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Growth Modulation – Vertebral Body Tethering | Hybrid

Overview

What is VBT?

Growth modulation with vertebral body tethering (VBT) is an innovative, minimally invasive surgical technique for the treatment of scoliosis in growing children and adolescents. Unlike spinal fusion, VBT is a non-fusion procedure that straightens the spine while preserving much of its natural flexibility and motion by modulating spinal growth as the child matures.

Who is it for?

If your child has progressive idiopathic scoliosis despite bracing and is still growing (skeletally immature), they may be a candidate for vertebral body tethering.

VBT is typically considered for patients who:

  • Have adolescent idiopathic scoliosis or early onset scoliosis showing progression
  • Have significant spinal growth remaining (not fully skeletally mature)
  • Are generally aged 8–16, depending on growth status
  • Have a flexible spinal curve that meets clinical and radiographic criteria
  • Have tried non-operative measures like bracing, without adequate control of curve progression

What the Procedure Involves

Here’s what to expect with VBT:

  • The operation is performed under general anaesthetic, usually using a minimally invasive thoracoscopic (keyhole) approach to access the spine from the side
  • Screws are placed into the vertebral bodies along the convex (outer) side of the curve
  • A strong, flexible cord (the tether) is threaded and secured to these screws
  • Tension is applied to partially straighten the spine during surgery, with further correction expected as the child grows​
  • The incision is closed and a dressing is placed; the operation usually takes 3–5 hours depending on curve severity and levels involved
  • For “hybrid” techniques, VBT may be combined with standard fusion for certain complex or double curves to preserve lumbar flexibility​

Risks and Complications

While VBT is generally well-tolerated, possible risks include:
Potential complications of this procedure include:

  • Infection or bleeding
  • Injury to the lungs, blood vessels, nerves or spinal cord
  • Tether breakage (which may require further surgery)
  • Loss or lack of further correction as growth ends, or over-correction (spine bends too far in the opposite direction)​
  • Need for revision to spinal fusion in case of complications or curve progression
  • Pneumothorax (air in the chest) or lung complications
  • Chest wall scarring, diaphragm or psoas muscle irritation
    Most complications are uncommon, but rates of reoperation and tether breakage are higher than with traditional fusion and should be discussed with your surgeon.

Recovery Expectations and Duration

Recovery after VBT is generally faster than fusion surgery:
Most children and teens can expect the following after VBT:

  • Hospital stay of 3–5 days​
  • Walking, stair-climbing, and light daily activities encouraged soon after surgery
  • Return to school within 2–4 weeks based on comfort, energy and doctor’s advice​
  • Sports and high-impact activities are usually limited for 2–3 months, with return to full activity between 6–12 months​
  • Ongoing improvement of spinal alignment as the child continues to grow
  • Regular follow-up is needed to monitor curve correction and implant integrity

FAQs

Will my child’s spine stay flexible after tethering?
Yes, the aim of VBT is to correct the curve while preserving spinal motion and growth, unlike fusion which stops movement at the treated levels.

Is tethering permanent?
The ultimate goal is to achieve long-term curve control until growth is finished. Some patients may require further surgery if the tether breaks or if over-correction or loss of correction occurs as growth continues.