Vertebral body tethering for idiopathic scoliosis in children and young people

2.1 Scoliosis is a 3‑dimensional spinal deformity. It causes the bones of the spine to twist or rotate so that the spine curves sideways. Scoliosis curves most commonly happen in the upper and middle back (thoracic spine). It can also develop in the lower back and, occasionally, happens in both the upper and lower parts of the spine.

2.2 Idiopathic scoliosis is the most common type of scoliosis. It is a progressive condition, and its exact cause is unknown. There are 3 types of idiopathic scoliosis: infantile idiopathic scoliosis, juvenile idiopathic scoliosis and adolescent idiopathic scoliosis.

2.3 Treatment of idiopathic scoliosis depends on a number of factors, including age, severity and location of the spinal curve, and the pattern and progression of the curve. In many cases, idiopathic scoliosis is mild and does not need treatment other than close monitoring and physical therapy. For moderate and severe scoliosis, treatment may progress through casting and bracing to spinal surgery.

2.4 Vertebral body tethering is a nonfusion spinal treatment for idiopathic scoliosis. The aim is to preserve the flexibility of the spine and modulate its growth on the concave and convex sides, so slowly correcting the scoliosis.

2.5 In this procedure, under general anaesthesia, screws are placed into each vertebra on the convex side of the spine. The screws are connected by a flexible cord. Tension is then applied to the cord to partially correct and tether the convex side of the spine and so restrict its growth. Thoracic tethers are usually done through a thoracoscopic or open approach and lumbar tethers need a mini‑open approach. After surgery, the cord continues to restrict growth on the convex side while allowing faster growth on the concave side, so potentially producing further correction of the scoliosis.

2.6 The technique exploits a known reaction of bone to being stretched or being compressed. This response is known as the Heuter‑Volkmann law and notes that bone growth increases when stretched and decreases when compressed. In scoliosis this response can be used on a curved spine if the bones still have significant growth potential.