Making the Case for Vertebral Body Tethering: What's the Evidence?

Area of Science:

• Orthopedic surgery
• Spinal disorders
• Biomechanical engineering

Background:

• Adolescent idiopathic scoliosis (AIS) affects spinal alignment during growth.
• Posterior spinal fusion is a traditional treatment but restricts spinal motion.
• Vertebral body tethering (VBT) is an emerging growth-modulating technique for AIS.

Purpose of the Study:

• To critically review the current evidence on Vertebral Body Tethering (VBT) for adolescent idiopathic scoliosis.
• To assess VBT's indications, surgical techniques, outcomes, and comparisons with spinal fusion.
• To explore VBT's potential in new patient populations and future innovations.

Main Methods:

• Systematic literature review and critical appraisal of existing studies on VBT.
• Analysis of radiographic and functional outcomes in VBT patients.
• Comparison of VBT data with historical data from posterior spinal fusion.

Main Results:

• VBT is a viable, motion-preserving alternative to fusion for select AIS patients, particularly those with remaining skeletal growth.
• Evidence supports VBT's efficacy in correcting spinal curves and maintaining spinal motion.
• Patient selection based on skeletal maturity is crucial for optimal VBT outcomes.

Conclusions:

• Vertebral body tethering (VBT) represents a significant advancement in scoliosis treatment, preserving motion compared to fusion.
• Further standardization in reporting and long-term data are needed to fully establish VBT's role.
• Ongoing innovations in implant design and predictive modeling promise to enhance VBT's application and efficacy.