1. Vertebral Body Tethering (VBT) In 2014
A fusionless treatment option for scoliosis in the growing spine
UPDATED
March 2014

2. Spinal Tethering
Old use: FDA approved as a “dynamic stabilizer” in the posterior lumbar (lower) spine
New use: Physician directed scoliosis treatment as a dynamic stabilizer in the growing anterior thoracic (upper) spine
“Growth modulation”- partially restraining one side of the spine to allow growth on the other side to reverse the abnormal scoliosis growth pattern

3. Here is a bone model of the tether (white cord) attached to bone screws in the vertebral bodies of the spine
(posterior)
back of
the spine
(anterior)
front of
the spine

4. Components
Titanium pedicle screws placed on the convexity (outside) of the vertebrae causing scoliosis
Polyethylene-terephthalate (PET)* flexible tether connects to each screw and when tightened, compresses the adjacent screws to help straighten the spine
Cable safety extensively studied
Animal and computer simulation models show scoliotic correction
Early adolescent cases show scoliotic correction
*Dynesys system by Zimmer spine

5. “Ideal” candidate Idiopathic scoliosis (adolescent or juvenile) or
Idiopathic “like” (i.e. post syrinx decompression)
>10yrs old with remaining spine growth
( done TOO young increases risk of overcorrecting the curve)
Thoracic, thoracolumbar or lumbar curves ° to 60°

6. Tethering advantages FUSIONLESS Allows the spine to grow
Allows the spine to move and bend
Most are one time surgery ( may need an adjustment of tether if overcorrection seen)
“burns no bridges”, can do a later fusion if needed

7. Case #1 Feb 2011 12 yo female Before surgery 5 days after surgery
During surgery
Tethering 
Staples 

8. Case #1
Before surgery
3 years later
35°
35°

9. Case #3 Aug 2011 14 yo male Before surgery 2 years later 1st erect 6°
38°
25° 6°

10. Case #6 Oct 2011 13 yo female Before surgery 2 years later 44° 6° 36°

11. Case #11 Feb yo female
Before surgery
18 months later
50° 3°

12. Case #65 Nov yo female
Before surgery
6 weeks later

13. Unknowns New use of an existing technology No long term follow-up
Potential for overcorrection (curve opposite way)
Refined criteria for “ideal” candidate
Quicker return to all activities (currently 6 weeks)

14. For More Information
If you have questions about tethering (VBT), please feel free to contact Janet Cerrone, PA-C