According to the National Scoliosis Foundation, scoliosis – the abnormal curvature of the spine – affects 2 to 3% of the global population, or an estimated 7 million people. In an overwhelming number of cases, there is no known cause – this type of scoliosis is called idiopathic scoliosis. It most commonly occurs in adolescents between the ages of 10 and 15; and girls are eight times more likely than boys to experience curvature that requires medical intervention to correct it.
For decades, treatment has been broken into three main categories, depending on the patient’s age and degree of spinal curve: observation, bracing or surgery:
• Observation: If the spinal curve is mild, physicians may take a “watch and see” approach. As the skeleton matures, sometimes the curve will correct itself, or at the very least, it won’t get worse.
• Bracing: With bracing, patients with a mild-to-moderate curve wear a brace around their torso to help stop the curve from getting worse, though it cannot correct the curve. The brace is worn for several hours every day, usually until the patient stops growing.
• Surgery: In severe cases, patients must undergo surgery to correct the curve. For decades, the most common surgical method has been spinal fusion, where doctors implant rods along the spine that are fastened by screws to keep the spine straight.
While spinal fusion (especially as it relates to the minimally-invasive advances this technique has seen in recent years) has proven effective for correcting scoliosis, it is surgery nonetheless. Yet until recently, other treatment options have been designed to slow or halt curvature growth, which is great. But it isn’t correction.
However, there is encouraging news on this front. In recent years, the FDA has approved an alternative surgical procedure called Vertebral Body Tethering, which appears to hold some promise, though further research on long-term effectiveness is still needed.
What is Vertebral Body Tethering?
With Vertebral Body Tethering (VBT), titanium screws are placed on the curved portion of the spine and connected opposite a flexible cable. Unlike a fixed rod that is fused to the spine, the cable allows for stretching, movement and growth on the side of the spine that needs to “straighten out,” while inhibiting further curvature in the wrong direction.
Vertebral Body Tethering endeavors to halt further curving of the spine, help the patient maintain fuller range-of-motion in the spine, and not inhibit future growth. This means if a child still has plenty of time until she is fully developed, she could experience complete correction. In addition, this surgery is minimally-invasive, requiring only a few small incisions for arthroscopic placing of the cable, rather than leaving a lengthy scar down the back with rod implantation. Less invasive surgery typically equates to fewer days in the hospital and a quicker recovery time too. Furthermore, if the severity of the curve is not cured by Vertebral Body Tethering, surgeons can still go back and perform a traditional fusion surgery down the road, if necessary.
Who is right for Vertebral Body Tethering?
Currently, there are only a handful of physicians performing Vertebral Body Tethering around the world because the technique is still very new and not every patient is a good candidate for the procedure. Ideally, this surgery works best for patients with the following characteristics:
• 10 years or older
• Not fully developed
• Diagnosed with idiopathic scoliosis
• Has a curve between 35 and 60-degrees
What to expect
Patients will undergo surgery and spend a few days in the hospital before returning home to recover over three to four weeks. While patients are still in the hospital, they are fitted for a brace they must wear for three months post-surgery. At the three-month follow-up, patients are typically cleared to remove the brace and return to complete physical activity with little-to-no limitations.
Though more research and observation are needed to see how the spine continues to grow and adapt after this relatively new procedure, but so far, the patients who have undergone it have reported experiencing the benefits of greater mobility, and seemingly, a future with complete scoliosis correction.
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