pdf . live .
  12. Dr. Amer Samdani, Vertebral Body Tethering (VBT) Non-Fusion Surgery interviewed by Dr. Derek Lee . 6 June 2020 . Lee . Derek . Videotape.
  13. Web site: Scoliosis Symptoms, Causes and Treatment Shriners Children's . 2024-01-06 . www.shrinerschildrens.org . en . 2024-01-06 . https://web.archive.org/web/20240106154537/https://www.shrinerschildrens.org/en/pediatric-care/scoliosis . live .
  14. Web site: 23 January 2019 . VBT Procedure Corrects Scoliosis, Helps Wrestler Get Back on the Mat. . MU Health Care . 1 February 2021 . 28 January 2021 . https://web.archive.org/web/20210128045755/https://www.muhealth.org/our-stories/vbt-procedure-corrects-scoliosis-helps-wrestler-get-back-mat . live .

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