Anterior vertebral body tethering (AVBT) is a relatively new surgery for the treatment of

scoliosis Scoliosis is a condition in which a person's spine has a sideways curve. The curve is usually "S"- or "C"-shaped over three dimensions. In some, the degree of curve is stable, while in others, it increases over time. Mild scoliosis does not t ...

in pediatric patients. Left untreated, severe scoliosis can worsen and eventually affect a person's lungs and heart.

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 In mathematics, curvature is any of several strongly related concepts in geometry. Intuitively, the curvature is the amount by which a curve deviates from being a straight line, or a surface deviates from being a plane. For curves, the canon ...

. Fusion surgery in children employs pedicle screws 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. However, fusion has drawbacks, and pioneers in the field of pediatric orthopedics and neurosurgery have introduced AVBT as a minimally invasive alternative.

New developments

The US Food and Drug Administration (FDA) approved the

compassionate use Expanded access or compassionate use is the use of an unapproved drug or medical device under special forms of investigational new drug applications (IND) or IDE application for devices, outside of a clinical trial, by people with serious or life ...

of AVBT for a small population of patients. VBT uses a strong, flexible tether that is attached to

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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 Standard anatomical terms of location are used to unambiguously describe the anatomy of animals, including humans. The terms, typically derived from Latin or Greek roots, describe something in its standard anatomical position. This position prov ...

" is connected with this technique because it can be done through the front or side of the

chest wall The thoracic wall or chest wall is the boundary of the thoracic cavity. Structure The bone, bony human skeleton, skeletal part of the thoracic wall is the rib cage, and the rest is made up of muscle, skin, and fasciae. The chest wall has 10 lay ...

(rather than the back) 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

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(which measures

skeletal maturity A skeleton is the structural frame that supports the body of an animal. There are several types of skeletons, including the exoskeleton, which is the stable outer shell of an organism, the endoskeleton, which forms the support structure inside ...

) of 3-4.

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 Health, according to the World Health Organization, is "a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity".World Health Organization. (2006)''Constitution of the World Health Organizat ...

; nevertheless several state-of-the-art US health systems ( Cincinnati Children's Hospital,

Mayo Clinic The Mayo Clinic () is a nonprofit American academic medical center focused on integrated health care, education, and research. It employs over 4,500 physicians and scientists, along with another 58,400 administrative and allied health staff, ...

, 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. Most patients are eventually able to return to sports and other physical activities that require spinal flexibility.

References

{{reflist Surgical procedures and techniques