The different applications of Vertebral Body Tethering - Narrative review and clinical experience

Vertebral body tethering (VBT) has been originally developed as a growth modulation technique for the surgical management of skeletally immature patients with adolescent idiopathic scoliosis (AIS). Given the positive results obtained in this setting, the use of VBT is gradually expanding to other patient categories, such as those with no or limited remaining growth or with non-idiopathic scoliosis. Aim of this manuscript is to offer an overview over the current applications of VBT, along with imaging and comments derived from the clinical experience. The work was based on a literature search conducted in January 2023 on Pubmed, Scopus and Web of Science databases. Following keywords were used for the search: vertebral body tethering, adolescent idiopathic scoliosis, early onset scoliosis, neuromuscular scoliosis, syndromic scoliosis.

Three patient categories in which VBT has been applied have been highlighted: VBT for growth modulation in AIS, VBT as anterior scoliosis correction in AIS and VBT for non-idiopathic curves or early-onset scoliosis.

While growth modulation in AIS still represents the most widespread use of VBT, the use of this technique has yielded positive results in different settings as well, such as scoliosis correction in AIS or temporary or definitive curve management in non-AIS curves. While long-term results are lacking, patient selection seems to play a central role to reduce the complication rate and ensure predictable and stable results.