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Vertebral Body Tethering (VBT) In 2014

Vertebral Body Tethering (VBT) In 2014. A fusionless treatment option for scoliosis in the growing spine. UPDATED March 2014. Spinal Tethering. Old use: FDA approved as a “dynamic stabilizer” in the posterior lumbar (lower) spine

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Vertebral Body Tethering (VBT) In 2014

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  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 posteriorlumbar (lower) spine New use: Physician directed scoliosis treatment as a dynamic stabilizer in the growing anteriorthoracic(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 30°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 3 years later Before surgery 35° 35°

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

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

  11. Case #11 Feb 2012 12 yo female Before surgery 18 months later 50° 3°

  12. Case #65 Nov 2013 12 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 janetcerrone@comcast.net jcerrone@spineandscoliosis.com

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